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29 Cards in this Set
- Front
- Back
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Emesis gravidarum
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Occurs in 70% of pregnancies
4-8 weeks onset Improves by 14-16 weeks No weight loss, ketonemia, electrolyte disturbances |
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Hyperemesis gravidarum
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Often results in weight loss, ketonemia, electrolyte disturbances
Can persist throughout pregnnacy |
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Etiology of HG
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Relaxation of smooth muscle (progesterone)
Elevated hCG Associated psychologic disorders More common in female fetus More often have favorable pregnancy outcome |
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Diagnosis of HG
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Significant weight loss
Electrolyte imbalances Rule out pancreatitis, cholecystitis, hepatitis, thyroid |
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Treatment of EG
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Supportive
Small meals Bland diet B12, doxylamine, or natural remedies |
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Treatment of HG
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Hospitalization with IV hydration
Anti-emetics Enteral or parenteral feeding - last resort |
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Causes of vaginal bleeding
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Placental implantation
Subchorionic hemorrhage Cervical or vaginal trauma Early pregnancy loss Ectopic pregnancy |
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Subchorionic hemorrhage epidemiology
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20% of early pregnancy losses
Increased risk in pregnancy loss Increased risk of preterm birth |
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Subchorionic hemorrhage treatment
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Follow-up ultrasound to confirm fetal viability and growth
Patient reassurance |
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Cervical or vaginal trauma diagnosis
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History
Speculum exam |
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Cervical or vaginal trauma treatment
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Repair any injury and avoid further trauma
Unlikely to adversely affect the pregnancy |
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Epidemiology of early pregnancy loss
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80% of spontaneous abortions are in first trimester
Only 3% lost after 8 weeks |
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Risk factors for early pregnancy loss
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Increasing maternal age
Prior loss |
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Etiology of early pregnancy loss
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Chromosomal abnormalities in over 50%
Other genetic causes Uterine Endocrine Immunologic Infections Drugs Radiation Chemicals |
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Uterine etiologies of early pregnancy loss
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Congenital anomalies
Leiomyoma Synechiae |
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Endocrine etiologies of early pregnancy loss
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Luteal phase progesterone deficiency
Thyroid disease Poorly controlled DM |
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Immunologic etiologies of early pregnancy loss
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Antiphospholipid antibody
SLE |
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Diagnosis of early pregnancy loss
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Characterize bleeding
Pain Exam Transvaginal ultrasound |
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b-hCG levels in pregnancy loss diagnosis
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If above 1500, should see intrauterine pregnancy
Should be rising by 67% every 2 days |
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Diagnostic evaluation of vaginal bleeding
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Ultrasound to check for embryonic demise
If embryo is visualized, check for cardiac activity Then check for and follow heart rate |
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Fetal heart rate parameters
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>100bpm by 6 weeks
>120bpm by 8 weeks |
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Evaluation of recurrent pregnancy loss
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Perform after 3 losses
Fetal karyotype 3 generation pedigree Parental karyotypes Rule out thyroid disorder and diabetes Chlamydia culture Look for uterine abnormalities (HSG or hysteroscopy) Stop social habits and exposures |
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Treatment of early pregnancy loss
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Expectant management
Medical - misoprostol Surgical - D and C |
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Best treatment for early pregnancy loss
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Surgery
Risk of trauma and uterine and endometrial scarring |
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Epidemiology of ectopic pregnancy
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5-10% maternal mortality
25% recurrence rate |
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Location of ectopic pregnancy
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96% in fallopian tube
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Diagnosis of ectopic pregnancy
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Abdominal pain, irregular vaginal bleeding, hypotension
Diagnose by US or laporoscopy Serum progesterone - <5 is nonviable, >25 is normal Serum b-HCG - <67% increase every 2 days |
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Treatment for ectopic pregnancy
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Salpingectomy
Follow serum b-HCG post-operatively until it decreases |
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Eligibility criteria for medical treatment with methotrexate
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Hemodynamically stable
Unruptured Mass <4cm in diameter No embryonic cardiac activity |
