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EOR OB/GYN > Pregnancy complications 2 > Flashcards

Pregnancy complications 2 Flashcards

1
Q

Cervical insufficiency (incompetent cervix)

A

the inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of clinical contractions or labor

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2
Q

common causes of cervical insufficiency

A

history of cervical trauma or procedures, collagen disorders, and congenital anomalies of the cervix.

Cervical trauma may include prior cone biopsies, prior deep cervical lacerations, and use of instruments during labor

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3
Q

dx cervical insufficiency

A

The diagnosis of cervical insufficiency is preferably made based on obstetric history and the cervical length on transvaginal ultrasound, but the diagnosis can be made based on obstetric history alone. The diagnosis is often made based on obstetric history in women with at least two consecutive second-trimester pregnancy losses or extremely early preterm births (prior to 28 weeks) associated with minimal or mild symptoms (usually painless). or at least three preterm births prior to 34 weeks gestation in which other causes have been excluded

The diagnosis of cervical insufficiency is often made based on obstetric history and exam or ultrasound in women with at least one prior preterm birth and advanced changes on physical examination before 24 weeks of gestation or cervical length ≤ 25 mm on transvaginal ultrasound examination

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4
Q

Exam findings cervical insufficiency

A

dilated and effaced cervix in a woman without contractions or with minimal contractions inconsistent with the amount of cervical change

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5
Q

tx cervical insufficiency

A

cervical cerclage and progesterone supplementation beginning at 16 weeks gestation

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6
Q

at what point in pregnancy is a cervical cerclage recommended

A

A cervical cerclage is recommended beginning at 12–14 weeks of pregnancy for women who meet the obstetric history criteria for a diagnosis of cervical insufficiency

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7
Q

management of Women with suspected cervical insufficiency who do not meet the obstetric history criteria

A

monitored with frequent surveillance via transvaginal ultrasound. This monitoring should be started at 14–16 weeks gestation

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8
Q

who else should be given supplemental progesterone in regards to cervical insufficiency

A

Women who meet the ultrasound criteria for a cervical cerclage with a prior history of a spontaneous preterm birth are also treated with progesterone supplementation beginning at 16 weeks gestation

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9
Q

The diagnosis of cervical insufficiency is limited to what type of pregnancies

A

singleton gestation pregnancies

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10
Q

At which gestational age in the pregnancy are cervical cerclages typically removed?

A

36–37 weeks gestation or with the onset of preterm labor

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11
Q

Placental abruption is also known as

A

abruptio placentae

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12
Q

placental abruption

A

a condition in which there is partial or complete placental detachment from the uterine wall prior to delivery of the fetus. Severe cases are associated with increased maternal and fetal morbidity

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13
Q

strongest RF for placental abruption

A

history of a previous placental abruption

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14
Q

Other RF placental abruption

A

Abdominal trauma, cocaine use, and eclampsia
polyhydramnios, chronic hypertension, preeclampsia, prelabor rupture of membranes, chorioamnionitis, and smoking

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15
Q

sx placental abruption

A

acute onset of painful vaginal bleeding (dark red blood) accompanied by uterine contractions and abdominal or back pain. Bleeding may be mild or profuse and life-threatening

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16
Q

PE placental abruption

A

a firm, rigid, or tender uterus

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17
Q

Findings that are concerning for increased maternal and fetal morbidity in placental abruption

A

abdominal pain, hypotension, and fetal heart rate abnormalities

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18
Q

dx placental abruption

A

primarily clinical

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19
Q

classic TVUS placental abruption

A

Retroplacental hematoma

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20
Q

placental abruption and risk of DIC

A

A placental abruption of > 50% significantly increases the risk for acute disseminated intravascular coagulation (DIC) and fetal death

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21
Q

Complications of placental abruption

A

DIC
fetal death
excessive blood loss resulting in hypovolemic shock, kidney failure, respiratory distress syndrome, multiorgan failure, and death

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22
Q

tx for life threatening placental abruption

A

Emergency cesarean section or peripartum hysterectomy

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23
Q

Grade 1 placental abruption

A

Mild bleeding with a normal fetal heart rate

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24
Q

Grade 2 placental abruption

A

mild to moderate vaginal bleeding, significant uterine contractions, and fetal heart rate abnormalities

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25
Q

Grade 3 placental abruption

A

mild to severe bleeding, severe abdominal pain, and evidence of fetal demise

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26
Q

what should be avoided with placental abruption

A

A pelvic exam or other cervical stimulation

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27
Q

what should be obtained in all women w bleeding in the third trimester

A

CBC, blood type and cross, and fibrinogen level should be obtained

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28
Q

diagnostic test of choice for placental abruption

A

Transvaginal ultrasound demonstrating a hematoma in between the placenta and endometrium is a specific and safe test to evaluate for placental abruption and thus is the diagnostic test of choice

