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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?

A

49th day

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
Q

Complications of termination of pregnancy

A 
Infection
Uterine perforation
Hemorrhage
Uterine scarring (Asherman's syndrome)
Retained products of conception with hemorrhage
Cervical lacerations
26
Q

Recurrent abortion

A

Three successive spontaneous abortions

27
Q

Uterine causes of recurrent abortion

A

Septum
Leiomyoma
Incompetent cervic

28
Q

Genetic causes of recurrent abortion

A

Chromosomal abnormalities with one or both partners resulting in non-viable embryos

29
Q

Rheumatic causes of recurrent abortion

Endocrine causes of recurrent abortion

A

Lupus

Thyroid, under-treated DM, PCOS, luteal phase defect

30
Q

Hematologic causes of recurrent abortion

Other causes of recurrent abortion

A

Thrombophilias, esp factor V Leiden
Antiphospholipid syndrome
Maternal infections, esp TORCH infections

31
Q

Incompetent cervix

A

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
Q

Risks of incompetent cervix

A 
Congenital uterine or cervical anomaly
Previous obstetric trauma
Previous mechanical dilation
-D&amp;C
-TOP
-Hysteroscopy
Treatments for CIN
33
Q

Tx of incompetent cervix

A

Cerclage

Better outcomes if done before membranes are visible

34
Q

When is an ectopic pregnancy more common?

A

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
Q

Which type of ectopic pregnancy is a leading cause of maternal deaths in the 1st trimester?

A

Tubal pregnancy

36
Q

PE of ectopic pregnancy

A

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
Q

Dx of ectopic pregnancy

A

TVUS followed by quantitative beta-hCG testing

38
Q

Heterotopic pregnancy

A

Where there is an IUP and ectopic at the same time

39
Q

DDx of ectopic pregnancy

A 
Acute appendicitis
Miscarriage
Ovarian torsion
PID
Ruptured corpus luteum cyst or follicle
Tubo-ovarian abscess
Urinary calculi
40
Q

Tx of ectopic pregnancy

A

Surgical removal of pregnancy and tube

Methotrexate (PO or IM-IM more effective)

41
Q

Details about using methotrexate for ectopic pregnancy

A

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
Q

Other therapeutic agents for an ectopic pregnancy

A

Hyperosmolar glucose
Prostaglandins
Mifepristone

43
Q

Who is a good candidate for expectant management of ectopic pregnancy

A

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
Q

Isoimmunization

A

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
Q

Pathogenesis of Rh isoimmunization

A

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
Q

Prevention of isoimmunization

A

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
Q

Tx of isoimmunization

A

Best tx is still prevention

Tx of the fetus with tranfusion in utero is standard of care for severely affected fetuses

48
Q

What are the two types of hydatidiform mole?

A

Complete

Partial

49
Q

Complete mole

A

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
Q

Tx of complete mole

A

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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