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reproductive system > pregnancy complications > Flashcards

pregnancy complications Flashcards

1
Q

what percentage of ectopics occur in the ampulla of the fallopian tube

A

55%

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2
Q

common cause of the ectopic pg

A

secondary to adhesions

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3
Q

unilateral adnexal pain, amenorrhea or spotting, tenderness to the mass(mass felt 20%)

A

classic symptoms of ectopic

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4
Q

severe abdominal or shoulder pain associated with peritonitis, tachycardia, syncope, orthostatic hypotension

A

ruptured ectopic pg

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5
Q

what test is diagnostic in ectopic gestation

A

transvaginal u/s

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6
Q

hCG is what to show evidence of a developing intrauterine gestation on transvaginal ultrasound

A

1500

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7
Q

how to treat ectopic early

A

methotrexate (folic acid analog)

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8
Q

4 tests for ectopic

A

pelvic exam, pg test, serum progesterone, u/s

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9
Q

threatened abortion

A

cramping(often painless), bloody discharge, closed cervical os. small percentage will go into spontaneous abortion

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10
Q

inevitable abortion

A

obvious rupture of membranes and leaking of amniotic fluid in the first 12 wks.

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11
Q

what if a inevitable abortion occurs with cervical dilation,

A

it will likely progress to a miscarriage

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12
Q

complete abortion

A

complete detachment of the placenta from the uterus and expulsion of the products of conception. The os will be closed once complete

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13
Q

incomplete abortion

A

cervical os is open with some portion of the fetus and/or placenta remaining in the uterus

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14
Q

missed abortion

A

the cervical os is closed and the terminated fetus remains in the uterus.

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15
Q

recurrent abortion and prognosis

A

3 or more consecutive spontaneous abortions

-prognosis good

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16
Q

what abortions can be treated with bed rest, routine exam, u/s
- Rh negative

A
  • threatened and inevitable

- give immunoglobulin

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17
Q

which 2 abortions have an open os

A

incomplete and inevitable

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18
Q

which 2 abortions have no POC expulsion

A

threatened and inevitable

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19
Q

which abortion has no bleeding

A

missed

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20
Q

definition of spontaneous abortion

A

abortion is the termination of pregnancy before 20 wks of gestation

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21
Q

incidence of spontaneous abortions

  • when
  • 50% have what
A

15-20%; 80% first trimester; 50% have chromosomal abnormalities

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22
Q

what 3 tests to confirm a viable pregnancy

A

serial hCG, serum progesterone, or serial ultrasounds

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23
Q

inappropriate development/interval growth, poorly formed or unformed fetal pole, fetal demise

A

non viable pregnancy

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24
Q

% of developing diabetes in 5 years with gestational diabetes

A

50%

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25
Q

recurrence rate of gestational diabetes

A

60-90%

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26
Q

hyperacceleration of general diabetic complications, traumatic birth, shoulder dystoccia, preeclampsia

A

fetal complications of gestational diabetes

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27
Q

when should you screen postpartum gestational diabetes pts

A

at 6 weeks and yearly intervals thereafter

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28
Q

office visits of gestational diabetes pts when necessary

A

2 hr postprandial blood glucose; if greater than 105 (fasting) or 120(2 hr), may require insulin

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29
Q

when to deliver pts with gestational diabetes

A

if well controlled and no signs of macrosomia: 40 wks.

if glucose is poorly controlled or if signs of macrosomia: 38 wks

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30
Q

tight maternal glucose control

A

fasting is less than 95
1 hr postprandial is less than 140
2 hr postprandial is less than 120

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31
Q

NST for gestational diabetes

A

begin at 34 wks

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32
Q

pre-eclampsia like sx before 20 wks, hCG over 100,000(complete), hyperemesis gravidum, abn uterine size, vag bleeding

A

molar pregnancy

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33
Q

snowstorm or grape clusters on u/s

A

molar pregnancy

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34
Q

is a complete or incomplete molar pg more common

A

complete

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35
Q

% of partial hydatidiform moles progress to malignancy

A

less than 5%

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36
Q

tx of benign and low risk metastatic tumors (hydatidiform moles)

A

chemo

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37
Q

high risk tx (hydatidiform moles)

A

combo of chemo w/ or w/out radiation and surgery

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38
Q

surgical tx of hydatidiform moles and cure rates

A

suction curretage and hysterectomy.

cure rates 80-100%

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39
Q

hydatidiform moles post tx and contraception

A

monitor serial hCG.

contraception recommended 6-12 months after remission

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40
Q

choriocarcinoma definition and treatment

A

malignant cancer found in the placenta following a hydatidiform mole
tx: chemo and hysterectomy

41
Q

preeclampsia/eclampsia triad

A

HTN, edema, and proteinuria

edema no longer necessary for dx

42
Q

HELLP

A

severe preeclampsia
Hemolysis
Elevated liver enzymes
Low Platelets

43
Q

what is eclampsia

A

preeclampsia with seizures

44
Q

most common risk factor for preeclampsia

A

nulliparity

45
Q

extreme pg age(under 20 or over 35), multiple gestation, DM, pre-existing renal disease, chronic HTN

A

other risk factors for preeclampsia

46
Q

cerebral hemorrhage, pulm edema, DIC, HELLP, abruption placenta

A

maternal complications of preeclampsia

47
Q

hypoxia, low birth wt, preterm delivery, perinatal death

A

fetal complications of preeclampsia

48
Q

HYPERreflexia, HTN, proteinuria

A

signs of preeclampsia

49
Q

RUQ pain, edema face/hands, visual disturbances, HA, N/V, decreased urine output, sudden wt gain

