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Women's Health EOR > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

If performing abortion in 1st trimester what can be given PO to complete abortion? (2)

  • what is time frame for medical abortion w/pill?
  • what lab value required to do this method
  • dosing (days) for each?

What ABX ppx given or this type of abortion/length?

A
  1. 1st T Ab –> Mifepristone (Mifeprex) + Misoprostol (Cytotec)
  • can be done up 9 wks gestation
  • must have Hgb of > 10

day 1 = mifepristone (200-600 mg)
day 2-3 = misoprostol (400-800 mcg)

Ppx = doxycycline for 7 days

note: at PG they give 2 doses of Cytotec

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2
Q

1st T Medical Ab

  1. What type of drug is Mifepristone/what does it cause?
  2. What about Misoprostol?
A

1st T Ab

  1. Mifepristone
    - progesterone antag –> decr endometrial growth, cant maintain preg

Misoprostol (Cytotec)
- PGE1 analog –> causes uterine contractions–> expel fetus

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3
Q

1st T Medical Ab:

2 main S/Es a/w Medical Ab in 1st T

A

1st T Ab: 2 main S/Es

  1. abd pain/cramping
  2. bleeding
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4
Q

1st T Medical Ab w/injection

What is given for medical abortion injection occurring in 1st trimester? (2) - rarely used but more commonly used for _____ preg

A

1st T Ab w/injection

IM Methotrexate + Misoprostol (cytotect)

  • rarely used but for Ab more commonly used for ectopic preg
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5
Q

1st T Ab f/u: Medical

1+2. What are 2 options that can confirm the medical Ab is complete 2 wks later

  1. What is also given to Rh- mothers
A

1st T Ab f/u: 2 things confirm medical Ab is complete 2 wks later

  1. US
  2. bhCG level
  3. give Rh- moms Rhogam
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6
Q

1st T Ab: Surgical

  1. 2 options
  2. What is given to cause cervical dilation? when?
    Next step?
A

1st T Ab: Surgical

  1. 2 options
    - D+C
    - MVA (Manual Vacuum Aspiration)
  2. For D+C –> misoprostol to cause cervical dilation at 13+ wks –> suction aspiration
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7
Q

2nd T Ab: Surgical

Two types of surgical abortion performed in the 2nd trimester?

Which one can be performed later in preg? when?

Which has higher complication rate (so rarely done unless mom at risk)?

What do they both require prior the surgery? What is it made of?

A
  1. D & E (dilation & evacuation)
  2. D & X (dilation & extraction)
    - done later –> 21+ wks
    - higher complication rate (rarely done)

BOTH: require input of laminaria into vagina–> dilate cervix
- sterile, compressed seaweed

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8
Q

6 complications of ALL surgical abortions

A
  1. Incomplete abortion
  2. Uterine perforation
  3. Cervical trauma/insuffic
  4. Infection (endometritis)
  5. Hemorrhage/Bleeding
  6. Adhesions (Asherman’s Syn)

Note: adhesions only affect ability to stay preg

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9
Q

Other Option for 2nd T Ab

uses cervical ripening agents, aminotomy, high dose IV oxytocin (pitocin)

S/Es = retained placenta, uterine rupture, hemorrhage, infxn

Cons: longer process (days)

Pros: may have intact fetus –> postmortem eval

A

Other Option for 2nd T Ab = IOL

uses cervical ripening agents, aminotomy, high dose IV oxytocin (pitocin)

S/Es = retained placenta, uterine rupture, hemorrhage, infxn

Cons: longer process (days)

Pros: may have intact fetus –> postmortem eval

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10
Q

What is the definition of SAB (spontaneous abortion)/ Miscarriage

  • what is it often d/t
A

loss of preg < 20 wks gestation

often d/t chrom abnormalities

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11
Q

4 major RFs for SAB?

