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Women's Health Rotation > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

When do the majority of spontaneous abortions occur?

Why do they occur?

A

80% occur in the first 12 wks

Most likely d/t chromosomal abnormalities

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2
Q

Threatened abortion

A

Pt of <20 wks’ gestation who presents with vaginal bleeding and no cervical dilation or effacement

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3
Q

What does an Rh neg mom need with a threatened abortion?

A

RhoGAM

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4
Q

What is the prognosis of a threatened abortion if cardiac motion is found on u/s?

A

95% will carry to term

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5
Q

What must be the primary differential for threatened abortion?

A

Ectopic

Get serum quantitative hCG and transvaginal u/s

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6
Q

Inevitable abortion

A

Pts with an open cervical os found on pelvic exam but without a hx or evidence of passage of tissue

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7
Q

Prognosis and presentation of inevitable abortion

A

All pts spontaneously miscarry
Cramping caused by uterine contraction is common and is usually preceded by bleeding
May need D&C to complete the process and RhoGAM if Rh neg

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8
Q

Complete abortion

A

Complete miscarriage characterized by resolution of sx and the total expulsion of products of conception (POC)

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9
Q

Presentation of complete abortion

A

On pelvic exam, the cervical os is closed and u/s demonstrates an empty uterus

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10
Q

Plan of care of complete abortion

A

OB/GYN f/u and counseling, along with RhoGAM if indicated

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11
Q

Incomplete abortion

A

Dx-ed when only part of the POC has passed through the cervical os

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12
Q

Presentation and tx of incomplete abortion

A

Pts have a closed cervical os and u/s reveals fetal or placental tissue remaining in the uterus
Needs a D&C within 1-3 days to limit risk of sepsis and RhoGAM if Rh neg

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13
Q

Septic abortion

A

Refers to an intrauterine infection

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14
Q

Causes of septic abortion

A

Can occur in elective terminations performed with poor asceptic techniques or inadequate evacuation of the uterus
Can occur in pts using an IUD for contraception, in HIV, and in women who are diabetic

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15
Q

What can be a misdiagnosis of septic abortion?

A

PID when pregnancy status is not checked

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16
Q

Plan for septic abortion

A 
CBC
BCx
Cervical cultures
Gram stains
Triple abx coverage ex: ampicillin, gentamicin, and metronidazole
OB consult for urgent D&amp;C
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17
Q

Missed abortion

A

Occurs when fetus or embryo dies in utero and is not diagnosed
Can happen in women who are using some form of birth control (inconsistently) and don’t realize they are pregnant
Needs OB consult for D&C

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18
Q

RFs for spontaneous abortion

A 
Increased maternal age
Smoking
Hx of 3 or more miscarriages
No previous live birth
Environmental toxins
Infections
Drug and/or alcohol use
Maternal diseases
Genital tract abnormalities (large fibroids, bicornuate uterus, cervical dysfunction after procedures)
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19
Q

What hx is needed to evaluate for spontaneous abortion?

A 
LMP
Gestational hx
Amount of time bleeding has occurred
Number of pads used
Passage of any tissue
Presence/absence of cramping
Last sexual intercourse
Drug/EtOH use
General med/surgical hx
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20
Q

PE of spontaneous abortion

A

Speculum exam to visualize os

Any adnexal tenderness or masses

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21
Q

Work up for spontaneous abortion

A

TVUS to assess for presence or absence of POC within the uterus, eval of adnexa and presence or absence of fluid in the cul-de-sac
Serum progesterone level
Serum serial quantitative hCG level

22
Q

Up to what time can a termination of pregnancy be medication-induced?

23
Q

Medications that can be used in the termination of a pregnancy

A

Methotrexate
Prostaglandins
Mifepristone
Statistically less likely to complete the process as compared to surgical termination

