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Repro Pt.2 > Pregnancy pathology > Flashcards

Pregnancy pathology Flashcards

1
Q

The most common location of ectopic pregnancy is _

A

The most common location of ectopic pregnancy is ampulla of the fallopian tube
* Abdomen and cervix are less common

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2
Q

Name (6) risk factors of ectopic pregnancy

A
  1. Previous ectopic
  2. PID
  3. IUD
  4. IVF
  5. Increased maternal age
  6. Endometriosis
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3
Q

Ectopic pregnancies usually present _ weeks after the last period

A

Ectopic pregnancies usually present 4-6 weeks after the last period

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4
Q

How does ectopic pregnancy present?

A
  • Normal sx of pregnancy (morning sickness, breast tenderness)
  • Vaginal bleeding
  • Abdominal pain
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5
Q

Ruptured ectopic pregnancy may be suspected with _ signs

A

Ruptured ectopic pregnancy may be suspected with acute abdominal pain & signs of shock

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6
Q

Ectopic pregnancy is associated with a (faster/slower) rise in beta-hCG

A

Ectopic pregnancy is associated with a slower rise in beta-hCG
* Should double every 48 hours

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7
Q

What imaging is indicated when ectopic pregnancy is suspected?

A

Ultrasound will show no evidence of intrauterine gestation

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8
Q

_ is the medication of choice when ectopic pregnancy is caught early enough (before complications)

A

Methotrexate is the medication of choice when ectopic pregnancy is caught early enough (before complications)
* Contraindicated in breastfeeding mothers

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9
Q

_ is a purified anti-Rh antibody that is given to moms with risk of Rh incompatability

A

RhoGAM is a purified anti-Rh antibody that is given to moms with risk of Rh incompatability
* This prevents mom from making her own anti-Rh antibodies
* Decreases risk for complications in future pregnancies

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10
Q

Hypertension in a pregnant mother prior to 20 weeks is classified as _

A

Hypertension in a pregnant mother prior to 20 weeks is classified as chronic hypertension
* Hypertension persists post delivery
* Causes: obesity, diabetes

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11
Q

Hypertension in a pregnant mother after 20 weeks is classified as _

A

Hypertension in a pregnant mother after 20 weeks is classified as gestational hypertension

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12
Q

Moms with gestational diabetes normally return to normal BP around _

A

Moms with gestational diabetes normally return to normal BP around 6 weeks post delivery
* Risk increases with multiple pregnancies

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13
Q

Gestational hypertension can be attributed to _

A

Gestational hypertension can be attributed to increased blood volume, increased circulatory load

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14
Q

(4) Anti-hypertensive drug options for pregnant mothers

A

Hypertensive Moms Love Nifedipine
* Hydralazine
* Labetalol
* Methyldopa
* Nifedipine

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15
Q

Preeclampsia can be defined as _ + _

A

Preeclampsia can be defined as gestational hypertension + proteinuria OR organ dysfunction

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16
Q

Eclampsia is defined as _ + _ + _

A

Eclampsia is defined as hypertension + proteinuria + seizures
* In other words it is preeclampsia + seizures

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17
Q

Explain the etiology of preeclampsia/ eclampsia

A
  1. Abnormal placental spiral arteries
  2. Placental vasoconstriction
  3. Placental ischemia
  4. Release of chemokine mediators
  5. Increased systemic vascular tone
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18
Q

Name some risk factors for preeclampsia

A

Preeclampsia risk factors:
* Anti-phospholipid syndrome
* Improper implantation
* Inflammatory changes
* Advanced maternal age
* Hypertension

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19
Q

Preeclampsia is managed with antihypertensives + _

A

Preeclampsia is managed with antihypertensives + magnesium sulfate
* Magnesium sulfate is a prophylactic measure to prevent seizures; neuroprotective

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20
Q

(3) Maternal complications of preeclampsia

A
  1. Renal failure
  2. Intracerebral hemorrhage –> stroke
  3. ARDS
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21
Q

Fetal complications of preeclampsia include _ and _

A

Fetal complications of preeclampsia include uteroplacental insufficiency and placental abruption

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22
Q

HELLP syndrome (3) components

A
  1. Hemolysis: destruction of RBCs
  2. Elevated liver enzymes: necrosis of hepatocytes
  3. Low platelets platelets destroyed
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23
Q

What causes HELLP syndrome?