A
  1. AMA
  2. previous SAB
  3. Smoking
  4. Meds/Substances
    - EtOH, cocaine, NSAIDs

NSAIDs = PG inhib

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12
Q

Complete abortion:

  • how does cervical os look?
  • POC expelled?
  • what seen on sono?
  • Tx?
A

Complete abortion:

  • cervical os = CLOSED
  • POC EXPELLED
  • Sono –> empty uterus
  • Tx = follow bhCG levels
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13
Q

INcomplete abortion:

  • definition
  • how does cervical os look?
  • POC expelled?
  • what seen on sono?
  • Tx?
A

INcomplete abortion:

  • incomplete = misscarriage in process
  • cervical os = OPEN/DILATED
  • Some POC retained/visible
  • Sono –> no IUP, debris in uterine cavity
  • Tx = intervention to complete the abortion
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14
Q

Missed abortion:

  • definition/bhCG levels
  • how does cervical os look?
  • POC expelled?
  • what seen on sono?
  • Tx?

only difference seen w/blighted ovum on sono?

A

missed abortion

  • NON-VIABLE preg (bhCG decreasing), hasnt been expelled yet
  • Cervical os = closed
  • No POC expelled
  • sono–> no cardiac activity
    Tx: give something to expel POC

blight ovum
- large GS + yolk sac but NO EMBRYO

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15
Q

What is the only type of abortion that may be viable/continue

A

Threatened abortion

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16
Q

Threatened abortion

  • cervical os?
  • what is seen on sono that is different from all other abortions
  • sxs?
  • tx?
A

Threatened abortion

  • cervical os = closed (preg still may be viable)
  • Sono - VIABLE IUP (heartbeat)
  • Sx = spotting
  • Tx = expectantly manage
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17
Q

Inevitable Ab

  • how does cervical os look?
  • POC expelled?
  • what seen on sono but why cant preg continue?
  • Tx?
A

Inevitable Ab

  • os = open
  • POC not expelled
  • sono = viable IUP but preg
    cant continue b/c os is open
  • Tx = expectantly or surgical procedure to expel fetus
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18
Q

23 y/o F underwent D+C 3 days ago. C/o continued vaginal bleeding, lower abd cramping, and recently noted fever/chills x1 day. PE - temp = 102, BP = 90/48, HR = 120. Abd/Pelvic exam reveals open os, uterine tenderness and CMT. Labs show elevated WBCs.

Dx?
Tx - what 2 ABXs best and what procedure should be done 4 hrs after ABX start

A

Dx = Septic Abortion

Tx = Broad spectrum ABX w/ Gentamicin + Clindamycin
- after 4 hrs –> D+C to remove POC

note: also give IVF for HoTN

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19
Q

Septic Abortion

  1. what type of infxn
  2. what type of vaginal d/c is it a/w it
  3. What is tx if refractory to ABX and D+C
A

Septic Abortion

  1. ascending infxn
  2. foul smelling, purulent vaginal d/c
  3. refractory to ABX and D+C = Hysterectomy
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20
Q

Confirming preg w/lab tests:

  1. Which type of pregnancy test is qualitative?
  2. Which type of pregnancy test is quantitative?
    - what levels are definitive (+)?
    - how do the levels change in a norm preg

Other method than lab testing to confirm preg?

A

Confirming preg w/lab tests:

  1. urine pregnancy test (UPT) = qualitative
  2. B-hCG = quantitative (blood test)
    - > 25 = definitive confirmation of preg
    - double every 2-3 days in norm preg

Other method to conifrm preg = TVUS

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21
Q

TVUS & preg confirmation:

  1. What should be present at 4-5 wks?
  2. at 5 wks
  3. at 6 wks
  4. at 6.5 wks
  5. At what level of b-hCG is normal IUP visualized?
  6. will bhCG double q48hrs w/ectopic
A

TVUS & preg confirmation:

  1. 4-5 wks –> gestational sac
  2. 5 wks –> yolk sac
  3. 6 wk –> fetal pole
  4. 6.5 wks –> FHM (fetal heart motion)
  5. norm IUP visualized at b-hCG > 1500-2000
  6. No, bhCG wont double q48 hrs w/ectopic preg
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22
Q

MC site of ectopic pregnancy

A

Ampulla

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23
Q

Pt pts w/ unilateral pelvic/abd pain, amenorrhea, and vaginal bleeding. Pt has h/o endometriosis, PID and smoking. She currently uses IUD for contraception. On PE pt has an adenexal mass and CMT w/mild uterine enlargement. bhCG level is 2500 but no intrauterine gestational sac seen on US.

