pregnancy complications Flashcards
what percentage of ectopics occur in the ampulla of the fallopian tube
55%
common cause of the ectopic pg
secondary to adhesions
unilateral adnexal pain, amenorrhea or spotting, tenderness to the mass(mass felt 20%)
classic symptoms of ectopic
severe abdominal or shoulder pain associated with peritonitis, tachycardia, syncope, orthostatic hypotension
ruptured ectopic pg
what test is diagnostic in ectopic gestation
transvaginal u/s
hCG is what to show evidence of a developing intrauterine gestation on transvaginal ultrasound
1500
how to treat ectopic early
methotrexate (folic acid analog)
4 tests for ectopic
pelvic exam, pg test, serum progesterone, u/s
threatened abortion
cramping(often painless), bloody discharge, closed cervical os. small percentage will go into spontaneous abortion
inevitable abortion
obvious rupture of membranes and leaking of amniotic fluid in the first 12 wks.
what if a inevitable abortion occurs with cervical dilation,
it will likely progress to a miscarriage
complete abortion
complete detachment of the placenta from the uterus and expulsion of the products of conception. The os will be closed once complete
incomplete abortion
cervical os is open with some portion of the fetus and/or placenta remaining in the uterus
missed abortion
the cervical os is closed and the terminated fetus remains in the uterus.
recurrent abortion and prognosis
3 or more consecutive spontaneous abortions
-prognosis good
what abortions can be treated with bed rest, routine exam, u/s
- Rh negative
- threatened and inevitable
- give immunoglobulin
which 2 abortions have an open os
incomplete and inevitable
which 2 abortions have no POC expulsion
threatened and inevitable
which abortion has no bleeding
missed
definition of spontaneous abortion
abortion is the termination of pregnancy before 20 wks of gestation
incidence of spontaneous abortions
- when
- 50% have what
15-20%; 80% first trimester; 50% have chromosomal abnormalities
what 3 tests to confirm a viable pregnancy
serial hCG, serum progesterone, or serial ultrasounds
inappropriate development/interval growth, poorly formed or unformed fetal pole, fetal demise
non viable pregnancy
% of developing diabetes in 5 years with gestational diabetes
50%
recurrence rate of gestational diabetes
60-90%
hyperacceleration of general diabetic complications, traumatic birth, shoulder dystoccia, preeclampsia
fetal complications of gestational diabetes
when should you screen postpartum gestational diabetes pts
at 6 weeks and yearly intervals thereafter
office visits of gestational diabetes pts when necessary
2 hr postprandial blood glucose; if greater than 105 (fasting) or 120(2 hr), may require insulin
when to deliver pts with gestational diabetes
if well controlled and no signs of macrosomia: 40 wks.
if glucose is poorly controlled or if signs of macrosomia: 38 wks
tight maternal glucose control
fasting is less than 95
1 hr postprandial is less than 140
2 hr postprandial is less than 120
NST for gestational diabetes
begin at 34 wks
pre-eclampsia like sx before 20 wks, hCG over 100,000(complete), hyperemesis gravidum, abn uterine size, vag bleeding
molar pregnancy
snowstorm or grape clusters on u/s
molar pregnancy
is a complete or incomplete molar pg more common
complete
% of partial hydatidiform moles progress to malignancy
less than 5%
tx of benign and low risk metastatic tumors (hydatidiform moles)
chemo
high risk tx (hydatidiform moles)
combo of chemo w/ or w/out radiation and surgery
surgical tx of hydatidiform moles and cure rates
suction curretage and hysterectomy.
cure rates 80-100%
hydatidiform moles post tx and contraception
monitor serial hCG.