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29
Q

Indications for C section for placental abruption

A

if there are signs of fetal distress, deteriorating hemodynamic status of the mother, persistent vaginal bleeding, or active labo

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30
Q

IV steroids and tocolytics for placental abruption

A

Intravenous steroids and tocolytics are indicated for women with placental abruption who are < 34 weeks gestation to promote fetal lung maturity and prevent labor

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31
Q

on top of tocolytics and steroids, women less than 32 weeks with placental abruption should also receive

A

magnesium sulfate for neuroprotection

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32
Q

indications for expectant management placental abruption

A

Expectant management of a placental abruption is reasonable for women between 24–34 weeks gestation who are not in active labor and when both the fetus and the mother are hemodynamically stable

33
Q

placenta previa

A

the placenta implants itself over the internal cervical os

34
Q

RF placenta previa

A

previous placenta previa, previous cesarean delivery, multiparity, smoking, and increasing maternal age

35
Q

dx placenta previa

A

US

36
Q

sx placenta previa

A

painless bright red vaginal bleeding, which can range anywhere from light spotting to profuse hemorrhaging

occurs during the second half of pregnancy

37
Q

management placenta previa

A

Initially, all women with placenta previa should be hospitalized for stabilization and bed rest. For pregnancies at 36 weeks gestation or earlier, if the bleeding and abdominal cramping have subsided, patients can be discharged and closely monitored. However, for pregnancies at 37 weeks or greater, a cesarean section delivery is indicated

38
Q

when is placenta previa MC diagnosed

A

Placenta previa is also frequently diagnosed when it is identified on the fetal anatomic survey ultrasound performed between 16 and 20 weeks gestational age. However, 90% of placenta previa cases identified on an ultrasound before 20 weeks gestation resolve prior to delivery

39
Q

when should you suspect placenta previa

A

The diagnosis of placenta previa should be suspected in all pregnant women presenting with vaginal bleeding at more than 20 weeks gestation

40
Q

management asx women w placenta previa

A

Women who are asymptomatic with placenta previa should have an ultrasound repeated in the third trimester around 32 weeks. If the placenta previa has not resolved, then the patient should have a cesarean delivery between 36 and 38 weeks gestational age. Furthermore, these patients should be educated on lifestyle modifications to reduce the risk of bleeding, which include avoiding sexual intercourse and heavy lifting

41
Q

management for women w placenta previa and resolved episode of bleeding

A

Women who have placenta previa and a resolved episode of bleeding can typically be treated outpatient as long as they are stable and able to return to the hospital if bleeding recurs. These women should have a cesarean delivery between 36 weeks and 37 6/7 weeks gestation

42
Q

what should be given to all Rh negative women w bleeding from placenta previa

A

Anti-D immune globulin

43
Q

indications for c section placenta previa

A

active labor (cervical dilation around 4–6 cm), refractory maternal hemorrhage, nonreassuring fetal status, and any significant bleeding after 34 weeks

Cesarean delivery is recommended between 36–38 weeks gestation in women with asymptomatic placenta previa

44
Q

what should be avoided by providers in placenta previa

A

health care clinicians should avoid speculum examinations in women who are known to have placenta previa

45
Q

Preeclampsia

A

emergency pregnancy condition that consists of hypertension with proteinuria or hypertension with signs of severe end-organ involvement

new-onset hypertension with proteinuria after the 20th week of gestation

systolic blood pressure ≥ 140 mm Hg or a diastolic blood pressure ≥ 90 mm Hg on at least two occasions at least 4 hours apart in a previously normotensive patient

45
Q

RF preeclampsia

A

a prior history or family history of preeclampsia, preexisting medical conditions (e.g., pregestational diabetes, chronic hypertension, prepregnancy body mass index > 25 kg/m2 or body mass index > 30 kg/m2), nulliparity, and advanced maternal age

46
Q

pre-hypertensive values

A

between 120 and 139 mm Hg systolic and 80 and 90 mm Hg diastolic

47
Q

overt HTN for preeclampsia

A

≥ 140/90 mm Hg

48
Q

when does preeclampsia MC manifest

A

37 weeks gestation

49
Q

Preeclampsia with severe features

A

patients who present with systolic blood pressure values ≥ 160 mm Hg or diastolic values ≥ 110 mm Hg with proteinuria. This diagnosis is also used for patients with hypertensive values who have evidence of end-organ dysfunction as manifested by new-onset cerebral or visual disturbances (e.g., severe, persistent headache, blurred vision, scotomata, altered mental status), severe, persistent right upper quadrant or epigastric abdominal pain, thrombocytopenia (< 100,000 platelets/microL), progressive kidney insufficiency (serum creatinine > 1.1 mg/dL), or pulmonary edema