A

symptoms of severe preeclampsia

50
Q

5 labs for preeclampsia/eclampsia

A

sterile urine protein, 24 hr urine protein, CBC, fibrinogen, PT/PTT

51
Q

chem panel for preeclampsia/eclampsia (3)

A

liver enzymes, creatinine, uric acid

52
Q

what is pregnancy induced HTN

A

HTN after 20 wks with no other symptoms

53
Q

BP in mild and severe preeclampsia/eclampsia

A
  • 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
54
Q

proteinuria for mild and severe preeclampsia

A

mild: over 300mg/24 hr but <5 g/24 hr
severe: 5 g/24 hr

55
Q

uric acid for mild and severe preeclampsia

A

mild is > 4.5

severe is much more then 4.5

56
Q

creatinine for mild and severe preeclampsia

A

mild is normal

severe is elevated

57
Q

liver enzymes for mild and severe preeclampsia

A

mild is normal

severe is elevated AST, ALT, LDH

58
Q

first line med for inpt mgmt to decrease chance of seizures

A

MgSO4 IV drip, continue for 24 hrs after delivery

59
Q

monitor what what MgSO4

A

urine output b/c it is cleared through kidney leading to an increased risk of mag toxicity when urine output is low

60
Q

meds for acute tx of HTN

A

hydralazine or labetolol

61
Q

what med to enhance fetal lung maturity

A

bethmethasone

62
Q

% of gestation HTN progress to preeclampsia

A

25%

63
Q

what meds to avoid in HTN PG

A 
ace inh (uterine ischemia)
diuretics (aggrevate low plasma volume to the point of uterine ischemia)
64
Q

mag toxicity signs

A

loss of DTRs, respiratory paralysis, coma

65
Q

common organism in pg UTI

A

e coli 70-90%

66
Q

UTI tx pg

A

3-7 days nitrofurantoin, cephalexin, or augmentin

67
Q

pyelo tx pg

A

admit to hosp. IV fluids and IV 3rd gen cephalosporin

68
Q

administer in hyperemesis gravidarum

  • initial
  • antihistamine
  • 2 nausea drugs
A

vitamin B6
doxylamine
dimenhydrinate or promethazine

69
Q

doxylamine

A

antihistamine for hyperemesis gravidarum

70
Q

severe hyperemesis gravidarum

A

prochlorperazine, reglan, zofran, promethazine

71
Q

dimenhydrate IV, fluids, nutritional supplementation

A

dehydration in hyperemesis gravidarum

72
Q

high incidence of what with multiple gestations

A

placenta previa

73
Q

what occurs 1 out of 80 births

A

twins

74
Q

what is 3% of births

A

multiple gestation

75
Q

fraternal twins incidence

A

2/3.

76
Q

blacks, moms with above wt & ht, FH, fertility drugs

A

increased chance of dizygotic twins

77
Q

4 common complications of multiple gestation

A

spontaneous abortion and preterm birth

preeclampsia and anemia

78
Q

HIV

  • placenta
  • labs
  • tx
  • transmission rate
A
  • 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
79
Q

neonatal herpes

  • sx
  • tx
A

fatal! very serious!

  • active herpes chancre
  • acyclovir 36 wks
80
Q

syphillis

  • occur when
  • dx
  • tx
A
  • can occur anytime during pregnancy
  • u/s, blood work
  • PCN. 50-100% transmission rate when untreated
    1-2% transmission rate when treated
81
Q

still birth, late term abortions, transplacental infection, congenital syphillis, intrauterine growth restriction

A

-complications of syphillis

82
Q

group B strep

  • % of active carriers
  • active infection
  • labs and when
  • tx
A

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.
83
Q

group B strep

  • mom can develop what (2)
  • newborn can develop what (3)
A
  • mom: UTI, endometritis

- newborn: pneumonia, sepsis, meningitis

84
Q

Group B strep tx if allergic to PCN

A

ampicillin, clinda, vanco

85
Q

RUQ vs RLQ pain

A

RUQ: cholecystitis, supportive tx
RLQ: appendicitis, do surgery

86
Q

what level is low platelets

A

100,000

87
Q

which placenta abruption is more severe and common

A

external is more common and less severe

concealed is less common and more severe

88
Q

incidence of placenta abruption and previa

A

abruption is 1 in 100

previa is 1 in 200

89
Q

painful and dark vaginal bleeding

A

abruption

90
Q

painless and bright red vaginal bleeding

A

previa

91
Q

fetal distress with abruption and previa

A

usually abruption

92
Q

uterus hypertonic

A

abruption

93
Q

diagnostic test for abruption and previa

A

abruption is clinical

previa is ultrasound

94
Q

also order what 3 studies for abruption and previa

A

CBC, coag studies, type/cross

95
Q

tx for abruption

A

delivery. usually c section

96
Q

tx for previa`

A

c section later. bethamethasone 28-32 weeks

97
Q

DIC with what placenta disorder

A

abruption

98
Q

risk factors for what?

abdominal trauma, HTN, alcohol/cocaine/tobacco use, preeclampsia, decreased folic acid levels

A

abruption

99
Q

first step in diagnosis hyperemesis gravidarum

A

rule out molar pregnancy with u/s +/- B hCG

reproductive system (11 decks)

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