Dx?
Tx?

A

Dx = Ectopic Pregnancy

Tx = MTX

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24
Q

Main Sx a/w Atypical presentation of Ectopic preg?
What does this cause?

Type of Ecotopic?

A

Atypical presentation = shoulder pain –> fluid irritating diaphargm –> peritonitis

Ruptured Ectopic

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25
Q

Pt comes in to ED and you find out she has an ectopic pregnancy. She is cool, tachycardic, HoTNsive, and has severe abd pain, N/V and is dizzy. On PE you find free fluid in her pelvis.

What type of ecotopic pregancy is this?

A

Ruptured Ecotopic Pregnancy

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26
Q

How to distinguish ectopic preg from miscarriage?

A

heavy bleeding (miscarriage) –> declining b hCG

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27
Q

Medical Tx of Ecotopic pregnancy w/MTX:

  • what days do you check b hCG levels
  • how often do you follow them til?
  • what do you do if this method fails (2 options)
A

Medical Tx of Ecotopic pregnancy w/MTX:

  • check b hCG levels on Day 1, 4, 7
  • follow b hCG til < 5
  • MTX fails –> 2nd dose MTX or surgery
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28
Q

Surgical Tx of Ectopic Preg

2 surgical options (Laparoscopic)

How are they different?

Which is 1st line Tx?

which is not good for pts who want to get preg later on?

which type must you follow bhCG levels < 5

A

Laparoscopic

  1. Salpingectomy = 1st line
    - remove fallopian tube
    - not good if want to get preg later on
  2. Salpingostomy
    - just remove pregnancy –> must follow bhCG
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29
Q

If you cant definitively determine if ectopic or rule it out then what 2 things should be repeated/when?

A
  1. Repeat b hCG in 48hrs

2. Repeat TVUS - once b hCG above discriminatory zone

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30
Q

Inability to maintain pregnancy d/t premature dilation

MC in what trimester

A

Incompentent Cervix/ Cervical Insuffic

Inability to maintain pregnancy d/t premature dilation

MC in 2nd Trimester

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31
Q

biggest RF for Incompentent Cervix/ Cervical Insuffic

A

biggest RF for Incompentent Cervix/ Cervical Insuffic

h/o cervical trauma/surgery
cone bx, cervical lac

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32
Q

G2P1 Pt who is 20 wks gestation presents c/o vaginal bleeding and d/c but no pain. on PE you notice dilated cervix that is somewhat effaced. Pt had h/o cervical lac w/ prior delivery and had cone Bx done to r/o cervical CA.

Dx?
Tx?

A

Dx = Incompentent Cervix/ Cervical Insuffic

Tx = Cerclage

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33
Q

What is GTD (Gestational Trophoblastic Dz)

What is the MC type? (usu benign or malig)

A

abn proliferation of placental/ trophoblastic tissues (fetal tissue)

MC type = molar preg (usu benign)

34
Q

How does GTN differ from GTD

main example?

A

GTN = malignant neoplasm arising from GTD

main example = choriocarcinoma

35
Q

37 y/o Asian preg pt presents w/painless vaginal bleeding, severe N/V. She has a h/o infertility and OCP use. Her labs reveal she is hyperthyroid. Her uterine size > dates, bhCG = 105,000 and on US there is a snowstorm appearance but no fetal parts present. Karyotype is 46 XX

Dx?
Tx?

