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Endo Repro Exam > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

hypertensive disorders of pregnancy - subtypes

A

*chronic HTN
*gestational HTN
*preeclampsia
*preeclampsia with severe features
*eclampsia
*HELLP

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2
Q

hypertensive disorder of pregnancy: chronic HTN

A

*SBP 140+ and/or DBP 90+ (2 readings at least 4 hours apart or more) in one of the following settings:
1. pre-existing hypertension (diagnosed before pregnancy) OR
2. HTN diagnosed PRIOR TO 20 wks gestation OR
3. HTN persisting > 6 weeks postpartum

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3
Q

chronic hypertension in pregnancy - treatment

A

*treat to goal BP: SBP < 140 and < 90 DPB
*continue or switch to medications safe in pregnancy: LABETALOL, nifedipine, hydralazine, methyldopa
*should NOT take ACE inhibitors or thiazides
*monitor for progression to preeclampsia
*depending on treatment / control, delivery between 37-40 weeks

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4
Q

hypertensive disorder of pregnancy: gestational hypertension

A

*NEW ONSET hypertension (SBP 140+ and/or DBP 90+) AFTER 20 weeks gestation
*cannot have pre-existing hypertension
*no proteinuria or end-organ damage

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5
Q

gestational hypertension - treatment

A

*recommended delivery by 37th week of pregnancy
*monitor for evidence of preeclampsia
*do NOT treat BP unless becomes severe range (160/110 or higher)

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6
Q

preeclampsia (w/o severe features) - defined

A

*new onset HTN with proteinuria AFTER 20 weeks gestation
*at least 2 elevated BP 4+ hours apart (SBP 140+ and/or DBP 90+) AND elevated protein:creatinine ratio (300+ or 0.3+)

*treatment: deliver by 37th week

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7
Q

preeclampsia with severe features - defined

A

*new onset HTN with end-organ dysfunction AFTER 20 weeks gestation
*at least 2 elevated BP 4+ hours apart (SBP 140+ and/or DBP 90+) AND end-organ damage or symptoms

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8
Q

preeclampsia with severe features - symptoms of end-organ damage

A

*neuro: scitomas (or vision changes), severe unresponsive HA
*resp: SOB (outside of normal pregnancy SOB)
*cardio: chest pain
*liver: RUQ pain, persistent N/V/epigastric pain without cause

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9
Q

preeclampsia with severe features - signs of end-organ damage

A

*resp: flash pulmonary edema (CXR); hypoxia
*cardio: EKG changes (i.e. acute MI); severe range BP (160/110+)
*liver: 2x ULN LFTs; low platelets (<100)
*kidneys: creatinine 1.1+ or 2x baseline

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10
Q

preeclampsia with severe features - etiology

A

abnormal placental spiral arteries → endothelial dysfunction → vasoconstriction → ischemia

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11
Q

preeclampsia with severe features - risk factors

A

*pre-existing HTN
*diabetes
*chronic renal disease
*autoimmune disorders (thrombophilias, anti-cardiolipin antibodies, SLE, etc)
*previous pregnancy with preeclampsia (especially early)

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12
Q

preeclampsia with severe features - complications

A

*placental abruption
*coagulopathy
*renal failure
*uteroplacental insufficiency
*may lead to eclampsia and/or HELLP

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13
Q

preeclampsia with severe features - treatment

A

*IV magnesium sulfate
*anti-hypertensives (labetalol, nifedipine, hydralazine, methyldopa)
*move toward delivery (if 34w0d or later)

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14
Q

eclampsia - overview

A

*preeclampsia (new onset HTN after 20 weeks gestation with proteinuria and/or end-organ dysfunction) + SEIZURES; a medical emergency
*maternal death occurs due to: stroke, intracranial hemorrhage, ARDS

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15
Q

eclampsia - treatment

A

1) IV magnesium sulfate
2) antihypertensive medications
3) immediate delivery
*consider protecting airway

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16
Q

HELLP syndrome - overview

A

*type of severe preeclampsia: preeclampsia with thrombotic microangiopathy of the liver
*can lead to hepatic subcapsular hematomas → rupture → severe hypotension
*HELLP acronym:
H - Hemolysis
EL - Elevated Liver enzymes
LP - Low Platelets (blood smear → schistocytes)

