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EOR Women's Health > pregnancy complications > Flashcards

pregnancy complications Flashcards

1
Q

dystocia definition

A

failure to progress labor, prolonged labor

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2
Q

3 P’s of labor

A

Power (cervical dilation/contractions/descent, 25 mmHg pressure, min 3 contractions/10min)

Passenger (excess fetal wt, presentation, lie)

Passage (pelvis)

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3
Q

1st stage disorders

A 
latent phase (onset-4cm dilation)
>20 hrs null, >14 hrs multi
active phase (4-10cm dilation)
dilation <1.2-1.5 cm/hr multi
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4
Q

augmentation in 1st stage prolongation

A

oxytocin (incr contractions)

amniotomy (rupture membranes)

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5
Q

2nd stage disorders

A

> 3 hrs if anesthesia

>2 hrs if no anesthesia

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6
Q

Tx of prolonged 2nd stage labor

A

C section
forceps
vacuum extraction

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7
Q

shoulder dystocia maneuvers

A

McRoberts maneuver
mom’s thighs hyperflexed against abdomen
pressure over lower abdomen
episiotomy

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8
Q

shoulder dystocia injuries

A
  • brachial plexus injury
  • Erb Duchenne palsy: tear C5, C6; arm paralysis, motor movement hand intact
  • Klumpke paralysis: C8-T1 tear; hand paralysis
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9
Q

acceleration fetal HR means?

A
  • NORMAL

- normal with fetal scalp stim/vibroacoustic stim test

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10
Q

early deceleration fetal HR means?

A

-physiologic, occurs with uterine contractions (decr blood flow to fetus, hypoxia)

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11
Q

late deceleration fetal HR means?

A
  • FETAL HYPOXIA

- uteroplacental insufficiency

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12
Q

meconium aspiration: risk of developing what?

A

pneumonitis, pneumothorax

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13
Q

meconium aspiration Tx

A

immediate suction, intubation

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14
Q

MCC maternal death

A

postpartum hemorrhage

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15
Q

when does postpartum hemorrhage occur?

A

1st 24 hrs

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16
Q

causes of postpartum hemorrhage

A 
MCC: uterine atony
retained placenta
coag disorders
ruptured uterus
inverted uterus
genital tract trauma
hematomas
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17
Q

uterine atony

A

no constriction of arteries at site of placental separation to stop bleeding

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18
Q

RF for uterine atony

A

stretched uterus

polyhydramnios, twins, abnorm labor

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19
Q

uterine atony Sx

A

boggy uterus (normally firm)

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20
Q

Tx uterine atony

A

contractions!

  • manual massage (short term)
  • immediate breastfeeding
  • methylergonovine maleate
  • prostaglandins: misoprostol
  • surgery: compression sutures, selective artery embolization
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21
Q

retained placental tissue definition

A

sheared/torn cotyledons

placenta: missing cotyledons

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22
Q

cause of retained placental tissue

A

abnorm adherence, incomplete placenta separation

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23
Q

abnormal adherence causing retained placental tissue: placenta accreta / increta / percreta

A

superficial lining of uterus
uterine muscle
entire thickness of muscle, no separation at all

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24
Q

Tx retained placental tissue

A

currettage

hysterectomy

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25
Q

uterine inversion cause, Tx

A
  • tug umbilical cord during placental delivery

- manually replace

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26
Q

uterine rupture RF, Tx

A

RF: uterine surgery/procedure, C section
Tx: hysterectomy

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27
Q

amniotic fluid embolism cause, Sx

A

amniotic fluid into maternal circulation

-resp distress–> cyanosis–> CV collapse–> hemorrhage/coag DIC–> coma

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28
Q

ectopic MC site

A

fallopian tube

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29
Q

RF for ectopic

A
  • tubal ligation/tubal surgery
  • Hx ectopic
  • IUD
  • DES exposure (diethylstillbestrol)
  • PID
  • infertility Tx
  • endometriosis (scar, adhesions)
  • tobacco
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30
Q

DES assoc with

A

vaginal clear cell carcinoma, ectopic, miscarriage, breast CA

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31
Q

Sx ectopic

A

amenorrhea, vaginal bleeding, abdom pain on affected side

adnexal tenderness

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32
Q

DDx ectopic

A

abortion, ovarian cyst rupture, renal calculi, appendicitis

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33
Q

differentiate DDx ectopic

A

amenorrhea not in appendicitis/renal calculi

appendicitis- RLQ pain

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34
Q

Dx ectopic

A
  • serum HCG: lower than expected
  • transvaginal US: no gestational sac, free fluid pouch of Douglas, echogenic adnexal mass

