WH- lecture 3 Flashcards
Ectopic
usually Ampullary portion of Fallopian tube
Most common sx of Ectopic
1st trimester bleeding
abd pain
breasts tender
orthostatic dizzy/faint
back pain
shoulder pain
Ecotpic preg sx
Rebound and guarding with Abdominal pain
Normal prog level of pregnancy
> 20
Prog level reflecting abnormal pregnancy
<5
Discriminatory zone
Above a certain hCG, the landmarks of a normal pregnancy should be visible on US
3,500
Transvag US at 5 wks, should see
Double ring
Transvag US at 5.5-6 wks, should see
Fetal pole w cardiac activity
Tx for Ectopic
Expectant: follow hCG
Meds: MTX
Surgery: SalpinECTOMY vs OSTOMY
How often hCG measured for expectant mgmt of ectopic
every 48-72 hours
if beta hcg is <200
most pts with experience Resolution of preg
MTX
Folate antagonist
affects ACTIVELY REPLICATING TISSUE
SE of MTX
Abdominal pain
How long does MTX take to work
2-4 weeks, maybe up to 8 weeks
if not decreased by 15% on day 4-7, may need more MTX or Surgery instead
Salpingostomy
leaving the fallopian tube in tact
just removing the ectopic
RISK for future ectopic
SalpingECTOMY
removing the ectopic preg AND the fallopian tube
Hydadiform mole
the MOST COMMON form of gestational trophoblastic dz
Complete hydadi Mole
Paternally derived
NO Fetus
sx:
vaginal bleeding
enlarged uterus
dx:
HIGH beta hCG
“Snow storm”
definitive:
need tissue pathology
Tx for Complete hydadi Mole
REMOVE uterine tissue
immediately w suction dilation and curettage
birth control
Partial mole
mom and dad derived
Presence of a fetus
sx:
delayed period
Dx:
“swiss cheese”
Partial mole tx
Immediate removal with suction dilation and currettage
if normal preg also present: may continue to term
Invasive Mole
Following evacuation of molar pregnancy
persistent uterine bleeeding with plateau or rise in hCG after tx
US shows Intrauterine mass and increased vascularity
Invasive Molar Pregnancy
Tx for Invasive Molar Pregnancy
Single agent
MTX or Actinomycin-D
Choriocarcinoma
malignant necrotizing tumor
wks to years after pregnancy
Tx: single agent MTX or multi agent EMACO
Placental site trophoblastic tumor
arises from placental
Tx: Hysterectomy
1st line tx for Hyperemesis
Vit B6 and Doxylamine
RH incompatible
Mom is negative
Baby is +
Goal of RH tx
Keep mom from becoming sensitized
RhoGAM
anti-D immunoglobulin
0.3 mg of Rhogam will eradicate 15 mL of fetal RBCs
Titer 1:16 or greater is at risk for
Fetal hydrops
If greater than 1:16
may need Amniocentesis to determine fetal blood type
If fetal blood type +
Screen for fetal anemia
How do you screen for fetal anemia?
Middle Cerebral Artery dopplers
MCA doblers
If fetal anemia suspected
proceed w Percutaneous Umbilical Blood Sampling
PUBS
Leading cause of mom morbidity and death in developed nations
HTN
Chronic HTN
dx before 20 wks gestation
Gestational HTN
after 20 wks gestation (didnt have it before)
> 140/90
Severe: >160/110
Pre-ecamplsia
HTN after 20 wks and PROTEINURIA or if not proteinuria
thrombocytopenia renal insuff impaired LFT pulm edema HA
Pre-eclampsia pathophys
Failure to establish adequate uteroplacental blood flow
Dx of Pre-ecamp
TWO readings of >140/90 more than four hrs apart
dx of Pre-examp
Persistent BP >160/110 requiring tx with IV
Pre-ecamp with NO severe features tx
Delivery at 37 wks
Pre-ecamp with severe features tx
Deliver at 34 weeks
In the meantime: IV Labetolol, hydralazine, PO Nifedipine Mg sulfate Steroids
HELLP syndrome
Hemolysis
Liver enzymes
Low platelets
” a severe form of Pre-ecamp”
Tx of HELLP
all the same things
+
PLATELET TRANSFUSION
IU growth restriction
below the 10th percentile in second half of preg
Estimated fetal weight determined by
Biparital diameter
head circum
abdominal
femur
Screening for IUGR
Fundal height at every prenatal visit after 16 wks
When to deliver IUGR with no complications
38-39 weeks
When to deliver IUGR with abnormal uterine doppler
32-37 weeks
When to deliver IUGR with other conditions
34-37
When to screen for DM
24-28 weeks
with 1 hr test
If measure is >140, proceed to 3 hours test
if >200, diagnosed
3 hour test
must be fasting for 8 hrs
1 hour postprandial
<140
2 hours post prandial goals
<120
1st line tx for Dm
Insulin