A

Dx = Complete Molar Pregnancy

Tx = D+C

36
Q

15 y/o Asian preg pt presents w/painless vaginal bleeding.She is nulliparous and smokes. PE is normal. on US uterine size < dates and IUGR present, and fetal parts present. bhCG levels normal and Karyotype is 69 XXY.

Dx?
Tx?

A

Dx = Partial Molar Pregnancy

Tx = D+C

37
Q

What gives definitive Dx of GTD/molar pregnancy?

A

Definitive Dx of GTD

pathology of placenta after D+C

38
Q

GTD: Complete vs Partial Mole

  1. a/w norm egg fertilized by 2 sperm
  2. a/w Absent fetal tissue
  3. a/w all paternal chrom
  4. Uterine size small for dates
  5. extremely high bhCG level
  6. Theca lutein cysts common
  7. Chorionic villi: hydrophic/ swollen and US show snowstorm/cluster of grapes
  8. higher malig potential
A

GTD: Complete vs Partial Mole

  1. a/w norm egg fertilized by 2 sperm = Partial
  2. a/w Absent fetal tissue = Complete
  3. a/w all paternal chrom = Complete
  4. Uterine size small for dates = Partial
  5. extremely high bhCG level = Complete
  6. Theca lutein cysts common
  7. Chorionic villi: hydrophic/ swollen and US show snowstorm/cluster of grapes = Complete
  8. higher malig potential = Complete
39
Q

Complete Molar Pregnancy

high hCG levels –> mole can can act as homolog to:

  1. FSH + LH –>
  2. TSH –>
  3. high levels –> 2 conditions
A

Complete Molar Pregnancy

high hCG levels –> mole can can act as homolog to:

  1. FSH + LH –> theca lutein cysts
  2. TSH –> hyperthyroid
  3. high levels –> hyperemesis gravidarum, preeclampsia
40
Q

Complete Molar preg

  1. pts has signs of preeclampsia what med is given
  2. pt has signs of hyperthroid what med given to prev thyroid storm
A

Complete Molar preg

  1. pts has signs of preeclampsia what med is given
  2. pt has signs of hyperthroid what med given to prev thyroid storm
41
Q

Tx of GTN/Choriangiocarcinoma

  1. Main form of Tx
  2. low risk/non-metastatic –>
  3. high risk/metastatic –>
  4. other surgical option (not common)
A

Tx of GTN/Choriangiocarcinoma

  1. Main form of Tx = CHEMO
  2. low risk/non-metastatic –> single agent chemo (MTX)
  3. high risk/metastatic –> multi-agent chemo
  4. other surgical option (not common) = hysterectomy
42
Q

F/u for GTD

  1. what must be done serially (look for progression to GTN)
  2. what must pts be on after D+C
A

F/u for GTD

  1. Do serial bhCG levels (look for progression to GTN)
  2. After D+C –> contraception
43
Q

Screening for GDM

  1. normal time to screen (no RFs)
  2. if pt has RFs for GDM when are they screened
  3. What is the screening test
  4. What is the confirmation test (done if screening test +)

which is fasting, which is non fasting

A

Screening for GDM

  1. normal time to screen = 24-28 wks
  2. RFs for GDM –> screened at 1st prenatal visit
  3. screening = 1 hr, 50g Oral glucose challenge Test (GCT)
    - NON-fasting
  4. Confirmatory test = 3hr, 100g Oral Glucose Tolerance Test (GTT)
    - fasting
44
Q

GDM Management:

  1. What type of GDM needs medication as Tx?
    - what med is preferred?
  2. What can the other type be controlled with?
A

GDM Management:

  1. A2 GDM - needs Medication
    - insulin preferred
  2. A1 GDM - controlled w/diet
45
Q

Pathophysiology of GDM

Placental rel of what hormone antagonizes insulin –> insulin resis during preg

A

Pathophysiology of GDM

Placental rel of HPL (human placental lactogen) antagonizes insulin –> insulin resis during preg