A

Liver thrombotic microangiopathy (microclots in the liver; vasospasm)

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24
Q

Complications of HELLP include:

A
  • Liver capsule hematomas –> hypovolemia
  • Tissue factor exposure –> DIC
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25
What causes peripheral edema in pregnancy?
**Maternal dilutional anemia** --> **low oncotic pressure** --> increased fluid leak to interstitial space
26
Gestational thrombocytopenia can be secondary to _
Gestational thrombocytopenia can be secondary to **dilutional anemia** * Need to rule out ITP or HELLP
27
Nausea and vomiting in pregnancy are usually due to high levels of _
Nausea and vomiting in pregnancy are usually due to high levels of **beta-hCG**
28
When nausea and vomiting during pregnancy becomes severe we call it _
When nausea and vomiting during pregnancy becomes severe we call it **hyperemesis gravidarum**
29
Pregnant women can have hyperthyroidism due to _
Pregnant women can have hyperthyroidism due to **b-hCG having similar structure to TSH**
30
Pregnancy can induce a state of insulin resistance due to the release of _
Pregnancy can induce a state of insulin resistance due to the release of **human placental lactogen**
31
What is supine hypotensive syndrome?
Compression of the IVC by the growing fetus --> Hypotension while supine * Risk of possible pregnancy loss if growing fetus loses adequate blood supply
32
_ is a condition in which the placenta abnormally extends over the cervical os
**Placenta previa** is a condition in which the placenta abnormally extends over the cervical os * Can be partial or complete
33
Placenta previa is caused by _
Placenta previa is caused by **improper implantation location**
34
Which factors increase the risk of placenta previa?
*Anything that reduces the healthy surface area for implantation* * C-section * Increased maternal age * Multiple gestations * Previous placenta previa
35
_ is a common cause of painless 3rd trimester vaginal bleeding
**Placenta previa** is a common cause of *painless* 3rd trimester vaginal bleeding * It is often found on routine ultrasound
36
Placenta previa (does/ does not) cause fetal distress
Placenta previa **does not** cause fetal distress
37
Digital vaginal exam is contraindicated in placenta previa due to _ risk
Digital vaginal exam is contraindicated in placenta previa due to **hemorrhage risk**
38
_ is when fetal vessels cover the cervical os
**Vasa previa** is when fetal vessels cover the cervical os
39
Vasa previa is associated with _ umbilical cord
Vasa previa is associated with **velamentous umbilical cord** * Vessels lie outside of the umbilical cord, not protected by the jelly
40
Vasa previa becomes dangerous when _
Vasa previa becomes dangerous when **water breaks --> baby no longer suspended --> cord compression**
41
Vasa previa triad:
Vasa previa triad: 1. **Membrane rupture** 2. **Fetal bradycardia** (cord compression) 3. **Painless vaginal bleeding** (vessel rupture)
42
Placenta accreta is caused by _
Placenta accreta is caused by **increased depth of invasion of chorionic villi**
43
Placental accreta spectrum invades past the _ and into the _
Placental accreta spectrum invades past the **decidua** and into the **myometrium**
44
Placenta *accreta* is _ (degree of invasion)
Placenta *accreta* is **attachment to uterine myometrium without penetration**
45
Placenta *increta* is _ (degree of invasion)
Placenta *increta* is **penetration into the myometrium**
46
Placenta *percreta* is _ (degree of invasion)
Placenta *percreta* is **penetration of uterine serosa and pelvic organs**
47
Risk factors for placenta accreta:
Risk factors for placenta accreta: * Higher maternal age * Multiple gestations * Infertility procedures * Uterine surgery * C-section
48
Placental abruption is when _
Placental abruption is when **placenta detaches from the uterine wall**
49
Placental abruption is caused by _
Placental abruption is caused by **blood vessel failure in decidua basalis** (+/- trauma)
50
Risk factors for placental abruption:
Risk factors for placental abruption: * Smoking * Cocaine * Hypertension * Uterine abnormalities (fibroids, bicornuate uterus)
51
Conditions that cause (vasodilation/vasoconstriction) like smoking and cocaine can increase the risk of placental abruption
Conditions that cause **vasoconstriction** like smoking and cocaine can increase the risk of placental abruption
52
Placental abruption will present with _ type bleeding
Placental abruption will present with **continual painful bleeding** * Often presents as sudden pain and bleeding in the third trimester with contractions
53
Risk factors of placental abruption:
Risk factors of placental abruption: * DIC * Fetal distress * Retroplacental hematoma
54
Name (4) T's of postpartum hemorrhage (causes)
1. **Tone**: atony 2. **Trauma**: laceration 3. **Thrombin**: clotting issue 4. **Tissue**: retained products
55
Postpartum hemorrhage presents with > _ mL blood loss following vaginal delivery or > _ mL blood loss following C-section
Postpartum hemorrhage presents with **> 500 mL** blood loss following vaginal delivery or **> 1000 mL** blood loss following C-section
56
_ is the leading cause of maternal death (25% globally)
**Postpartum hemorrhage** is the leading cause of maternal death (25% globally) * Uterine artery receives 15% of cardiac output (500-700 mL/min)
57
The most common cause of postpartum hemorrhage is _
The most common cause of postpartum hemorrhage is **uterine atony** * Others: trauma, retained placenta, coagulopathy