contraception recommended 6-12 months after remission
choriocarcinoma definition and treatment
malignant cancer found in the placenta following a hydatidiform mole
tx: chemo and hysterectomy
preeclampsia/eclampsia triad
HTN, edema, and proteinuria
edema no longer necessary for dx
HELLP
severe preeclampsia
Hemolysis
Elevated liver enzymes
Low Platelets
what is eclampsia
preeclampsia with seizures
most common risk factor for preeclampsia
nulliparity
extreme pg age(under 20 or over 35), multiple gestation, DM, pre-existing renal disease, chronic HTN
other risk factors for preeclampsia
cerebral hemorrhage, pulm edema, DIC, HELLP, abruption placenta
maternal complications of preeclampsia
hypoxia, low birth wt, preterm delivery, perinatal death
fetal complications of preeclampsia
HYPERreflexia, HTN, proteinuria
signs of preeclampsia
RUQ pain, edema face/hands, visual disturbances, HA, N/V, decreased urine output, sudden wt gain
symptoms of severe preeclampsia
5 labs for preeclampsia/eclampsia
sterile urine protein, 24 hr urine protein, CBC, fibrinogen, PT/PTT
chem panel for preeclampsia/eclampsia (3)
liver enzymes, creatinine, uric acid
what is pregnancy induced HTN
HTN after 20 wks with no other symptoms
BP in mild and severe preeclampsia/eclampsia
- taken 2 times at least 6 hrs apart
mild: over 140/90 but under under 160/110 - or increase of 30 systolic or 15 diastolic from prepregnancy BP
severe: over 160/180
proteinuria for mild and severe preeclampsia
mild: over 300mg/24 hr but <5 g/24 hr
severe: 5 g/24 hr
uric acid for mild and severe preeclampsia
mild is > 4.5
severe is much more then 4.5
creatinine for mild and severe preeclampsia
mild is normal
severe is elevated
liver enzymes for mild and severe preeclampsia
mild is normal
severe is elevated AST, ALT, LDH
first line med for inpt mgmt to decrease chance of seizures
MgSO4 IV drip, continue for 24 hrs after delivery
monitor what what MgSO4
urine output b/c it is cleared through kidney leading to an increased risk of mag toxicity when urine output is low
meds for acute tx of HTN
hydralazine or labetolol
what med to enhance fetal lung maturity
bethmethasone
% of gestation HTN progress to preeclampsia
25%
what meds to avoid in HTN PG
ace inh (uterine ischemia) diuretics (aggrevate low plasma volume to the point of uterine ischemia)
mag toxicity signs
loss of DTRs, respiratory paralysis, coma
common organism in pg UTI
e coli 70-90%
UTI tx pg
3-7 days nitrofurantoin, cephalexin, or augmentin
pyelo tx pg
admit to hosp. IV fluids and IV 3rd gen cephalosporin
administer in hyperemesis gravidarum
- initial
- antihistamine
- 2 nausea drugs
vitamin B6
doxylamine
dimenhydrinate or promethazine
doxylamine
antihistamine for hyperemesis gravidarum
severe hyperemesis gravidarum
prochlorperazine, reglan, zofran, promethazine
dimenhydrate IV, fluids, nutritional supplementation
dehydration in hyperemesis gravidarum
high incidence of what with multiple gestations
placenta previa
what occurs 1 out of 80 births
twins
what is 3% of births
multiple gestation
fraternal twins incidence
2/3.
blacks, moms with above wt & ht, FH, fertility drugs
increased chance of dizygotic twins
4 common complications of multiple gestation
spontaneous abortion and preterm birth
preeclampsia and anemia
HIV
- placenta
- labs
- tx
- transmission rate
- placenta: cannot cross; but can be transmitted through breast milk
- labs: ELISA
- tx: antiretroviral therapy throughout pregnancy for mom and 6 wks for the newborn
- transmission rate is 25-45%, 1-8% with proper tx
neonatal herpes
- sx
- tx
fatal! very serious!
- active herpes chancre
- acyclovir 36 wks
syphillis
- occur when
- dx
- tx
- can occur anytime during pregnancy
- u/s, blood work
- PCN. 50-100% transmission rate when untreated
1-2% transmission rate when treated
still birth, late term abortions, transplacental infection, congenital syphillis, intrauterine growth restriction
-complications of syphillis
group B strep
- % of active carriers
- active infection
- labs and when
- tx
group B strep
- % of active carriers is 30%
- active infection can be bad for mom and baby no matter vag or c section
- labs: vag cultures at 35-37 wks
- tx: PCN given during labor.
group B strep
- mom can develop what (2)
- newborn can develop what (3)
- mom: UTI, endometritis
- newborn: pneumonia, sepsis, meningitis
Group B strep tx if allergic to PCN
ampicillin, clinda, vanco
RUQ vs RLQ pain
RUQ: cholecystitis, supportive tx
RLQ: appendicitis, do surgery
what level is low platelets
100,000
which placenta abruption is more severe and common
external is more common and less severe
concealed is less common and more severe
incidence of placenta abruption and previa
abruption is 1 in 100
previa is 1 in 200
painful and dark vaginal bleeding
abruption
painless and bright red vaginal bleeding
previa
fetal distress with abruption and previa
usually abruption
uterus hypertonic
abruption
diagnostic test for abruption and previa
abruption is clinical
previa is ultrasound
also order what 3 studies for abruption and previa
CBC, coag studies, type/cross
tx for abruption
delivery. usually c section
tx for previa`
c section later. bethamethasone 28-32 weeks
DIC with what placenta disorder
abruption
risk factors for what?
abdominal trauma, HTN, alcohol/cocaine/tobacco use, preeclampsia, decreased folic acid levels
abruption
first step in diagnosis hyperemesis gravidarum
rule out molar pregnancy with u/s +/- B hCG