(decr progesterone = nonviable preg; blood in cul-de-sac)

gestational sac visualized 1000-2000 IU/L

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35
Q

Tx ectopic

A

methotrexate (abort, folic antagonist, stops rapidly dividing cells)
surgery if needed (salpingostomy)

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36
Q

spontaneous abortion / miscarriage definition

A

expulsion before 20 wks gestation

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37
Q

early miscarriage cause

A

chromosomal abnorm (trisomy)

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38
Q

2nd trimester miscarriage cause

A

maternal systemic dz, placental abnorm

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39
Q

RF for miscarriage

A

infection (chlamydia, syphilis, HIV, GBS), thryoid autoAb/hypothyroidism, DM 1, smoking, radiation, coag disorders, uterine leiomyomata, Hx DES

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40
Q

threatened abortion

A

BLEED WITHOUT TISSUE LOSS, bleeding then cramping days later

risk of preterm delivery, low birth wt

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41
Q

inevitable abortion

A

gross rupture membranes, cervical dilation

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42
Q

classifications of spontaneous abortion

A

complete, incomplete, missed

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43
Q

complete spontaneous abortion

A

<10 wks, everything expelled

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44
Q

incomplete spontaneous abortion

A

later in preg, not everything expelled, tissue partially protrude through cervix, remove with forceps/suction

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45
Q

missed spontaneous abortion

A

retained failed intrauterine preg for months, no uterine growth, loss of early preg Sx, resolve spontaneously

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46
Q

medical induced abortion when?

A

< 49 days

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47
Q

induced abortion how for <49 days?

A

antiprogestin (mefepristone), methotrexate, prostaglandin (misopristol)

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48
Q

induced abortion how for >49 days?

A

surgical- suction currettage

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49
Q

concerning finding in fetal HR monitoring?

A

late decelerations

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50
Q

hydatidiform mole (partial? complete?)

A

partial: 1 egg, 2 sperm
non viable, recognize fetal material
69 XXX, XXY

complete: egg without DNA, 2 sperm
NO recognize fetal material
46 XX, XY

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51
Q

gestational trophoblastic neoplasia aka

A

hydatidiform mole

range of neoplasms from trophoblastic tissue

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52
Q

gestational trophoblastic neoplasia / hydatidiform mole Sx

A

neoplasia = grows out of control

  • vaginal bleeding, pain, hyperemesis gravidarum
  • uterine enlargement, ovarian enlargement (TLC), no fetal HR
  • HTN!! (if <20 wks), EXCESSIVE HCG
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53
Q

gestational trophoblastic neoplasia / hydatidiform mole Dx

A

US: hydatidiform mole = snowstorm, clusters of grapes

excessive HCG

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54
Q

gestational trophoblastic neoplasia / hydatidiform mole Tx

A 
evacuation- D&C dilation & curettage
monitor HCG until zero
-weekly until zero x 4 wks
-monthly x 1 yr
OCP (prevent preg b/c recurrence x 1 yr)
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55
Q

gestational trophoblastic neoplasia / hydatidiform mole complications & Tx

A

invasive mole: HCG doesn’t drop
-Tx methotrexate

choriocarcinoma
-Tx methotrexate (chemo), XRT, monitor HCG

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56
Q

RF for choriocarcinoma

A

molar preg!!

abortion, ectopic

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57
Q

chronic vs. gestational HTN

A

20 wks

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58
Q

RF for hydatidiform mole

A

chronic HTN <20 wks/before preg

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59
Q

chronic HTN BP mild, severe

A

mild >140/90

severe >180/100

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60
Q

mild preeclampsia

A

HTN + proteinuria >20 wks
>140/90
proteinuria >0.3 g x 24hr urine

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61
Q

severe preeclampsia

A 
>160 (180)/110
proteinuria >5 g x 24hr urine, 3+ protein dip x 2
oliguria <500 mL x 24 hrs
cerebral visual disturbance (HA, scotomata)
RUQ pain (hep hemorrhage)
pulm edema
hepatic dysfn
thrombocytopenia
IUGR
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62
Q

delivery guidelines in severe preeclampsia

A

delivery regardless of gest age

63
Q

RF for (pre)eclampsia

A

**nulliparity

multi fetal gestation, >35 y/o, chronic HTN, nephropathy, obesity, AA, DM, Hx of preeclampsi

64
Q

eclampsia

A

severe preeclampsia + grand mal seizure

fetus can withstand 20 min seizure: fetal hypoxia

65
Q

Sx preeclampsia

A

**puffy face, edema doesn’t resolve with elevation, HTN

RUQ tender, hyperreflexia, ankle clonus

66
Q

labs preeclampsia

A

incr Hct, thrombocytopenia, incr PT/PTT, decr renal function, proteinuria, hepatic dysfn

