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Reproductive System > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

hCG:

What 3 other hormones is it structurally similar to?

which subunits?

A

LH, FSH, TSH

  • alpha subunit identical
  • beta subunit unique
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2
Q

hCG

  • function
  • secreted by what
A

Human Chorionic Gonadotropin

  • ‘rescues’ and maintains the corpus luteum during beginning of pregnancy
  • hCG is secreted by the synciotrophlolblast of the placenta.
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3
Q

hCG

  • How quickly do hCG levels rise in early pregnancy?
  • When during pregnancy do hCG levels rise and fall? When is the peak?
A
  • double every 48 hours in early pregnancy
  • Peak hCG: 10 weeks, at 100,000 mIU/mL

(see image)

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4
Q

hCG
-what can exogenous hCG be used to treat? (2)

A
  1. induce ovulation in females
  2. stimulate testosterone production in males

This is because hCG is structurally similar to LH and can function as an LH analogue

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5
Q

Urine pregnancy test

  • mechanism
  • detection threshold (what is the hCG level at time of missed menses?)
A
  • utilize a monoclonal antibody specific to the beta subunit of hCG.
  • detection threshold: 20-100 mIU/ml depending on brand. At time of missed menses, hCG level is ~100 mIU/ml
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6
Q

What is the most sensitive and precise type of pregnancy test?

-what’s its threshold detection level

A

Quantitative Serum hCG

-Pregnancy is negative if hCG <3-5 mIU/ml

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7
Q

Discriminatory zone of hCG

  • what is it, and specifically what #
  • what is the practical application
A

The serum hCG level above which a fetus should be consistently visible on transvaginal Ultrasound.

-hCG level of 1500-2000 (hCG is ~100 at 1 month)

If hCG levels reach the discriminatory zone but there is no visible fetus on US, there is likely an ectopic pregnancy!

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8
Q

Spontaneous abortion/miscarriage/pregnancy loss

  • definition
  • what % of pregnancies
A
  • Fetal loss before 20 weeks (from last menstrual period)
  • 15% of clinical recognized pregnancies
  • 80% occur in 1st trimester
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9
Q

Threatened abortion

A

In pregnant woman:

  • Bleeding or cramping
  • no passage of tissue, and closed os.
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10
Q

Inevitable abortion

A

In a pregnant woman:

  • bleeding, with open os.
  • No passage of conception products (yet)
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11
Q

Incomplete abortion

A

In pregnant woman:

  • partial passage of conception products
  • open os, variable bleeding
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12
Q

Missed abortion

  • what is it
  • divided into what 2 types
A

This is intrauterine demise <20 weeks w/o any passage of conception products

  1. Embryonic demise
    - embryonic pole visible on US, but no cardiac activity. (fetus died)
  2. Anembryonic demise
    - gestational sac but no embryo visible on US
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13
Q

Abortion/Miscarriage:

-what 3 terms to know

A
  1. threatened abortion–bleeding, closed os
  2. inevitable abortion–bleeding, open, no passage of products
  3. incomplete abortion–partial passage of conception products
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14
Q

Recurrent pregnancy loss

  • definition
  • what % of couples have this?
A

3 or more spontaneous pregnancy losses before 20 weeks

-occurs in <1% of couples attempting to have children

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15
Q

Ectopic pregnancy

  1. what % of pregnancies does this occur?
  2. most common implantation location
A
  1. 2% of all pregnancies
  2. Fallopian tube 98% of the time (majority in ampulla).

Others include: cervical, ovarian, interstitial, abdominal

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16
Q

Heterotopic pregnancy

  • what is it
  • risk factors?
A

Co-existing intrauterine AND extrauterine pregnancy.