46
Q

Pt has poorly controlled GDM and macrosomia. What range should the baby be delivered

A

poorly controlled GDM and macrosomia –> deliver 37-39 wks

47
Q

Growth scan at 34-37 wks shows EFW > 4500g what procedure is indicated?
- what is there a risk of

A

Growth scan at 34-37 wks shows EFW > 4500g

  • C section indicated b/c risk of shoulder dystocia
48
Q

Why are women w/GDM screened again postpartum (75g OGTT) and yearly afterwards

A

women w/GDM screened again postpartum (75g OGTT) and yearly afterwards b/c high risk of developing DM

49
Q

5 Types of Hypertensive D/o in Pregnancy

A

5 Types of Hypertensive D/o in Pregnancy

  1. Chronic HTN
  2. Gestational HTN/PIH
  3. Preeclampsia
  4. Preeclampsia w/severe features
  5. Eclampsia
50
Q

How does chronic HTN differ from all other types of Hypertensive D/o in Pregnancy

A

Chronic HTN occurs BEFORE 20 wks

all the others occur AFTER 20 wks

51
Q

Pt presents for routine prenatal visit at 24 wks w/ elevated BP 150/95 x2. 24 hr urine protein = 200 mg.

Dx?
Tx (gen)

A

Dx = Gestational HTN/PIH
- GA > 20 wks w/incr BP but preeclampsia ruled out w/ 24 hr urine protein

Tx = expectantly manage/monitor closely

52
Q

Pathophysiology of Preeclampsia

What is responsible for uteroplacental insuffic in preeclampsia (2 steps)

A

Pathophysiology of Preeclampsia

vasoconstriction –> decr blood flow to placenta –> uteroplacental insuffic

53
Q

Epidemiology of Preeclampsia

  1. when is it MC
  2. how long after deliv are concerned about it
A

Epidemiology of Preeclampsia

  1. MC in 3rd T
  2. also occurs postpartum (6 wks)
54
Q

G1P0 35 y/o F pregnant w/twins w/ h/o GDM and CKD presents for routine prenatal visits at 24 wks w/ incr BP of 150/95 x2. 24 hr urine protein = 350 mg.

Dx?

A

Dx = Preeclampsia

55
Q

What 2 Hypertensive D/o in Pregnancy arent a/w proteinuria

A

Hypertensive D/o in Pregnancy not a/w proteinuria

  1. Gestational HTN
  2. Chronic HTN
56
Q

Hemolysis (incr LDH)
Elevated Liver enzymes
Low Platelets

are a/w what type of preeclampsia and what is the name of this syndrome

A

Hemolysis (incr LDH)
Elevated Liver enzymes (AST/ALT)
Low Platelets

a/w Pre-eclampsia w/SEVERE Features

called HELLP Syndrome

57
Q

How does the presentation of Eclampsia differ from Pre-eclampsia w/SEVERE Features?

Tx?

A

Eclampsia has same Sxs as Pre w/SEVERE Features + SEIZURES –> life threat

Tx= delivery ASAP

58
Q

Tx of Hypertensive D/o in Pregnancy

  1. Do any pts make it 40 wks
  2. Med given for seizure ppx
  3. med given to enhance FLM
  4. What BP meds safe in preg to prev eclampsia
A

Tx of Hypertensive D/o in Pregnancy

  1. NO pt make it 40 wks (risk of still birth)
  2. seizure ppx –> MgSO4
  3. enhance FLM–> BMZ
  4. BP meds safe in preg to prev eclampsia
    - Labetalol
    - Methyldopa
    - Nifedipine (Procardia)
    - Hydralazine
    (LMN for HTN)
59
Q

When to deliver pts w/ Hypertensive D/o

  1. Eclampsia –>
  2. Preeclampsia w/severe features –> ___ wks
  3. Preeclampsia–> ___ wks
  4. GHTN/PIH –> ___ wks
  5. Chronic HTN –> ___ wks
A