58
How do we treat pp hemorrhage?
* Fluid and blood replacement * Find/treat cause * Uterotonic agents * Uterine tamponade * Hysterectomy
59
Spontaneous abortion is defined as _
Spontaneous abortion is defined as **loss of pregnancy before 20 weeks gestation** * Risk factors: smoking, past history, increased maternal age
60
Medical induction of abortion can include medication combo of _ + _
Medical induction of abortion can include medication combo of **mifepristone** + **misoprostol**
61
D & C stands for _
D & C stands for **dilation and curettage**
62
The mechanism of action of the drug used to treat ectopic pregnancy:
Methotrexate- **folate antimetabolite**
63
Labor between _ weeks gestation is considered preterm labor
Labor between **20-37 weeks** gestation is considered preterm labor
64
Name some causes of pre-term labor
Name some causes of pre-term labor: * Idiopathic * Infection * Hemorrhage
65
Risk factors for pre-term birth:
Risk factors for pre-term birth: * Prior pre-term deliveries * Multiple gestations * Uterine anamolies * Short cervix * Maternal co-morbidities * Low BMI * Tobacco, drug use
66
To be "in labor" you must have _ + _
To be "in labor" you must have **uterine contractions** + **cervical dilation**
67
_ are sometimes administered to pre-term infants to avoid neonatal respiratory distress syndrome
**Corticosteroids** are sometimes administered to pre-term infants to avoid neonatal respiratory distress syndrome
68
Tocolytics are drugs that _
Tocolytics are drugs that **stop or slow contractions**
69
Name (4) tocolytics used in pre-term labor
Name (4) tocolytics used in pre-term labor: 1. **Magnesium sulfate** 2. **Nifedipine** (calcium channel blocker) 3. **Indomethacin** (NSAID) 4. **Terbutaline** (B2 adrenergic receptor agonist) *"It's not my time"*
70
When baby has low amniotic fluid we call this _
When baby has low amniotic fluid we call this **oligohydramnios** * Can be detected on ultrasound
71
Oligohydramnios is associated with problem of baby's _
Oligohydramnios is associated with problem of baby's **kidneys** * Results in umbilical cord compression, fetal anomalies, fetal death
72
Potter sequence is _
Potter sequence is.. * **Bilateral renal agenesis or dysplastic kidneys** * **Oligohydramnios** * **Potter facies** (low set ears, beaked nose, downward slant eyes) * **Limb deformities** * **Pulmonary hypoplasia** (NRDS)
73
How do we manage placenta previa?
**Delivery via C-section**; do not check the cervix!!!
74
Placental abruption is _
Placental abruption is **partial/complete separation of placenta from the uterus**
75
Placental abruption will present with _ type bleeding
Placental abruption will present with **painful bleeding** + contractions
76
Causes of placental abruption:
Causes of placental abruption: * Trauma * Maternal HTN * Cocaine use
77
How do we treat a mom with placental abruption?
Stabilize the patient + deliver baby
78
(Placenta previa/ placental abruption) commonly involves abdominal discomfort
**Placental abruption** commonly involves abdominal discomfort
79
(Placenta previa/ placental abruption) can be associated with coagulation defects
**Placental abruption** can be associated with coagulation defects
80
Gestational diabetes is caused by _ and _
Gestational diabetes is caused by **insulin resistance** and **inadequate maternal insulin secretion**
81
Gestational diabetes is associated with (oligohydramnios/polyhydramnios)
Gestational diabetes is associated with **polyhydramnios**
82
Complications of polyhydramnios:
Complications of polyhydramnios: * Fetal malposition * Maternal respiratory compromise * Placental abruption * Preterm contractions/labor * Premature rupture of membranes * Uterine atony --> hemorrhage * Umbilical cord prolapse
83
The most common fetal complication of GDM is _
The most common fetal complication of GDM is **macrosomia** * Can cause shoulder dystocia
84
GDM can cause (hyperglycemia/hypoglycemia) in the infant at birth
GDM can cause **hypoglycemia** in the infant at birth * Also hypocalcemia, IDA, polycythemia, hyperbilirubinemia
85
Universal GDM screening is done between weeks _ of pregnancy
Universal GDM screening is done between **24-28 weeks** of pregnancy
86
Every pregnant woman has to undergo a _ test for GDM after 24 weeks gestsation
Every pregnant woman has to undergo a **1 hr oral glucose tolerance test** for GDM after 24 weeks gestsation * Drink 50g glucose solution * Blood draw in 1 hr * Over 130-140 mg/dL = insulin resistance
87
Women who fail the 1 hr oral glucose tolerance test must come back for a _
Women who fail the 1 hr oral glucose tolerance test must come back for a **3 hr oral glucose tolerance test** * Drink 100g glucose solution * Blood glucose at 1, 2, 3 hours * Fasting > 126 or more than 2 elevated values
88
The first treatment suggested for GDM is _
The first treatment suggested for GDM is **lifestyle modification** * Med options: metformin, insulin, glipizide
89
Hypertension in a pregnant woman is indiciated by BP > _
Hypertension in a pregnant woman is indiciated by **BP > 140/90**
90
We start pharmacotherapy in pregnant women with BP > _
We start pharmacotherapy in pregnant women with **BP > 160/110**
91
Preeclampsia treatment includes delivery at _ weeks
Preeclampsia treatment includes delivery at **37 weeks**
92
Complications of eclampsia include:
Complications of eclampsia include: * Intracranial hemorrhage * Temporary blindness * Cardiopulmonary arrest * Intrauterine fetal demise

Repro Pt.2 (6 decks)

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