Pregnancy Complications Flashcards
A 25-year-old female, G2 P1001, presents to your office at 11 weeks gestation with vaginal bleeding, mild lower abdominal cramping, and bilateral lower pelvic discomfort. On examination, blood is noted at the dilated cervical os. No tissue is protruding from the cervical os. The uterus by palpation is 8-9 weeks gestation. No other abnormalities are found.
what time period is associated with spontaneous abortion
before 20 weeks of gestation
what are fetal risk factors for spontaneous abortion
chromosomal abnormalities (MC: trisomy, monoscomy X), congenital anomalies
what are maternal risk factors for spontaneous abortion
previous spontaneous abortions
smoking
maternal infection
anatoic anomalies
asherman syndrome
maternal disease
gavidity
fever
prolonged time to achieve pregnancy
BMI <18.5 or > 25
celiac disease
what is the medication for medical abortion for spontaneous abortion
mifepristone (antiprogestin) or misoprostol (prostaglanding)
what is a threatened abortion
bloody vaginal discharge beefore 20 weeks of gestation with or without uterine contractions in the presence of a closed cervix
What is an inevitable abortion
dilated cervical os without passage of tissue before 20 weeks of gestation
what is incomplete abortion
dilated cervical os with the passage of some but not all products of conception before 20 weeks of gestation
what is a missed abortion
death of fetus before 20 weeks of gestation, with products of conception remaining intrauterine
what classifies recurrent, spontaneous abortions
three or more consecutive preganancy losses
a 32-year-old female who presents with sudden onset of left lower abdominal pain that radiates to the scapula and back and is associated with vaginal bleeding. Her last menstrual period was five weeks ago. She has a history of PID and unprotected intercourse.
What is the diagnosis
ectopic pregnancy
where is the most common location of an ectopic pregnancy
fallopian tube
what are classic symptoms of an ectopic pregnancy
abdominal pain, bleeding and adenexal mass in a pregnant woman
what is the most common cause of ectopic pregnancy
occlusion of tube secondary to adhesions
what are risk factors associated with ectopic pregnancy
hx of previous ectopic
previous salpingitis (caused by PID)
previous abdominal or tubal surgery
use of IUD
assisted reproduction
smoking
what is a ruptured ectopic pregnancy and is presenting symptoms
MEDICAL EMERGENCY
severe abdominal or shoulder pain, peritonitis, tachy, syncope, orthostatic HTN
how is ectopic pregnancy diagnosed
beta HCG >1,500 but no fetus in utero
- serial increases of bhcg
Ultrasound - ring of fire sign
what is the ring of fire sign
aka ring of vascularity
signifies a hypervascular lesion with peripheral vascularity on color or pulsed doppler exam in adnexa d/t low impedance high diastolic flow
what is the treatment of ectopic pregnancy
Methotrexate (only if bhcg <5,000)
surgical treatment
what are contraindications for ectopic pregnancy treatment with methotrexate
currently breastfeeding
active pulmonary disease
immunodeficiency
hypersensitivity to methotrexate
what is the MOA of methotrexate
folic acid antagonist that inhibits DNA replication
what are indications for methotrexate use
hemodynamically stable patient
hcg levels below 5,000 IU/L
mass <3.5 cm
no fetal cardiac activity
ability to comply with post-treatment follow up
what is the most common complication of gestational diabetes
macrosomia
how should glucose be monitored during pregnancy
random gluose during first prenatal visit
repeat screening at 24-28 weeks
what is the treatment of gestational diabetes
insulin - goal is fasting glucose of < 95
what is the only oral hypoglycemic that does not cross the placenta
glyburide - increases risk for eclampsia
what are risk factors for molar pregnancies
maternal age extremes - younger than 20, older than 35 and previous molar pregnancy
what is Gestational trophoblastic disease
group of tumors that form during abnormal pregnancies
what are signs of Gestational trophoblastic disease
beta Hcg higher than expected
size-date discrepancy
hyperemesis
how are Gestational trophoblastic disease diagnosed
hcg > 100,000 mIU/ml are diagnostic of molar pregnacies
TVUS - “snowstorm” or “swiss cheese” pattern
what is the treatment of Gestational trophoblastic disease
uterine evacuation via suction curettage
what is the treatment of choriocarcinoma
resect, methotrexate, chemotherapy
a 32-year-old, G7P0A3, who is in her thirteenth week of pregnancy. She has lost three consecutive normally formed fetuses before 20 weeks gestation, and she has had three spontaneous first-trimester abortions.
