Pregnancy complications part 2 Flashcards
Partial hydatidiform mole
Develops when two sperm fertilize a normal egg
These contain some fetal tissue. But this tissue is often mixed in with the trophoblastic tissue and is nearly always a triploid karyotype
Tx of partial mole
Only a small percentage of pts with partial moles need further tx after initial surgery. Partial moles rarely develop into malignant GTD
Sx of molar pregnancy- general
Almost all women with complete hydatidiform moles have irregular vaginal bleeding during pregnancy
Typically starts during the first trimester, often between the 6th and 16th week of pregnancy
Can present as blood clots or watery brown d/c. Sometimes bunch of grapes
When are women with partial moles most frequently diagnosed?
After partial or missed miscarriage
How sx of molar pregnancy differentiate from typical pregnancy
Abdominal swelling: gets bigger faster
Vomiting: More frequent and severe episodes
Preeclampsia: Can occur during first or second trimester
Potential signs of metastasis: vaginal bleeding, cough, hemoptysis, HAs, syncope
Molar pregnancy workup
Quantitative hCG
TVUS: snowstorm appearance
GTD- tx
D&C or hysterectomy as indicated by staging
Monitoring of weekly serum hCG levels to make sure levels fall to 0 (may take 6 mos) and then monthly for at least a year
If pt has had chemo, check every 3 mos for 5 yrs
Chemo if levels plateau or rise after falling
Persistent (invasive) GTD
A locally invasive tumor of the muscle
Includes GTD that has not been cured by D&C
Many cases in this category are complete moles that persist
Pathogenesis of invasive GTD
This may occur because D&C removes only the topmost layer of the endometrium, it does not remove the tumor if it is deep in the muscular wall of the uterus
Dx of invasive mole
beta-hCG decreases but then levels off or starts to rise again
Reexamination, CXR, TVUS, and possibly CT of head, abdomen/pelvis, and liver
Risks for persistent GTD
There is a long time (>4 mos) between the time periods had stopped and tx is started
Uterus has become very large
Woman is >40 yoa
Woman has had GTD in the past
If the tumor grows through the full thickness of the myometrium, it may result in a hole in the uterus that can hemorrhage
Tx of persistent GTD
Chemo is ordered based on the hCG
Choriocarcionoma
A malignant form of GTD
CA in the cells of the lining or epithelium of the layer of the membrane that surrounds the fetus
When can choriocarcinoma develop?
From a complete hydatidiform mole
After a normal pregnancy
After a pregnancy when the fetus is lost early
Characteristics of choriocarcinoma
It is usually not diagnosed promptly
It can be anywhere in the body and is a very aggressive CA. It metastasizes widely and early.
Very invasive and destroys the tissue. It bleeds profusely. If in the brain, then signs of a CVA or seizure may occur. If in lung, then hemoptysis; if in the uterus, irregular bleeding can occur
Simple pregnancy test that is pos will indicate the dx
Out of control blood sugars are more likely to cause what in pregnant women?
If not that result, what else could occur?
Spontaneous abortion
Heart and limb defects
Diabetic mothers have a twofold increase in what?
Development of pregnancy induced HTN
Pregnant pts have an increased risk of what? (Has to do with diabetes)
DKA
Retinopathy. Should receive an ophthalmalogic exam before or early in pregnancy.
Risks associated with DM
Macrosomia Polyhydramnios Preterm labor Stillbirth Neonatal hypoglycemia and respiratory distress
Diet for mothers with DM in pregnancy
35 Kcal/kg of ideal body weight, with 45% complex carbs, 35% fat, 20% protein
How often should BGs be taken in a woman with DM?
A minimum of five times/day and logged
FBS
2 hrs postprandial after each meal
HS