50
Q

testing preeclampsia

A

complete blood count, serum creatinine level, liver studies, and urinary protein determination (protein to creatinine ratio)

Fetal status should be determined while evaluating the mother with a nonstress test or biophysical profile test

51
Q

delivery for preeclampsia

A

Term pregnancies (≥ 37 weeks gestation) can be delivered at the time of presentation of preeclampsia without severe features, while preterm pregnancies should be treated via expectant management with delivery after 37 weeks gestation

52
Q

tx preeclampsia w severe features

A

magnesium sulfate for seizure prophylaxis. It is administered intravenously as 4–6 g over 20–60 minutes initially, with maintenance dosing at 1–2 g/h with therapeutic drug levels ranging from 4.8 to 8.4 mg/dL

Patients with preeclampsia with severe features should be delivered regardless of gestational age due to the maternal risks

53
Q

what should you test when you administer magnesium sulfate and how often

A

patellar reflex; testing every 6 hours to adjust the maintenance dosing as indicated

54
Q

when does loss of patellar reflex, respiratory paralysis, and cardiac arrest occur in regards to magnesium sulfate

A

Loss of patellar reflexes occurs at levels ≥ 10 mg/dL, with respiratory paralysis occurring at levels ≥ 15 mg/dL and cardiac arrest possible with levels ≥ 25 mg/d

55
Q

tx magnesium toxicity

A

Calcium gluconate

56
Q

All patients with preeclampsia should be monitored for

A

fluid balance, with total intravenous fluid administration not to exceed 80 mL/h to avoid pulmonary edema

57
Q

first line meds for HTN in preeclampsia

A

labetalol, nifedipine, and hydralazine

58
Q

target BP preeclampsia

A

130 to 150 mm Hg systolic and 80 to 100 mm Hg diastolic

59
Q

When can magnesium sulfate be discontinued?

A

At least 24 hours after delivery

60
Q

Is proteinuria a requirement for dx of preeclampsia

A

no

61
Q

Screening for preeclampsia

A

regular blood pressure measurements and urinalysis

All pregnant women should be screened with blood pressure measurements at all prenatal visits

62
Q

what reduces risk of preeclampsia

A

low dose aspirin

63
Q

definitive tx preeclampsia

A

delivery

64
Q

when is continued monitoring an appropriate tx for preeclampsia

A

blood pressure is < 160/110 mm Hg, and no evidence of end-organ dysfunction

antihypertensives are recommended when >60/110 or evidence of end-organ dysfunction

65
Q

Antihypertensive classes to avoid in pregnancy

A

angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid receptor antagonists

66
Q

True or false: cigarette smoking increases the risk of preeclampsia

A

False. Cigarette smoking is associated with a lower risk of preeclampsia

67
Q

fetal risks for preeclampsia

A

preterm delivery and being born small for gestational age

68
Q

maternal risks for preeclampsia

A

cerebral hemorrhage, cardiac failure, acute kidney injury, hepatic failure, and progression to eclampsia

69
Q

how to confirm proteinuria in preeclampsia

A

24-hour urine collection or by a random urine protein to urine creatinine ratio

≥ 300 mg (0.3 g) per 24-hour urine collection, urine protein to creatinine ratio > 0.3, or urine dipstick reading of ≥ 2+

70
Q

All patients with preeclampsia should be delivered at

A

37 weeks

71
Q

is preeclampsia an indication for C section

A

Preeclampsia is not an indication for a cesarean delivery regardless of the presence of severe features

72
Q

what should be administered to women with preeclampsia who are < 34 weeks pregnant

A

antenatal corticosteroids

73
Q

What are some side effects of magnesium sulfate?

A

Depressed reflexes, hypotension, flushing, drowsiness, impaired cardiac function, diaphoresis, and vision changes

74
Q

Development of grand mal seizures in a woman with preeclampsia

A

eclampsia

75
Q

HELLP syndrome

A

hemolysis, elevated liver enzymes, low platelets; recognized as a subtype of preeclampsia in which these features may present with or without hypertension or proteinuria

76
Q

What is the typical fetal response to maternal seizures in eclampsia?

A

Bradycardia during and immediately after the seizure

77
Q

What disorder is associated with preeclampsia that presents prior to 20 weeks of gestation?

A

A molar pregnancy

78
Q
A

EOR OB/GYN (18 decks)

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