pregnancy complications Flashcards
What are risk factors for ectopic pregnancy? most common site? diagnosis?
common site: ampulla of the fallopian tube.
risk factors: PID/salpingitis, ruptured appendix, prior tubal surgery.
diagnosis: look for inappropriately low rise in beta-hCG, amenorrhea, sudden lower abdominal pain.
polyhydramnios causes
too much amniotic fluid. seen with esophageal/duodenal atresia, anencephaly (both result in ability to swallow fluid), maternal DM, fetal anemia, multiple gestations
oligohydramnios causes
placental insufficiency, renal agenesis, posterior urethral valves. any profound oligohydramnios can cause Potter sequence.
placenta previa: what is it? presentation? risk factors?
placent implants close to the cervical os. it may be near the os (marginal), partially cover it, or completely cover it. presents as 3rd trimester bleeding. risk factors: multiparity, prior c-section
placental abruption: what is it? risk factors? presentation?
premature separation of the placenta from the uterine wall before delivery. risks: trauma, smoking, HTN, preeclampsia, cocaine.
presents as abrupt, painful bleeding (concealed or apparent) in the 3rd trimester. possible DIC, maternal shock, fetal distress. life-threatening for mom AND baby.
placenta accreta/increta/percreta: what are these, generally? presentation? risk factors?
defective decidual layer- abdnormal attachment and separation of the placenta after delivery. risks: prior C-section, inflammation, placental previa. presents as no separation of the placenta after delivery, massive bleeding. life threatening for mom.
differences btw accreta, increta, and percreta
accreta: placenta attaches to the myometrium without penentrating it.
increta: placenta invades the myometrium
percreta: penetrates the myometrium and invades uterine serosa. may cause placental attachment to the rectum or bladder.
hydatidiform moles: what are these, treatment, follow-up
cystic swelling of the chorionic villi and prolif of chorionic epithelium. due to an abnormal conception. she may begin to pass grape like villi in second trimester. or, she would have an ultrasound with abscent fetal heart sounds. treat with D&C, monitor beta-hCG (screens for choriocarcinoma)
complete mole vs. partial mole: karyotype, hCG, uterine size, convert to choriocarcinoma, fetal parts, symptoms, imaging
complete mole: 46XY or XX. enucleated egg + single sperm that duplicates its DNA, or, rarely, empty egg + 2 sperm. hCG is WAY WAY high. uterus is increased in size. 2% convert to choriocarcinoma. no fetal parts. causes vaginal bleeding, large uterus, hyperemesis, pre-eclampsia, hyperthyroidism. imaging shows honycombed uterus (clusters of grapes), or snowstorm on ultrasound (fluid-filled grape like masses)
partial mole: 69XXX, 69XXY, 69XYY. caused by 2 sperm + 1 egg. hCG is high. no change in uterine size. rarely converts to choriocarcinoma. fetal parts present. causes vaginal bleeding and abdominal pain.
treatment for gestational HTN
hydralazine, alpha methyl dopa, labetalol, nifedipine
preeclampsia: definition, causes
HTN in pregnancy + proteinuria after 20 wks gestation to 6 wks post partum. (HTN before that suggests molar pregnancy). caused by abnormal spiral arteries that cause maternal endothelial dysfunction, vasoconstriction, or hyperreflexia.
may have fibrinoid necrosis in the placenta.
risk factors and complications of preeclampsia
preexisting HTN, DM, chronic renal disease, autoimmunity. can cause placental abruption, coagulopathy,m renal failure, uteroplacental insufficiency, or eclapsia.
HELLP syndrome
hemolytic anemia, elevated liver enzymes, low platelets. severe preeclampsia.
choriocarcinoma: germ cell vs. complication of gestation
germ cell doesn’t respond to chemo. complication of gestation will respond to chemo