  • occurs in 1/30,000 pregnancies
  • risk factors include:
    1. in vitro fertilization
    2. ovulation induction
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17
Q

Ectopic pregnancy

-risk factors include: (6)

A

Think blockage:

  1. pelvic inflammatory disease
  2. gonorrhea/chlamydia
  3. previous tubal ligation, previous tubal pregnancy
  4. assisted reproductive technologies
  5. Smoking
  6. Pregnany with IUD in situ
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18
Q

Ectopic pregnancy

-describe surgical vs medical treatment

A

Surgical:

Salpingostomy–create hole in tube to remove fetus

Salpingectomy–remove tube

Medical:

Methotrexate–antimetabolite to inhibit DNA synthesis

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19
Q

Surgery for ectopic pregnancy

  • feared complication
  • how to prevent
A

Make sure to remove all ectopic tissue. Don’t leave any trophoblast cells behind, which can keep growing.

So, make sure hCG levels go to 0 after operation to ensure all cells were removed.

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20
Q

Gestational trophoblastic disease (GTD)

  • what is it
  • name the benign and malignant types
A

abnormal proliferation of trophoblastic tissue.

benign: hydatiform mole (includes complete and partial)
malignant: gestational trophoblastic neoplasia

(includes choriocarcinoma and placental site trophoblastic tumor (PSTT) disease)

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21
Q

Complete molar pregnancy

  1. etiology
  2. what is happening at microscopic level
  3. Gross appearance
  4. Ultrasound appearance
A
  1. results from fertilization of enucleate egg. 2 sets of paternal genes, no maternal. 46 XX or 46 XY (rarely)
  2. trophoblastic proliferation
  3. ‘Grape-like’ chorionic villi
  4. ‘snowstorm’ appearance
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22
Q

Partial molar pregnancy

  • etiology
  • malignancy risk?
A
  • fertilization of haploid ovum by 2 sperm or single sperm that duplicates. So, 3 sets of gene. 69 XXX, 69XYY, or 69 XXY
  • contains fetal tissue
  • Yes, malignancy risk of 1-2%
23
Q

Methotrexate

  • mechanism
  • treat what pregnancy problems? include: (3)
A

Antimetabolite: DHFR antagonist

  • inhibits DNA synthesis to treat:
    1. ectopic pregnancy
    2. hydatiform molar pregnancy
    3. choriocarcinoma
24
Q

Extremely high levels of hCG in pregnant woman.

Suspect what?

A

Suspect gestational trophoblastic disease when hCG is much higher than expected.

25
Q

You are monitoring hCG levels in a newly pregnant patient. hCG failes to increase by 53% or more over 48 hours. Suspect what?

A

Suspect a failing intrauterine pregnancy or an ectopic pregnancy.

hCG should be doubling every 48 hours until peaking at week 10 of pregnancy.

26
Q

What weeks?

1st trimester

2nd trimester

3rd trimester

A

1st trimester: <13 weeks

2nd: weeks 13-25 and 6 days
3rd: week 26 and onwards

27
Q

Fetal infections

-list them

A

TORCH infections

Toxoplasmosis

Other–syphilis, parvovirus B19

Rubella

CMV

Herpes

28
Q

Toxoplasmosis fetal infection

  • clinical presentation at:
    1. first trimester
    2. 2nd trimester
    3. 3rd trimester
A
  1. often death
  2. classic triad: 1) hydrocephalus
    2) intracranial calcifications
    3) chorioretinitis
  3. often asymptomatic at birth
29
Q

Classic triad of:

hydrocephalus

intracranial calcifications

chorioretinitis

what is this?

A

Toxoplasmosis fetal infection, in 2nd trimester

30
Q

Toxoplasmosis fetal infection

-how to diagnose? (2 tests)

A
  1. maternal IgM and IgG
  2. fetal PCR of amniotic fluid
31
Q

Syphilis fetal infection

-describe clinical manifestations

A
  • spontaneous abortion, stillbirth
  • non-immune hydrops
  • preterm birth
  • hepatomegaly
  • ascites
  • anemia, thrombocytopenia
32
Q

Anemic fetus

-suspect what?

A

Suspect Parvovirus B19 fetal infection.

-can cause transient aplastic crisis from lysis of erythroid progenitor cells

33
Q

Parvovirus B19 fetal infection

-clinical presentation

A

Anemia, from Transient apastic crisis

-from lysis of erythroid progenitor cells

Also: acute myocarditis, edema/hydrops, fetal demise

34
Q

Parvovirus B19 fetal infection:

-how to treat fetus?