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17
Q

HELLP syndrome - treatment

A

*immediate delivery

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18
Q

hydatidiform mole - overview

A

*cystic swelling of chorionic villi & proliferation of chorionic epithelium (trophoblast)
*can be complete (CHM) or partial (PHM)
*CHM: 1-2 sperm fertilize EMPTY ovum
*PHM: 1-2 sperm fertilize a viable ovum
*results in a “pregnancy” composed of PATERNAL DNA only
*dx: morphologic, genetic, histopathologic features

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19
Q

hydatidiform mole - clinical presentation

A

*may present with:
-vaginal bleeding
-emesis
-uterine enlargement more than expected
-pelvic pressure/pain

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20
Q

complete hydatidiform mole

A

*karyotype: 46, XX or 46, XY
*components: most commonly enucleated egg + single sperm (subsequently duplicates paternal DNA)
*fetal parts: NO
*uterine size: enlarged
*hCG: extremely high
*imaging: “honeycombed” uterus or “clusters of grapes”, “snowstorm” on ultrasound
*risk of malignancy (gestational trophoblastic neoplasia) and risk of choriocarcinoma

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21
Q

partial hydatidiform mole

A

*karyotype: 69, XXX; 69, XXY; or 69, XYY
*components: 2 sperm + 1 egg
*fetal parts: YES
*uterine size: normal
*hCG: high (not as high as complete mole)
*imaging: fetal parts
*risk of malignancy (gestational trophoblastic neoplasia) and risk of choriocarcinoma lower than in complete mole

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22
Q

hydatidiform mole - treatment

A

*D&C +/- methotrexate
*pertinent to trend b-hCG down to 0
*monitor monthly for 6 months (complete HM)
*can progress to choriocarcinoma

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23
Q

ectopic pregnancy - overview

A

*implantation of a fertilized ovum in a site other than the uterus (most often in ampulla of fallopian tube)
*amenorrhea + low rise of b-hCG for dates + sudden lower abdominal pain = ectopic until ruled out
*can be mistaken for appendicitis
*need to confirm pregnancy location with ultrasound

24
Q

ectopic pregnancy - clinical presentation

A

*presents with:
-first trimester bleeding
-lower abdominal pain
(often mistaken for appendicitis)
*suspect if: lower-than-expected risk in hCG based on dates

25
Q

ectopic pregnancy - risk factors

A

*prior ectopic pregnancy
*history of infertility
*salpingitis (PID)
*ruptured appendix
*prior tubal surgery

26
Q

ectopic pregnancy - treatment

A

*methotrexate or surgical removal
*if unstable patient, medical emergency = prompt surgical intervention

27
Q

spontaneous abortions - missed

A

*no vaginal bleeding
*closed cervical os
*no fetal cardiac activity or empty sac

28
Q

spontaneous abortions - threatened

A

*vaginal bleeding & cramping
*closed cervix, soft
*fetal cardiac activity present
*does not mean that it will definitely resolve in a miscarriage, but may

29
Q

spontaneous abortions - inevitable

A

*vaginal bleeding & cramping
*rupture of membranes
*dilated cervical os
*products of conception seen or felt at or above cervical os

30
Q

spontaneous abortions - INCOMPLETE

A

*vaginal bleeding & cramping
*DILATED cervical os
*products of conception incompletely expelled

31
Q

spontaneous abortions - COMPLETE

A

*vaginal bleeding
*CLOSED cervical os
*products of conception completely expelled

32
Q

vasa previa - overview

A

*fetal vessels overlying or in close proximity of internal cervical os
*associated with velamentous umbilical cord insertion (inserts in chorioamniotic membrane rather than placenta → fetal vessels are NOT protected by Wharton jelly)

“VASA” = vessels
“PREVIA” = overlying cervical os

33
Q

vasa previa - clinical presentation

A

*PAINLESS vaginal bleeding
*fetal bradycardia
*premature membrane rupture
first aid: presents with painless vaginal bleeding (fetal blood from injured vessels) upon rupture of membranes accompanied by fetal heart rate abnormalities (eg. bradycardia)

34
Q

vasa previa - complications

A

*fetal heart rate decelerations
*vessel rupture
*exsanguination
*fetal death

35
Q

vasa previa - treatment

A

*emergency cesarean section delivery

36
Q

placental abruption - overview

A

*premature separation of placenta from uterine wall (partial or complete) BEFORE delivery of infant