67
Q

BP goal pregnancy- in chronic HTN

A

150-160 / 110-110

68
Q

Tx chronic HTN in pregnancy

A

methyldopa, labetalol, nifedipine, hydralazine

CAN continue diuretics if on them

69
Q

Tx mild preeclampsia

A

MONITOR

non-stress test 2x/wk, US q 3 wks, fetal movement daily

70
Q

Tx severe preeclampsia

A

*hydralazine (HTN)
*Mg sulfate 4-6 mg/dL IV (seizure prophylaxis)
labor induction- C section
postdelivery- 24 hrs on Mg sulfate

(not diazepam, phenytoin)

71
Q

Mg sulfate reversal agent

A

10% Ca gluconate IV

72
Q

HELLP syndr

A

hemolysis, elev liver enzymes, low plts

sometimes with severe preeclampsia/eclampsia

73
Q

HELLP Sx

A

high BP, vague Sx malaise, RUQ pain

74
Q

HELLP complications

A

fetal mortality, hepatic rupture, ARF, pulmonary edema, postpartum hemorrhage, DIC

75
Q

Tx HELLP

A

plt transfusion (if <500)
RBC
FFP

76
Q

when to Tx anemia in pregnancy

A

Hg < 10-11

77
Q

folate supplemetation.

A

0.4 mg/day

78
Q

Fe def anemia supplement

A

PNV + Fe 60-120 mg/day + vit C

79
Q

gestational diabetes complications

A

spontaneous abortion, macrosomia (big), polyhydramnios

80
Q

gestational diabetes testing when, what

A

24-28 wks
glucose intolerance test: 1 hr glucose challenge (no fast)
if >140 then GTT

81
Q

Tx gestational diabetes

A

1st line: diet, nutrition

  • monitor
  • combo NPH/regular (immed, fast)
  • glyburide

NOT metformin after 1st trimester

82
Q

DM 1 in pregnancy complications

A

hypoglycemia, DKA, preeclampsia, ESRD (diabetic nephropathy), retinopathy

83
Q

postpartum thyroiditis def

A

painless hyperthyroid–> hypothyroid in 1 yr postpartum

84
Q

existing hypothyroidism in preg- mgmt

A

monitor levels once per trimester

85
Q

Tx UTI in preg

A

macrobid (not after 38 wks)
keflex
ceftin

NOT bactrim! (C)

86
Q

Tx pyelonephritis in preg

A

ceftriaxone (rocephin)

unasyn, ampicillin, gentamicin

87
Q

Tx asthma in preg

A

ICS (budesonide) + rescue (albuterol)

88
Q

Tx appendicitis in preg

A

open or laparoscopic ectomy

89
Q

Tx cholelithiasis in preg

A

asymptomatic: conservative
symptomatic: open or laparoscopic ectomy

90
Q

Tx trauma in preg

A

fetal monitor

minor: 2-6 hrs
major: min 24 hrs

91
Q

TORCH

A 
toxoplasmosis
other: syphilis, parvovirus, varicella, mumps, HIV
Rubella
CMV
Herpes
92
Q

Toxoplasmosis mom Tx

A

spiramycin (prevent transmission)

93
Q

fetal complications Toxoplasmosis

A

mental retardation, chorioretinitis

blind, epilepsy, hydrocephalus, intracranial calcifications

94
Q

congenital syphilis syndr

A

MP rash, snuffles, hepatosplenomegaly, jaundice, chorioretinitis, LAN, Hutchinsons teeth

95
Q

chorioretinitis assoc with

A

toxoplasmosis, syphilis, varicella

posterior uveitis

96
Q

parvovirus complications

A

spontaneous abortion, hydrops fetalis (fluid overload)

97
Q

treponema pallidum

A

syphilis

98
Q

varicella complications

A

skin scar, limb hypoplasia, chorioretinitis, microcephaly

99
Q

can you give varicella vaccine in preg?

A

no. live

100
Q

HIV Tx

A

antiretroviral therapy
C section at 38 wks
no breastfeeding

101
Q

breastfeeding if HIV?

A

no

102
Q

rubella testing when?

A

1st prenatal visit

103
Q

german measles

A

rubella

104
Q

rubella complications

A

mental retardation, deaf, cataracts, congenital heart dz, PDA

105
Q

can you give rubella vaccine in preg?