A

Anemic fetus can be given a blood transfusion directly to fetus itself. Using ultrasound guidance.

35
Q

Rubella fetal infection

-clinical presentation: symptoms include (4)

A
  1. deafness
  2. eye defects
  3. CNS defects
  4. cardiac malformations

other–microcephaly, metnal retardation, etc

36
Q

CMV fetal infection

-what is the characteristic clinical finding?

A

Periventricular calcifications

37
Q

Fetus with intracranial calcifications:

suspect what?

A
  1. toxoplasmosis
  2. CMV (specifically periventricular calcifications)
38
Q

CMV fetal infection

-histology appearance

A

-‘Owl’s eye” appearance of cellular inclusions.

39
Q

Herpes Simplex fetal infection

-how is the virus transmitted to fetus?

A
  1. perinatal (contact with vagina during delivery)
  2. contact after rupture of membrances
  3. direct contact with affected areas
    - transplacental infection is rare
40
Q

Herpes Simplex fetal infection

-how to diagnose (3)

A
  • HSV culture/PCR assay
  • HSV antibodies
  • Tzank smear (look for multinucleated giant cells and viral inclusions)
41
Q

Second trimester fetal complications:

-what are the 3 general categories?

A
  1. TORCH fetal infections
  2. Cervical insufficiency
  3. Fetal anomalies
42
Q

Cervical insufficiency

  • what is it
  • treatment
A
  • 2nd trimester complication
  • Painless cervical shortening or dilation leading to pregnancy loss.
  • Can be corrected with cervical cerclage (surgical tightening of the os)
43
Q

Fetal anomalies resulting from 2nd trimester complication:

  • how to diagnose?
  • risk factors include (2)
A
  • Fetal ultrasound
  • risk factors include:
    1. chromosomal/genetic abnormalities
    2. exposure to teratogens
44
Q

3rd trimester fetal complications

-List them (6)

A
  1. PPROM–preterm premature rupture of membranes
  2. preterm labor
  3. hemorrhage secondary to placental abnormalities
  4. intrauterine fetal demise
  5. intrauterine growth restriction
  6. macrosomia
45
Q

PPROM

  • what is it
  • how to diagnose?
A

preterm premature rupture of membrances (PPROM)

  • chorioamniotic membrane rupture before labor, <37 weeks gestation
  • Microscopy of fluid–you see “ferning”
46
Q

Preterm labor

  • defined by what weeks?
  • how to diagnose
A
  • labor/birth between 20 weeks and 36 6/7 weeks
  • regular contractions resulting in cervical dilation
47
Q

Hemorrhage secondary to placental abnormalities, in 3rd trimester

-name 4 such types of complications

A
  1. placenta previa
  2. placenta accreta
  3. placenta abruption
  4. velamentous cord insertion
48
Q

Placenta previa

A

Placenta is implanted over/near cervical os. Painless, but danger occurs when fetus grows large enough to press upon the placenta.

49
Q

Placenta accreta

  • what is it, and what is the danger
  • What is placenta increta and placenta percreta?
A

-Placenta implantation extends inappropriately deep into the basal zone of the endometrium.

Placenta increta–placenta extends into myometrium

placenta percreta: placenta extends into uterine serosa

-Risk for hemorrhage after delivery. May require hysterectomy immediately after baby’s birth.

50
Q

Placenta abruption

A

-placental separation due to hemorrhage into decidual basalis before birth.

51
Q

Velamentous cord insertion

A

Umbilical cord attaches to chorion and amnion, rather than placenta.

-Risk for serious bleeding because umbilical vessels easily torn.

52
Q

Intrauterine fetal demise

-what trimester

A

-fetus dies secondary to complications in 3rd trimester (eg infection from PPROM)

53
Q

Intrauterine growth restriction

A
  • 3rd trimester complication
  • fetal weight in 3rd trimester is less than 10th percentile via ultrasound
54
Q

Macrosomia

A
  • 3rd trimester complication
  • fetal weight is excessive (>4500 grams)

Reproductive System (35 decks)

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