When to deliver pts w/ Hypertensive D/o

  1. Eclampsia –> IMMED after stabilized
  2. Preeclampsia w/severe features –> 34 wks
  3. Preeclampsia–> 37 wks
  4. GHTN/PIH –> 37-39 wks
  5. Chronic HTN –> 39 wks
60
Q

When to deliver pts w/ Hypertensive D/o

  1. Eclampsia –>
  2. Preeclampsia w/severe features –> ___ wks
  3. Preeclampsia–> ___ wks
  4. GHTN/PIH –> ___ wks
  5. Chronic HTN –> ___ wks
A

When to deliver pts w/ Hypertensive D/o

  1. Eclampsia –> IMMED after stabilized
  2. Preeclampsia w/severe features –> 34 wks
  3. Preeclampsia–> 37 wks
  4. GHTN/PIH –> 37-39 wks
  5. Chronic HTN –> 39 wks
61
Q

Rh Incompatibility in Preg

  1. Rh D –> IgM or IgG, can it cross the placenta
A

Rh Incompatibility in Preg

  1. Rh D
    - IgG –> CAN cross the placenta –>
62
Q

Rh Incompatibility

If a woman is Rh __ and her baby is Rh ___ then the mother may become sensitized to Rh antigen and develop IgG antibodies, which can cross the ______ and cause _____ of fetal RBCs

A

Rh Incompatibility

If a woman is Rh (-) and her baby is Rh (+) –> mother may become sensitized to Rh antigen and develop IgG antibodies, which can cross the placenta and cause hemolysis of fetal RBCs

63
Q

3 Fetal Consequences of Rh Incompatibility

A

3 Fetal Consequences of Rh Incompatibility.. baby has:

  1. Hemolytic Anemia
  2. Hydrops Fetalis/ Erythroblastosis Fetalis
  3. Fetal death
64
Q
  1. CVS or Aminocentesis
  2. Miscarriage
  3. Antepartum hemorrhage
  4. Abd trauma
  5. ECV (ext cephalic version)
  6. Delivery
  7. Placenta previa/abruption

Examples of

A
  1. CVS or Aminocentesis
  2. Miscarriage
  3. Antepartum hemorrhage
  4. Abd trauma
  5. ECV (ext cephalic version)
  6. Delivery
  7. Placenta previa/abruption

Examples of sensitizing events that could cause maternal + fetal blood mixing

65
Q

Dx of Rh Incompatibility

  1. what test looks to see if mom is making Abs to the fetal RBCs
  2. what test determines if maternal Abs are attaching/attacking fetal RBCs
  3. What Ab titer levels are concerning for fetal hydrops
A

Dx of Rh Incompatibility

  1. Indirect Coombs Test –> see if mom is making Abs to the fetal RBCs
  2. Direct Coombs test –> determines if maternal Abs are attaching/attacking fetal RBCs
  3. Ab titer levels 1:16 or greater = concerning for fetal hydrops
66
Q

If Rh- mother has Rh+ fetus and maternal and fetal blood mix what pregnancy is at risk

A

If Rh- mother has Rh+ fetus and maternal and fetal blood mix –> all subsequent pregnancies are at risk

67
Q

If Ab titer 1:16 or greater (1:4) how do you monitor the baby for anemia

A

If Ab titer 1:16 or greater (1:4) monitor for anemia in fetus by Fetal MCA doppler

(faster flow = thinner blood/anemia)

68
Q

Rh Incompatibility

Fetal MCA Doppler shows increased flow (> 1.5 MoM) –> what does that mean

A

Rh Incompatibility

Fetal MCA Doppler shows increased flow (> 1.5 MoM) –>
faster flow = thinner blood –> anemia

