Pregnancy Complications & Warning Signs for Providers Flashcards
1
Q
1st Trimester bleeding
A
- Bleeding in first 12wk of pregnancy
- 20-40% of women have this (90% w/FHT will progress to term)
- 80% of SAB occur in 1st Tri
- Any bleeding deserves attn.
2
Q
1st Trimester bleeding Differential Dx
A
- Threatened/Spontaneous abortion
- Ectopic pregnancy
- Cervical abnormality: cervicitis, cervical polyps
- Vaginitis
- Trauma
- Disappearing twin
- Subchorionic hemorrhage (most common abnormality on US w/viable embryo and bleeding)
3
Q
B-HCG
A
- 8-9d after fertilization
- Doubles q48-72hr with normal IUP
- Increases only by 1/3 if ectopic
- Rule of 10:
- 100 @ 1st missed period
- 100K @ 10wk
- 10K @ term
4
Q
Spontaneous Abortion
A
- SAB: occurs w/out cause
- Threatened AB: S/S of possible loss (bleeding with or without pain)
- Inevitable AB: Cervix is dilating
- Incomplete AB: Parts of products are retained
- Complete AB: all products are expelled
- Missed AB: Fetus died before 20wk but products retained for 2+wk
- Recurrent/Habitual AB: 3+ consecutive 1st Tri miscarriages
5
Q
Management of SAB
A
- Blood type: RhoGam for Rh-Negative women
- Baseline B-HCG in 48hr
- US: See IUP on ABD US @B-hCG 6500; On Transvaginal US @B-hCG 2000
- Inevitable or incomplete: D&C; observant mgmt.
- GC/Chlamydia test/Wet Prep
6
Q
Ectopic Pregnancy
A
- Implantation of blastocyte anywhere but uterus
- 2nd leading cause of maternal death in US
- 1:85 pregnancies; higher in 35+yo
- Causes: STD (GC, chlamydia), salpingitis, failed BTL
- S/S: Amenorrhea, spotting, unilateral lower ABD/Pelvic/adnexal pain; may be asymtomatic; severe vaginal pain with/without bleeding
7
Q
Ectopic Pregnancy: PE
A
- Severe ABD pain
- Missed period
- Free fluid of US
- Vaginal bleeding
- Mild S/S of pregnancy
- Asymptomatic, until tube ruptures
- Cul-de-sac fullness
- Shoulder pain r/t diaphragmatic irritation
- Vertigo, syncope
8
Q
Ectopic Pregnancy: Dx
A
- B-hCG >1500 but no IU gestatonal sac
- @5 wk gestational sac visible on TV US
- hCG never >6500 before tubal rupture
9
Q
Ectopic: Tx
A
- refer to OB/GYN
- methotrexate
- salpingectomy/tubal resection
- RhoGam if indicated
10
Q
Hydatiform Mole S/S
A
- Abnormal bleeding
- Size > dates frequency
- Lack of fetal activity and FHR
- Hyperemesis
- Gestational HTN before 20wk
11
Q
Hydatiform Mole Dx
A
- Ultrasound
- bHCG
- Not officially made until after tissue removed
12
Q
Hydatiform Mole Mgmt.
A
- Uterine evac by suction curettage
- CMP, CBC, LFT, Thyroid function
- Monitor for malignant changes
- Avoid pregnancy for 1yr
- Serial b-hCG q2wk until normal, then q month for 6mo, then q 2month for 1 yr
13
Q
Molar Pregnancy (Gestational trophoblastic Dz) types
A
- Complete/partial molar pregnancy (benign)
- Invasive molar pregnany: Goes through uterine wall but does not migrate
- Choriocarcinoma (malignant)
14
Q
Molar pregnancy cause
A
- Caused by father’s genes NOT mother’s
15
Q
Questions to ask about 1st Trimester bleeding
A
1) Has pregnancy been confirmed
2) Once confirmed, is this bleeding as heavy as a normal period?
3) Heavy? (6+pads/12hr)
- Heavy bldg + passing tissue + cramping? think SAB
- Heavy bldg. with no pain? Think molar
- Light bleeding + Pain? consinder ectopic
- Light bleeding + no pain = think AB or implantation
4) Abnormal pain or cramping? consider ectopic or SAB
16
Q
2nd Trimester Bleeding
A
- Midtrimester AB: Cocaine use?; anatomical; autoimmune?
- Incompetent cervix: Painless dilation, bloody show, spon ROM, pelvic pressure; CONSULT
- Placental problems: lowlying; 1/3 women in 1st trimester; 1% have previa at term
- Partial abruption: May resolve, may reabsorb; Dx w/US
17
Q
3rd Trimester Bleeding: Placenta Previa
A
- 20% of 3rd tri bldg.
- Partial, arginal or complete covering Os
- Higher in multips, previous c-section, uterine smoking, smoking
- S/S: Painless vag bleeding, unengaged fetal position or malpresentation, bleeding with contraction
18
Q
3rd Trimester Bleeding: Placenta Abruptio
A
- 30% of 3rd Tri bleeding
- Risks: HTN, Trauma, smoking, cocaine, multiparity, uterine anomalies
- S/S: Vag bldg.; uterine tenderness; rigidity; contractions; fetal tachy/bradycardia
- Complications: Shock, fetal death, DIC
- US, get help
19
Q
Placental Problems
A
- Low lying: 1/3 women in 1st Tri; 1% have previa at term
- Partial Abruption: may resolve, may reabsorb; Dx w/US
20
Q
HTN in Pregnancy
A
- Chronic HTN: BP >140/90 before pregnancy or before 20wk
- Chronic HTN w/superimposed preeclampsia: Chonic HTN w/new onset proteinuria (>300mg/24hr) but no proteinuria before 20wk (if after 20wk gestational HTN); or sudden increase in BP or PLT in HTN woman
- ACE-I (Contraindicated); Atenolol (may be associated w/ IUGR
21
Q
Pregnancy Induced HTN (PIH)
A
- Often asymptomatic
- BP 140/90 on 2 occasions w/out proteinuria
- 2nd measurement must be taken b/n 6hr to 7d after 1st
- Pt normotensive pre-pregnancy
- MGMT: Lifestyle modification, antiHTN Tx
- Severe HTN (>160/110) needs admission
22
Q
Watching for Preeclampsia (Old Criteria)
A
- Rise in SBP of 3mmHg OR rise in DBP 15mmHg + pathologic edema
- Risk factors: HTN, renal Dz, Connective tissue Dz, fetal growth restriction, Gestational HTN, prior preeclampsia, IDDM, multiple gestation, nullip, obesity, thrombophilia
23
Q
Preeclampsia: S/S
A
- Characterized by poor perfusion of multiple vital organs: (mothers) brain, liver, kidneys; fetus and placenta
- Dz of first pregnancy
- Wt gain
- Increasing edema
- Persistent HA
- Blurred vision
- Nonspecific: malaise, nausea, epigastric discomfort, RUQ discomfort
24
Q
Preeclampsia: Facts
A
- 140/90 & proteinuria >300mg/24hr
- Not easily predicted
- Hospitalization: NST, AFI, serial BP, 24hr urine, CBC, AST, ALT, creatinine
25
Q
Preeclampsia: Meds
A
- Keep BP 140/50-100 (minimizes uteroplacental insufficiency)
- If BP is >160/105: hydralazine, labetalol, or nifedipine
26
Q
Severe Preeclampsia
A
- Persistent BP >160/110
- Nephrotic range proteinuria
- Refractory oliguria (<5th%
