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Clinical: Woman's Health > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

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.

A
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2
Q

what time period is associated with spontaneous abortion

A

before 20 weeks of gestation

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3
Q

what are fetal risk factors for spontaneous abortion

A

chromosomal abnormalities (MC: trisomy, monoscomy X), congenital anomalies

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4
Q

what are maternal risk factors for spontaneous abortion

A

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

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5
Q

what is the medication for medical abortion for spontaneous abortion

A

mifepristone (antiprogestin) or misoprostol (prostaglanding)

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6
Q

what is a threatened abortion

A

bloody vaginal discharge beefore 20 weeks of gestation with or without uterine contractions in the presence of a closed cervix

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7
Q

What is an inevitable abortion

A

dilated cervical os without passage of tissue before 20 weeks of gestation

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8
Q

what is incomplete abortion

A

dilated cervical os with the passage of some but not all products of conception before 20 weeks of gestation

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9
Q

what is a missed abortion

A

death of fetus before 20 weeks of gestation, with products of conception remaining intrauterine

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10
Q

what classifies recurrent, spontaneous abortions

A

three or more consecutive preganancy losses

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11
Q

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

A

ectopic pregnancy

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12
Q

where is the most common location of an ectopic pregnancy

A

fallopian tube

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13
Q

what are classic symptoms of an ectopic pregnancy

A

abdominal pain, bleeding and adenexal mass in a pregnant woman

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14
Q

what is the most common cause of ectopic pregnancy

A

occlusion of tube secondary to adhesions

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15
Q

what are risk factors associated with ectopic pregnancy

A

hx of previous ectopic
previous salpingitis (caused by PID)
previous abdominal or tubal surgery
use of IUD
assisted reproduction
smoking

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16
Q

what is a ruptured ectopic pregnancy and is presenting symptoms

A

MEDICAL EMERGENCY
severe abdominal or shoulder pain, peritonitis, tachy, syncope, orthostatic HTN

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17
Q

how is ectopic pregnancy diagnosed

A

beta HCG >1,500 but no fetus in utero
- serial increases of bhcg
Ultrasound - ring of fire sign

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18
Q

what is the ring of fire sign

A

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

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19
Q

what is the treatment of ectopic pregnancy

A

Methotrexate (only if bhcg <5,000)
surgical treatment

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20
Q

what are contraindications for ectopic pregnancy treatment with methotrexate

A

currently breastfeeding
active pulmonary disease
immunodeficiency
hypersensitivity to methotrexate

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21
Q

what is the MOA of methotrexate

A

folic acid antagonist that inhibits DNA replication

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22
Q

what are indications for methotrexate use

A

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

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23
Q

what is the most common complication of gestational diabetes

A

macrosomia

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24
Q

how should glucose be monitored during pregnancy

A

random gluose during first prenatal visit
repeat screening at 24-28 weeks

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25
Q

what is the treatment of gestational diabetes

A

insulin - goal is fasting glucose of < 95

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26
Q

what is the only oral hypoglycemic that does not cross the placenta

A

glyburide - increases risk for eclampsia

27
Q

what are risk factors for molar pregnancies

A

maternal age extremes - younger than 20, older than 35 and previous molar pregnancy

28
Q

what is Gestational trophoblastic disease

A

group of tumors that form during abnormal pregnancies

29
Q

what are signs of Gestational trophoblastic disease

A

beta Hcg higher than expected
size-date discrepancy
hyperemesis

30
Q

how are Gestational trophoblastic disease diagnosed

A

hcg > 100,000 mIU/ml are diagnostic of molar pregnacies
TVUS - “snowstorm” or “swiss cheese” pattern

31
Q

what is the treatment of Gestational trophoblastic disease

A

uterine evacuation via suction curettage

32
Q

what is the treatment of choriocarcinoma

A

resect, methotrexate, chemotherapy

33
Q

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

A

incompetent cervix

34
Q

what is incompetent cervix

A

spontaneous, premature dilation or shortening of the cervix during the second or early third trimester

35
Q

how is incompetent cervix diagnosed

A

TVUS - will see funneling of cervix

36
Q

what is the treatment of cervical incompetence

A

cervical cerclage placed at 12-16 weeks and removed at 36-38 weeks to allow for delivery

37
Q

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

A

placenta abruption

38
Q

what is placenta abruption

A

premature seperation of all/sections of otherwise normally implanted placenta from uterine wall after 20 weeks of gestation resulting in hemorrhage

39
Q

what is the most common cause of third trimester bleeding

A

placenta abruption

40
Q

what are risk factors for placenta previa

A

placental abruption including trauma, smoking, HTN, preeclampsia and cocaine abuse

41
Q

how is placenta abruption diagnosed

A

clinical
US is minimally helpful - may show retroplacental blood collecton

42
Q

what is the best treatment for placental abruption

A

delivery of fetus and placenta = definitive tx
blood type and cross
coag studies and large-bore IV line

43
Q

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

A

placenta previa

44
Q

what is placenta previa

A

condition which the placenta lies very low in the uterus and covers all or part of the cervix

45
Q

what is the presentation of placenta previa

A

painless vaginal bleeding
usually occurs after 28 weeks gestation

46
Q

what are risk factors for placenta previa

A

prior c-section
multiple gestations
multiple induced abortions
advanced maternal age

47
Q

what is the treatment of placenta previa

A

strict pelvic rest (no intercourse)
modified bed rest
no vigorous exercise

48
Q

what differentiates eclampsia from preeclampsia?

A

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

49
Q

what is the time period in which pre-eclampsia may occur?

A

extends from 20 weeks of gestation to 6 weeks post partum

50
Q

what is the classic triad of preeclampsia

A

HTN
(+) Proteinuria
(+/-) edema after 20 weeks GA

51
Q

what are the characteristics of mild preeclampsia

A

BP 140/90 - 160/110
proteinuria - >300mg/24hours
edema of face, hands and feet

52
Q

what are characteristics of severe preeclampsia

A

BP > 160/110
proteinuria >5g in 24 hours
cerebral visual change
pulmonary edema

53
Q

What is HELLP syndrome

A

Hemolysis, elevated liver enzymes, and low platelets
- It’s a liver and blood clotting disorder that can cause excessive bleeding and damage the liver.

54
Q

what is the treatment of preeclampsia

A

delivery is only cure at 34-36 weeks
for severe preeclampsia: admit and start magnesium sulfate to prevent eclampsia

55
Q

what is the medication of choice for severe preeclampsia

A

Hydralazine

56
Q

how is eclampsia characterized

A

HTN + proteinuria + seizures or coma

57
Q

what is the treatment of eclampsia

A

magnesium sulfate for seizures
BP meds: hydralazie

58
Q

how is eclampsia diagnosed

A

HTN with proteinuria

59
Q

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

A

pregnancy-induced HTN

60
Q

how is gestational hypertension characterized

A

BP > 150/90 after 20 weeks into preganncy that resolves 12 weeks postpartum
clinically asymptomatic

61
Q

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

A

Rh incompatability

62
Q

what is the treatment for rh incompatability

A

Rhogam at 28 weeks, within 72 hours of delivery and during any uterine bleeding throughout the pregancy

63
Q

what are risks of rhogam

A

hydrops fetalis

64
Q

what is hydrops fatalis

A

severe swelling in an unborn baby or a newborn baby

Clinical: Woman's Health (12 decks)

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