37
Q

placental abruption - clinical presentation

A

*ABRUPT, PAINFUL vaginal bleeding, typically in 3rd trimester
*can result in DIC, maternal hypovolemic shock, or fetal distress
*life threatening to mother and fetus

38
Q

placental abruption - risk factors

A

*trauma (MVA, fall, IPV)
*smoking
*maternal HTN
*preeclampsia
*cocaine abuse

39
Q

placental abruption - treatment

A

*depending on gestational age & stability of mom and baby
*monitor (inpatient) vs. delivery

40
Q

placenta previa - overview

A

*attachment of PLACENTA over internal cervical os
*can be associated with placenta accreta spectrum

note - low lying placenta = located < 2cm from, but not covering, internal os

“PLACENTAL” = placenta
“PREVIA” = overlying internal cervical os

41
Q

placenta previa - clinical presentation

A

*PAINLESS vaginal bleeding in 3rd trimester

42
Q

placenta previa - risk factors

A

*multiparity
*prior cesarean or uterine surgery

43
Q

placenta previa - treatment

A

*monitor for resolution and/or bleeding
*delivery by cesarean if no resolution or significant bleeding episode

44
Q

placenta accreta spectrum - overview

A

*abnormal invasion of trophoblastic tissue into uterine wall:
-defective decidual layer during embryology
-abnormal attachment of placenta, abnormal separation after delivery
*spectrum based on depth of trophoblast invasion (accreta < increta < percreta)

45
Q

placenta accreta spectrum - risk factors

A

*prior cesarean (or other uterine surgery)
*inflammation
*placenta previa

46
Q

placenta accreta spectrum - presentation

A

*detected on ultrasound prior to delivery
*presents with difficulty separating placenta from uterus after fetal delivery
*severe postpartum bleeding / hemorrhage after manual removal of placenta (can cause Sheehan syndrome)

47
Q

placenta accreta spectrum: ACCRETA

A

*placenta ATTACHES to myometrium (instead of overlying decidua basalis)
*does NOT penetrate or invade myometrium
*most common and most mild type

48
Q

placenta accreta spectrum: INCRETA

A

*placenta partially invades / penetrates INTO myometrium
*intermediate subtype

49
Q

placenta accreta spectrum: PERCRETA

A

*placenta COMPLETELY PENETRATES or PERFORATES through myometrium and into uterine serosa
*can cause attachment into rectum/bowel, bladder
*most severe subtype

50
Q

placenta accreta spectrum - treatment

A

*cesarean hysterectomy

51
Q

polyhydramnios - overview

A

*too much amniotic fluid
*associated with fetal anomalies, maternal diabetes, fetal anemia, multiple gestations
*complications: preterm labor, PPROM, cord prolapse, unstable lie (breech), PPH/uterine atony

52
Q

oligohydramnios - overview

A

*too little amniotic fluid
*associated with: placental insufficiency, bilateral renal agenesis, posterior urethral valves
*complications: fetal growth restriction, fetal death/stillbirth, deformities, preterm birth, infection, delayed lung maturity, Potter Sequence

53
Q

low birth weight - overview

A

*infant born small for gestational age, usually <2500 g (~5.5 lbs)
*causes: prematurity, fetal growth restriction (formerly IUGR)
*risks: overall mortality, SIDS, poor thermoregulation, hypoglycemia, etc
*complications: infections, RDS, necrotizing enterocolitis, intraventricular hemorrhage, persistent fetal circulation

54
Q

postpartum hemorrhage (PPH) - overview

A

*1000mL + of blood loss within 24 hours of delivery
*occurs post delivery (after delivery of infant AND placenta)
*risk factors: twins, multiple gestations, coagulation disorders, hx of PPH

55
Q

postpartum hemorrhage (PPH) - causes

A

*4 T’s:
1. TONE (uterine atony)
2. TRAUMA (lacerations)
3. THROMBIN (DIC, etc)
4. TISSUE (retained placenta)

56
Q

postpartum hemorrhage (PPH) - management

A

*3 components of active management:
1. oxytoxin
2. uterine massage
3. umbilical cord traction
*other options: urine catheterization, early ambulation/bathroom use, breastfeeding

Endo Repro Exam (56 decks)

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