24
Q

Procedure of surgical termination

A

Vacuum
D&C
D&E

25
Complications of termination of pregnancy
``` Infection Uterine perforation Hemorrhage Uterine scarring (Asherman's syndrome) Retained products of conception with hemorrhage Cervical lacerations ```
26
Recurrent abortion
Three successive spontaneous abortions
27
Uterine causes of recurrent abortion
Septum Leiomyoma Incompetent cervic
28
Genetic causes of recurrent abortion
Chromosomal abnormalities with one or both partners resulting in non-viable embryos
29
Rheumatic causes of recurrent abortion | Endocrine causes of recurrent abortion
Lupus | Thyroid, under-treated DM, PCOS, luteal phase defect
30
Hematologic causes of recurrent abortion | Other causes of recurrent abortion
Thrombophilias, esp factor V Leiden Antiphospholipid syndrome Maternal infections, esp TORCH infections
31
Incompetent cervix
Cervical length of <2 cm and/or internal cervical os open 1 cm or greater is diagnostic Causes around 25% of second trimester losses Many times present with CC of painless increase in vaginal d/c On spec exam open os may be visible Funneling of the cervix may be noted on u/s
32
Risks of incompetent cervix
``` Congenital uterine or cervical anomaly Previous obstetric trauma Previous mechanical dilation -D&C -TOP -Hysteroscopy Treatments for CIN ```
33
Tx of incompetent cervix
Cerclage | Better outcomes if done before membranes are visible
34
When is an ectopic pregnancy more common?
When there is scarring of the internal genital tract such as with multiple D&Cs, STIs, PID, ahesions, endometriosis Infertility pts PREVIOUS ectopic is a HUGE risk factor
35
Which type of ectopic pregnancy is a leading cause of maternal deaths in the 1st trimester?
Tubal pregnancy
36
PE of ectopic pregnancy
On TVUS, you may see an empty uterus or there may be an empty gestational sac within the uterus You may or may not be able to appreciate a mass in the tube
37
Dx of ectopic pregnancy
TVUS followed by quantitative beta-hCG testing
38
Heterotopic pregnancy
Where there is an IUP and ectopic at the same time
39
DDx of ectopic pregnancy
``` Acute appendicitis Miscarriage Ovarian torsion PID Ruptured corpus luteum cyst or follicle Tubo-ovarian abscess Urinary calculi ```
40
Tx of ectopic pregnancy
Surgical removal of pregnancy and tube | Methotrexate (PO or IM-IM more effective)
41
Details about using methotrexate for ectopic pregnancy
Only works if the tube hasn't started to rupture The higher the baseline hCG level is, the less likely methotrexate is to work Must be done in conjunction with serial beta subunit hCG to verify pregnancy is ending-check q2-3 days NOT an option if heterotopic and parents want the IUP
42
Other therapeutic agents for an ectopic pregnancy
Hyperosmolar glucose Prostaglandins Mifepristone
43
Who is a good candidate for expectant management of ectopic pregnancy
Has a beta-hCG level <1,000 mIU per mL and declining Ectopic mass <3 cm No fetal heartbeat AND Has agreed to comply with f/u requirements
44
Isoimmunization
Affects babies of Rh neg mothers Only occurs if the baby is Rh pos Fetal cells enter maternal circulation and antibodies to those cells are created With future pregnancies, those antibodies attack the blood cells of future Rh pos babies
45
Pathogenesis of Rh isoimmunization
Initial response to D antigen is slow sometimes taking as long as 6 mos to develop Re-exposure to the antigen produces a rapid immunological response The sensitized mother produces IgG anti-D that crosses the placenta and coats D-pos fetal red cells which are then destroyed in the fetal spleen Severe hemolysis leads to RBC production by the spleen and liver leading to portal HTN with placental edema and ascites, eventually leading to hydrops (fetal heart failure)
46
Prevention of isoimmunization
All mothers should be blood typed and screened at first antenatal visit All mothers with no prenatal care should be blood typed at the hospital RhoGAM should be given to prevent future problems: at 28 wks, postpartum, after any miscarriage or termination, after any occurrence that could cause fetal cells to enter maternal circulation
47
Tx of isoimmunization
Best tx is still prevention | Tx of the fetus with tranfusion in utero is standard of care for severely affected fetuses
48
What are the two types of hydatidiform mole?
Complete | Partial
49
Complete mole
Develops when a sperm fertilizes an empty egg (contains no nucleus or DNA) All the genetic material comes from the father's sperm. Therefore, there is no fetal tissue A small percentage of complete moles may develop into choriocarcinoma
50
Tx of complete mole
Up to 20% of pts will need additional surgery or chemo after their initial surgery

Women's Health Rotation (15 decks)

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