Pregnancy Complications Flashcards by Lindsey Dutton

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.

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what time period is associated with spontaneous abortion

before 20 weeks of gestation

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what are fetal risk factors for spontaneous abortion

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

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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

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what is the medication for medical abortion for spontaneous abortion

mifepristone (antiprogestin) or misoprostol (prostaglanding)

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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

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What is an inevitable abortion

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

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what is incomplete abortion

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

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what is a missed abortion

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

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what classifies recurrent, spontaneous abortions

three or more consecutive preganancy losses

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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

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where is the most common location of an ectopic pregnancy

fallopian tube

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what are classic symptoms of an ectopic pregnancy

abdominal pain, bleeding and adenexal mass in a pregnant woman

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what is the most common cause of ectopic pregnancy

occlusion of tube secondary to adhesions

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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

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what is a ruptured ectopic pregnancy and is presenting symptoms

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

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how is ectopic pregnancy diagnosed

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

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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

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what is the treatment of ectopic pregnancy

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

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what are contraindications for ectopic pregnancy treatment with methotrexate

currently breastfeeding
active pulmonary disease
immunodeficiency
hypersensitivity to methotrexate

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what is the MOA of methotrexate

folic acid antagonist that inhibits DNA replication

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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

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what is the most common complication of gestational diabetes

macrosomia

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how should glucose be monitored during pregnancy

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

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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