A

no. live

106
Q

CMV screening and Tx

A

none. no routine screening b/c rare

107
Q

CMV complications

A

hydrops fetalis, IUGR

108
Q

genital herpes Tx when, what

A

acyclovir, 36 wks

109
Q

herpes delivery policy

A

no active infection: vaginal

active: C section

110
Q

Hep B breastfeeding policy

A

transmitted through breastmilk

can breastfeed if chronic carrier + infant vaccinated/HBIG

111
Q

Hep B Tx mom, infant

A

mom: HBIG + vaccine immediately
infant: in 12 hrs birth

112
Q

Hep B infectious

A

HBeAg

113
Q

Hep B acute infection

A

HBsAg

114
Q

Hep B transmission

A

high if contracted in 3rd trimester

115
Q

Hep C transmission

A

lower

high if viral load high

116
Q

GC ophtalmia infant Tx

A

emycin or tetracycline eye ointment

117
Q

chlamydia presentation infants

A

conjunctivitis birth, 1-2 mo pneumonia

118
Q

chlamydia Tx mom

A

ceftriaxone

1 g azithromycin

119
Q

hydrops fetalis assoc is

A

parvovirus, CMV

120
Q

IUGR

A

< 10th %

121
Q

SGA

A

lower extreme of normal

122
Q

IUGR complications

A

death, asphyxia

acidemia, seizures, sepsis, resp distress, meconium aspiration, low apgar

123
Q

RF for IUGR

A

mom medical dz, smoking, substance abuse, malnutrition, placental dz, multiple gestation, infection, genetic disorder, teratogen

124
Q

IUGR Tx

A

fetal monitoring
amniotic fluid vol (oligohydramnios)
amniocentesis (FLM)

125
Q

macrosomia

A

> 90th %
8.8-9.9 lb
4000-4500 g

126
Q

RF for macrosomia

A

DIABETES, Hx macrosomia, preg wt gain, male, genetics

127
Q

placenta previa def, Sx

A

close/over os

PAINLESS BLEEDING, spotting stops in 2 hrs
>30 wks gestation

128
Q

RF placenta previa

A

EXPERIENCED MOMS

Hx, C section, uterine surgery, multiparity, advanced age, cocaine, smoking

129
Q

Tx placenta previa

A

bed rest, fluids

C section usually

130
Q

complications placenta previa

A

placenta acreida (abnorm adherence)
fetal anomalies
preterm

131
Q

placental abruption def, Sx

A

premature separation from uterine wall

PAINFUL BLEEDING, continuous, increased

132
Q

RF placental abruption

A

HTN, preeclampsia, infection, trauma

+same as placenta previa

133
Q

Tx placental abruption

A

C section

134
Q

uterine rupture Px

A

bad. 75% mom mortality. fetal mortality

135
Q

preterm labor

A

<37 wks

136
Q

complications of preterm delivery

A

RESP DISTRESS, intraventricular hemorrhage, enterocolitis, sepsis, neuro impairment, seizure, cerbral palsy

137
Q

MCC preterm

A

mult gestations

PROM, Hx, cervical insuff, infection, uterine enlargement, smoking

138
Q

how to predict preterm

A 
fetal fibronectin (present if near delivery)
transvag US (cervical length)
cervix dilation/effacement
bacterial vaginosis (predisposes to preterm)
139
Q

Tx preterm labor

A

tocolytic agents- anti contraction (Mg sulfate!!!!), corticosteroids (for FLM)

140
Q

MC complication of PROM

A

intrauterine infection

141
Q

Dx PROM

A

gush/steady leakage
nitrazine: alkaline 7.1-7.3
fern test
US: vol amniotic fluid

*sterile speculum exams! no digital exams!

142
Q

Tx PROM >37 wks, 28-37 wks

A

> 37 wks: delivery
32-33 wks: corticosteroids (FLM), abx
24-31 wks: corticosteroids, abx, tocolytics
<24 wks: delivery (not enough amniotic fluid)

28-37 wks: labor in 24 hrs-1wk, amniocentesis (FLM), corticosteroids (FLM)

143
Q

goal of preg length

A

33 wks

144
Q

MCC postterm pregnancy

A

incorrect est of gestational age

obesity, nulliparity

145
Q

postterm complications

A

birth trauma, labor dysfn

macrosomia, shoulder dystocia, meconium aspiration, oligohydramnios

146
Q

result of isoimmunization (Rh D)

A

fetal anemia, jaundice, kernicterus

147
Q

Tx isoimmunization

A

rhogam anti-D = at 28 wks, and within 72 hrs delivery, and if bleeding/trauma

148
Q

1 Rhogam dose protects?

A

30 mL fetal blood

149
Q

isoimmunization test

A

Kleihauer-Betke test

150
Q

MC complication mult gestations

A

preterm L&D

polyhydramnios, preeclampsia!!!, spontaneous abortion

151
Q

adding each baby = decr gest age by

A

3-4 wks

152
Q

twin-twin transfusion syndr def, Tx

A

monochorionic

Tx: intrauterine laser Tx (helps both)

153
Q

death of one fetus Tx

A

none. damage done by the time of discovery (HOTN). no benefit to early delivery

EOR Women's Health (4 decks)

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