69
Q

What is indicated if MCA doppler flow is increased

what is also considered

A

MCA doppler flow is increased –> PUBS (Periumbilical Blood Sampling)

also consider Intrauterine transfusion

70
Q

What test is used to determine the Rh type of the fetus

A

Cell free DNA –> determines the Rh type of the fetus

71
Q

Rh Incompatibility + Rhogam

  1. What test determines the dose of Rhogam
  2. When is rhogam given (3 times)
A

Rh Incompatibility + Rhogam

  1. KB (Kleihauer-Betke) test determines the dose of Rhogam
    - give 300 mcg for every 15-30 mL blood mixed
  2. Rhogam given
    - at 28 wks
    - w/in 72 hrs of deliv (if fetus Rh+)
    - after any sensitizing event
72
Q

abn implantation of the placenta over the internal cervical os

A

Placenta Previa =

abn implantation of the placenta over the internal cervical os

73
Q

Abn placental invasion into the uterine wall

A

Placenta accreta = abn placental invasion into the uterine wall

74
Q

3 types of placenta accreta

  1. which is superficial invasion into myometrium
  2. which a/w placenta invading the myometrium
  3. which goes thru myometrium –> uterine serosa
A

3 types of placenta accreta

  1. accreta = superficial invasion into myometrium
  2. increta = placenta invades the myometrium
  3. percreta = goes thru myometrium –> uterine serosa
75
Q

2 major RFs for placenta accreta

A

RFs for placenta accreta

  1. H/o placenta previa
  2. incr risk w/ incr # of C sections
76
Q

Types of placenta previa

  1. name of type when edge of placenta reaches margin of the os
  2. name of type when placenta implants in lower uterine segment, close to os but not covering it
A

Types of placenta previa

  1. edge of placenta reaches margin of the os –> Marginal previa
  2. placenta implants in lower uterine segment, close to os but not covering it –> low lying previa
77
Q

36 y/o pt who is G5P4 at 32 wks presents to clinic c/o acute onset of painless vaginal bleeding. She had post coital spotting after having sex few wks ago. Pt has h/o myomectomy, multiple gestations and smoking. You obtain an transabdominal US w/ empty bladder that confirms your suspicion.

Dx?
should pt be admitted/what should be done (2 things)

A

Dx = placenta previa

YES admit any pt w/previa –> continuous fetal monitoring + obtain IV access

78
Q

Tx of Placenta Previa

  1. what meds given if < 34 wks for FLM and to prolong preg/avoid PTL
  2. What test done for Rh - pts
  3. How/when is earliest pts delivered

Prep for hemorrhage + PTB –> get blood type and cross matched ready

A

Tx of Placenta Previa

  1. If < 34 wks –> BMZ for FLM + Tocolytics to prolong preg/avoid PTL
  2. KB test done for Rh - pts
  3. Pt delivered by C/S and earliest at 34 wks

Prep for hemorrhage + PTB –> get blood type and cross matched ready

79
Q

Why should pts w/ placenta previa NOT undergo vaginal delivery

A

No vag delivery for pts w/previa b/c lower uterine seg has decr conractility –> risk of PPH

80
Q

35 y/o G5P4 at 39 wks had vag deliv. H/o myomectomy and 1 prior LTCS. Placenta doesnt deliver after 30 min –> attempt to manually extract it, but placenta noted to be firmly adherent to uterus.

Dx?
Next step in management?

A

Dx = Placenta

Tx = Hysterectomy
- trying to remove it manually –> hemorrhage

81
Q

Premature separation of the placenta from the uterine wall

A

placental abruption = Premature separation of the placenta from the uterine wall

82
Q

22 y/o G2P1 at 35 wks with PMH of cocaine use, HTN c/o of abd pain and vaginal bleeding. No leakage of fluid or h/o trauma. US norm. Fundus is tender and moderate amt of blood in vaginal vault. Cervix 1 cm dilated. FHR 160-170. BP 150/90

Dx?
Tx?

A

Dx = placental abruption

Tx = Deliver (anytime > 34 wks)

Women's Health EOR (7 decks)

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