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Women's Health > pregnancy complications > Flashcards

pregnancy complications Flashcards

1
Q

what is the medical management for gestational Diabetes?

A

*glyburide or metformin

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2
Q

What is a positive result from the 3 hr 100g oral glucose tolerane test?

A

*fasting >95mg/dL
*1hr >180mg/dL
*2hr >155mg/dL
*3hr >140mg/dL

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3
Q

What is a positive result from the 1 hr 50g oral glucose tolerane test?

A

glucose >130-140mg/dL 🡪 go on to 3hr test

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4
Q

What is the most common type of Gestational trophopblastic disease?

A

Benign Hydatidiform mole
-complete molar 90% & partial molar 10% pregnancies

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5
Q

what is Gestational Trophoblastic Disease

A

abnormal proliferation of placental trophoblasts arise from gestational tissue.

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6
Q

What is the difference between complete molar pregnancy & Partial moalr pregancy?

A

Complete: diploid (46, XX): a sperm fertilize an egg absent of maternal chromosomes & the sperm then duplicates.
Partial mole: triploid (69, XXX, XXY or XYY): 1 egg is fertilized by 2 haploid sperms

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7
Q

How is a molar pregnancy diagnosed?

A

VERY HIGH HCG (>100,000)
Complete moles: diagnosed by ultrasound examination: absence of an embryo or fetus and the presence of an intrauterine mass with many anechoic spaces (black) described as a “snowstorm” or “”cluster of grapes”.

Partial: gestational sac, fetal heart tone may be present + abnormal tissue.

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8
Q

How are molar pregnancies managed?

A

Dilation and curettage (D&C) + weekly β-hCG levels should be checked until they are undetectable for 3 consecutive weeks then every month for 1 yr.

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9
Q

What are the presentation of gestational trophoblastic disease

A

Painless vaginal bleeding (cherry-like clusters), **preeclampsia (HTN) BEFORE 20wks
**, hyperemesis gravidarum

uterine size & date discrepancies (larger or smaller than expected)

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10
Q

How dose excess beta HCG affect the ovaries? What disease is this associated with?

A

Ovarian theca lutein cysts: excess beta-hCG mimic LH & FSH causes hyperplasia of theca interna cells (rare)
*seen in hydatidiform mole

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11
Q

What is the treatment of low risk choricocarcinoma?

A

methotrexate monotherapy or combination with actinomycin D

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12
Q

What is the treatment of high risk choricocarcinoma? (hint: EMA-CO

A

EMA-CO
-Etoposide
-Methotrexate
-actinomycin-D
-Cyclophosphamide
-Vincristine

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13
Q

What is choriocarcinoma?

A

aggressive malignant neoplasm of trophoblastic cells (placental tissue) that can develop during or after pregnancy (most often a complete molar)

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14
Q

Where is the most common location for mets for choriocarcinoma?

A

lungs via spread through bloodstream

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15
Q

How is choriocarcinoma diagnosed?

A

Serum quantitative hCG – To assess response to therapy and disease status
Pelvic ultrasonography – May show persistent molar tissue in the uterus

Chest radiograph – Recommended because the lung is the most frequent site of metastasis

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16
Q

What is the presentation of choriocarcinoma?

A

abnormal bleeding 6 wks after pregnancy

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17
Q

What is incompetent cervix?

A

inability of the cervix to hold pregnancy in the 2nd trimester = premature os opening with fetal expulsion w/o contraction/labor

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18
Q

What is a common risk factor for incompetent cervix?

A

previous cervical trauma or procedure (LEEP, conization)

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19
Q

Presentation of cervical incompetence?

A

Mild pelvic pressure, backache
painless cervical changes, shortening, funneling at internal os

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20
Q

Incompetent Cervix Diagnostics

A

Transvaginal U/S: funneling of the cervical canal. (length <25 mm b/4 24 wks)

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21
Q

Incompetent Cervix treatment

A

Cerclage (suturing of cervical os)
Progesterone: help maintain pregnancy

22
Q

when is RH D administer?

A

between 26 and 28 weeks gestation and is administered again after delivery if the baby is Rh-positive.

23
Q

What is couvelaire uterus? What is it associated with?

A

Couvelaire uterus is the penetration of blood into the uterus resulting the uterus appearing bluish/purple on lap examination.
This is associated with placenta abruption-> on physical exam the uterus feels wood like and tender as a result of the blood generation.

24
Q

What is the most common complication of placenta abruption?

A

Disseminated intravascular coagulopathy-> Maternal bleeding leads to increased consumption of fibrinogen. No fibrin left for clot formation = bleed out.

25
Q

What are the main risk factors of placenta abruption?

A

1) history of placenta abruption
2) smoking, alcohol, cocaine use, maternal HTN = vasoconstriction.

26
Q

What is a low-lying placenta?

A

when the edge of the placenta is less than 2 cm from the internal cervical os but does not cover it

27
Q

what are the common risk factors for placenta previa?

A

Multifetal gestation
* Increasing parity and maternal age
* Previous cesarean delivery
* Previous placenta previa
* Previous intrauterine surgical procedure (e.g., curettage)
* Cigarette smoking

28
Q

Patient with placenta previa should avoid?