what is the diagnosis
incompetent cervix
what is incompetent cervix
spontaneous, premature dilation or shortening of the cervix during the second or early third trimester
how is incompetent cervix diagnosed
TVUS - will see funneling of cervix
what is the treatment of cervical incompetence
cervical cerclage placed at 12-16 weeks and removed at 36-38 weeks to allow for delivery
a 29-year-old at 36 weeks gestation who arrives at the emergency department with a sudden onset of back pain with uterine contractions that are very close together, one after another. She describes PAINFUL, bright red vaginal bleeding. There is pelvic tenderness on examination which reveals a closed cervix and no evidence of rupture of the membranes.
What is the likely diagnosis
placenta abruption
what is placenta abruption
premature seperation of all/sections of otherwise normally implanted placenta from uterine wall after 20 weeks of gestation resulting in hemorrhage
what is the most common cause of third trimester bleeding
placenta abruption
what are risk factors for placenta previa
placental abruption including trauma, smoking, HTN, preeclampsia and cocaine abuse
how is placenta abruption diagnosed
clinical
US is minimally helpful - may show retroplacental blood collecton
what is the best treatment for placental abruption
delivery of fetus and placenta = definitive tx
blood type and cross
coag studies and large-bore IV line
a 32-year-old woman, G2P1, at 35 weeks’ gestation with a complaint of painless vaginal bleeding that began two hours ago and has delivered a substantial amount of blood with clots. She has had no evident pain or cramping. Upon physical examination, the fetal heart rate is noted to be normal. Her last pregnancy was delivered by emergency cesarean at 37 weeks due to a breech presentation during labor.
What is the diagnosis
placenta previa
what is placenta previa
condition which the placenta lies very low in the uterus and covers all or part of the cervix
what is the presentation of placenta previa
painless vaginal bleeding
usually occurs after 28 weeks gestation
what are risk factors for placenta previa
prior c-section
multiple gestations
multiple induced abortions
advanced maternal age
what is the treatment of placenta previa
strict pelvic rest (no intercourse)
modified bed rest
no vigorous exercise
what differentiates eclampsia from preeclampsia?
eclampsia is defined as the development of seizures in a woman with preeclampsia
what is the time period in which pre-eclampsia may occur?
extends from 20 weeks of gestation to 6 weeks post partum
what is the classic triad of preeclampsia
HTN
(+) Proteinuria
(+/-) edema after 20 weeks GA
what are the characteristics of mild preeclampsia
BP 140/90 - 160/110
proteinuria - >300mg/24hours
edema of face, hands and feet
what are characteristics of severe preeclampsia
BP > 160/110
proteinuria >5g in 24 hours
cerebral visual change
pulmonary edema
What is HELLP syndrome
Hemolysis, elevated liver enzymes, and low platelets
- It’s a liver and blood clotting disorder that can cause excessive bleeding and damage the liver.
what is the treatment of preeclampsia
delivery is only cure at 34-36 weeks
for severe preeclampsia: admit and start magnesium sulfate to prevent eclampsia
what is the medication of choice for severe preeclampsia
Hydralazine
how is eclampsia characterized
HTN + proteinuria + seizures or coma
what is the treatment of eclampsia
magnesium sulfate for seizures
BP meds: hydralazie
how is eclampsia diagnosed
HTN with proteinuria
a 28-year-old G1P0 pregnant female presents for a prenatal visit at 37 weeks. The pregnancy has been unremarkable thus far. Her blood pressure (BP) is 148/94 mm Hg, and her urine dipstick shows +1 proteinuria.
What is the likely diagnosis
pregnancy-induced HTN
how is gestational hypertension characterized
BP > 150/90 after 20 weeks into preganncy that resolves 12 weeks postpartum
clinically asymptomatic
a 25-year-old woman presents at 28 weeks gestation for a scheduled check-up. She states that her baby is moving as much as usual and she is feeling well. On physical exam, you note a gravid uterus that extends 28 cm above the pubic symphysis. Of note, this is this mother’s first pregnancy. Her vitals are within normal limits, she is currently taking a multivitamin and folate and her blood type is A negative.
what is this patient at risk of
Rh incompatability
what is the treatment for rh incompatability
Rhogam at 28 weeks, within 72 hours of delivery and during any uterine bleeding throughout the pregancy
what are risks of rhogam
hydrops fetalis
what is hydrops fatalis
severe swelling in an unborn baby or a newborn baby
