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N825 > Pregnancy Complications & Warning Signs for Providers > Flashcards

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.
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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)
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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
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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
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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
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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
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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
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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
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9
Q

Ectopic: Tx

A
  • refer to OB/GYN
  • methotrexate
  • salpingectomy/tubal resection
  • RhoGam if indicated
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10
Q

Hydatiform Mole S/S

A
  • Abnormal bleeding
  • Size > dates frequency
  • Lack of fetal activity and FHR
  • Hyperemesis
  • Gestational HTN before 20wk
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11
Q

Hydatiform Mole Dx

A
  • Ultrasound
  • bHCG
  • Not officially made until after tissue removed
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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
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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)
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14
Q

Molar pregnancy cause

A
  • Caused by father’s genes NOT mother’s
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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

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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%

N825 (16 decks)

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