A

sexual intercourse and cervical examination for risk of causing further bleeding

29
Q

what is the difference between vasa previa and placenta previa?

A

vasa previa: fetal vessels are unprotected in the membranes near the internal os of cervix (painless vaginal bleeding and fetal distress (bradycardia))- blood from baby)

Placenta previa: the abnormal implantation of the placenta over the cervical os (partial or completely) = painless vaginal bleeding and no fetal distress (blood from mom)

30
Q

what are the causes of vasa previa?

A

1) bi-lobed placenta with the unprotected fetal vessels running between the two placenta over the internal cervical os.
2) One placenta is present however a portion of the fetal vessels are unprotected by wharton’s jelly and runs over the internal cervical os.

31
Q

what is the difference between the different placenta accreta spectrums?

A

Placenta accreta is invasion of the placenta into the uterine wall (myometrium)

1)placenta accreta: invasion into the uterine myometrium

2)placenta increta: invasion into deep into the myometrium

3) Placenta precreta: invasion through the myometrium to the uterine serosa and surrounding organs can be invaded.

32
Q

How are the placenta accreta spectrum treated?

A

Hysterectomy
high risk of postpartum hemorrhage

33
Q

What are the major risk factors of placenta accreta spectrum?

A

Intrauterine scarring
-prior c-section/multiple c-section births.
-myomectomy
-dilation & curettage
-uterine surgery
Due to uterine scaring, the placenta has to embed deeper into the uterus

34
Q

What is the presentation of uterine rupture?

A

Fetal distress
loss of fetal station
abdominal pain
cessation of uterine contractions
palpable fetal parts on abdominal exam
Hemodynamic instability, referred shoulder pain with abdominal irritation

35
Q

What is pre-eclampsia?

A

Systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg on two occasions at least 4 hours apart after 20 weeks’ gestation with previously normal blood pressures
+

Proteinuria >300mg/day on 24 hour urine collection or protein/creatinine ratio >0.3

OR END ORGAN damage(liver, kidney, eye, brain)

36
Q

What is the hypothesized cause of pre-eclampsia?

A

-abnormal remodeling of the spiral arteries causing placental hypo-perfusion.
-placenta releases inflammatory proteins = endothelial cell damaged
—> increased permeability
—>narrowing of vascular
–> Formation of thrombi (to fix permeability)
–>retention of Na+ in kidneys which cause damage = proteinuria.

37
Q

Eclampsia seizures may be treated with (med) _______________

A

magnesium sulfate

38
Q

is defined as the development of seizures in a woman with preeclampsia

A

Eclampsia

39
Q

Common complications associated with preeclampsia include placental abruption, coagulopathy, _______failure, and eclampsia.

A

Common complications associated with preeclampsia include placental abruption, coagulopathy, renal failure, and eclampsia.

40
Q

Eclampsia is definitively treated by .

A

Eclampsia is definitively treated by immediate delivery of the child

41
Q

Early signs of preeclampsia, before 20 weeks, can be an effect of the increased human chorionic gonadotropin associated with

A

Early signs of preeclampsia, before 20 weeks, can be an effect of the increased human chorionic gonadotropin associated with hydatidiform mole .

42
Q

_________is a variant of preeclampsia associated with thrombotic microangiopathy involving the liver.

A

Hemolysis, elevated liver enzymes, low platelets syndrome (HELLP syndrome) is a variant of preeclampsia associated with thrombotic microangiopathy involving the liver.

43
Q

____________ is a medication used in severe hypertensive emergency in pregnancy, where first-line medications have failed to lower the blood pressure.

A

Sodium nitroprusside

44
Q

Incomplete invasion of decidual arterioles by cytotrophoblasts during placentation is a common cause of

A

preeclampsia

45
Q

Patients with preeclampsia without severe symptoms are generally induced into labor after __________________weeks of gestation.

A

37

46
Q

What is the treatment of magnesium toxicity?

A

Calcium gluconate

47
Q

Pre-eclampsia w severe feature?

A

1 of the following
BP >160/110
platelets <100,000
Serum creatinine >1.1 or x2 normal limits
ALT/AST 2x normal limits or RUQ pain/epigastric pain
pulmonary edema
cerebral/visual changes (headache, blurry vision)

48
Q

In preeclampsia with severe features, delivery should occur at what gestational age?

A

34 weeks if well managed with anti-hypertensive
if not will managed & less than 34 weeks -> deliver.

49
Q

What are the two medications used for BP stabilization associated with eclampsia?

A

Labetalol & hydralazine

50
Q

What is the diagnostic criteria for HELLP syndrome?

A

Hemolysis (>2 of the following)
–> Schistocytes on peripheral blood smear
–>elevated serum bilirubin (>1.2mg/dL)
–> low serum haptoglobin
–> drop in Hgb unrelated to blood loss.

Elvavted Liver Enzymes
—> AST or ALT >2x upper limits of normal
—> Lactate Dehydrogenase > 2x upper limit of normal

Low Platelets
—> <100,000

Women's Health (12 decks)

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