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AIM-Repro > TBI Complications of Pregnancy > Flashcards

TBI Complications of Pregnancy Flashcards

1
Q

threatened abortion

A

vaginal bleed before 20 wk gestation

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2
Q

spontaneous abortion

A

loss of pregnancy before 20 wk gestation

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3
Q

misoprostol

A

PGE1 analog

induces smc contraction in uterus

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4
Q

missed abortion

A

non-viable early pregnancy

prod of conception remain in uterus

lil/no bleed

empty sac, no cardiac sounds

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5
Q

inevitable abortion

A

significant volume of bleeding

cervical os is OPEN

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6
Q

septic abortion

A

more assoc w/ induced abortion

fever, chills, malaise, abd pain, vaginal bleed/discharge

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7
Q

most common location of ectopic pregnancy is

A

ampulla of fallopian tube

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8
Q

hCG rises until

A

10 wk gestation

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9
Q

hCG levels indicating intrauterine pregnancy

A

1500-2000 mIU/ml

discriminatory zone

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10
Q

medical therapy for ectopic pregnancy

A

methotrexate
(folic acid antagonist)

inhibits growth of rapidly dividing cells (growing embryo)

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11
Q

contraindications of methotrexate for ectopic preg

A
  • embryo bigger than 4cm
  • ruptured ectopic
  • abd bleed signs
  • hepatic/renal/pulm/peptic ulcer/immunosuppressed
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12
Q

risk fx of ectopic preg

A

adhesions (PID, endometriosis, prev abd surg)

past ectopic

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13
Q

Placentia previa

A

placental tissue overlying or proximate to internal cervical os

beyond 24 wk gestation

PAINLESS BLEEDING in 3rd trimester

ABSENCE of abd pain/uterine contractions

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14
Q

how to distinguish Placentia previa from placental abruption

A

placenta abruption –> abd pain, uterine contractions

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15
Q

hCG levels higher than 2000 are more reliable in

A

ruling out a viable pregnancy

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16
Q

dx of Placentia previa

A

US

echogenic placental tissue overlying the internal cervical os

*BEFORE digital vaginal exam (may cause hemorrhage)

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17
Q

probs assoc w/ placenta previa

A
  • placenta accreta
  • malpresentation of fetus
  • preterm premature rupture of the membranes
  • intrauterine growth restriction
  • vasaprevia and velamentous umbilical cord
  • congenital anomalies
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18
Q

Placenta accreta

A

abnormal adherence to uterine wall

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19
Q

placenta increta

A

abnormal adherence of placenta through myometrium

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20
Q

placenta percreta

A

abnormal adherence in which placenta invades through myometrium to uterine serosa and even to adjacent organs

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21
Q

vasa previa

A

velamentous cord insertion causes fetal vessels to cross over os

22
Q

velamentous placenta

A

umbilical vessels course through amnionic sac before reaching placenta, which leaves vessels unprotected/vulnerable to rupture or compression

23
Q

succenturiate lobe

A

extra placental lobe that implants at some distance from the rest of the placenta

24
Q
  • vaginal bleeding
  • uterine tenderness/abd or back pain
  • uterine contractions
  • fetal distress/demise
A

placental abruption

25
Q

risk fx for placental abruption

A 
HTN/preeclampsia
Previous placental abruption
Premature rupture of membranes
Multiple gestations/overdistension
Polyhydramnios
Cigarette smoking
Trauma
Cocaine abuse
Advanced maternal age
Abnormalities of placentation and cord
Intrauterine infection
26
Q

uterine rupture tx

A

IMMEDIATE laparotomy with delivery of fetus and repair of uterus or hysterectomy

27
Q

vasa previa

A

rupture of fetal vessel –> perinatal mortality exceeds 50%

present. ..
- vag bleed
- non-reassuring fetal HR pattern (sinusoidal)
- need to deliver immediately by C. section

28
Q

pathogenesis of preeclampsia

A
  • faulty trophoblastic vascular remodeling of uterine a.s –> placental hypoxia –> release of placental fx into maternal circulation –> dysfunction of vascular endothelium –> vasospasm, coagulation
  • vasoconstriction –> inc resistance and HTN
  • damage to endothelium –> edema and microangiopathic hemolysis from platelet adherence and fibrin deposition (thrombocytopenia)
  • diminished blood flow –> end-organ damage (proteinuria, hepatocellular necrosis)
29
Q

gestational HTN dx criteria

A

systolic BP greater or equal to 140 mmHg

or

diastolic BP greater or equal to 90 mmHg

developing AFTER wk 20 in previously normotensive pt

and NO proteinuria

30
Q

preeclampsia dx criteria

A

systolic BP greater or equal to 140 mmHg

or

diastolic BP greater or equal to 90

^on 2 occasions at least 4 hr apart

AFTER wk 20 in a previously normotensive pt

AND

proteinuria or inc protein/creatinine ratio

31
Q

pt with new onset HTN without proteinuria, new onset of which findings is dx of preeclampsia?

A 
thrombocytopenia
inc serum creatinine
2x normal liver transaminases 
pulm edema
cerebral visual sx
32
Q

severe preeclampsia dx criteria

A

systolic greater or equal to 160 mmHg

or diastolic greater or equal to 110 mmHg on 2 occasions at rest

also CNS dysfunction (HA)
hepatic abnormality
thrombocytopenia
renal abnormality
pulm edema
33
Q

hemolysis
elevated LFTs
low platelets

A

HELLP syndrome

34
Q

risk fx for preeclampsia

A 
PHx of preeclampsia
first preg
black race
Fix of preeclampsia 
DM
chronic HTN
obesity
chronic kidney disease
antiphospholipid Abs
twin preg
advanced maternal age (>40)
35
Q

sx of preeclampsia become apparent in most women after how many weeks gestation?

A

34

36
Q

eclampsia

A

one or more generalized convulsions and/or coma in a woman with preeclampsia in absence of other neuro conditions

before, during delivery, or postpartum

37
Q

anti seizure meds for eclampsia

A

Mg sulfate

38
Q

tx of preeclampsia/eclampsia

A

DELIVERY

39
Q

HTN medical tx used dur preg

A
  • methyldopa
  • labetalol
  • nifedipine (CCB)
  • oral hydralazine
40
Q

HTN medical tx CONTRAINDICATED dur preg

A

nitroprusside

ACEi/ARBs

41
Q

Rh antigen

A

AD inheritance

most commonly D antigen

42
Q

Ig_ readily crosses placenta

A

IgG

43
Q

anti-D Ig

A

RhoGam

44
Q

Kleihauer-Betke

A

estimate of amount of fetal cells crossed into mother

smear of mothers blood, stain for fetal red cells

45
Q

Does prior spontaneous abortion put woman at inc risk of ectopic?

A

No

46
Q

painless bleeding during preg is ____ UPO

A

placenta previa

47
Q

Is advanced maternal age a risk fx of placental abruption?

A

No

48
Q

Is HTN a risk fx of placental abruption?

A

Yes

49
Q

Is advanced maternal age a risk fx of placental previa?

A

Yes

50
Q

Is HTN a risk fx of placental previa?

A

No

AIM-Repro (9 decks)

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