Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
147 Cards in this Set
- Front
- Back
|
Lab study to measure risk of preterm birth?
|
Fetal fibronectin
|
|
|
MCC of infecious vulvar ulcers?
|
HSV
|
|
|
Definition of Preterm Birth:
|
Infant born at a gestational age of less than 37 weeks.
|
|
|
*Prematurity vs Low Birth Weight
|
*Prematurity reflects gestational age, whereas low birth weight is based solely on weight (less than or equal to 2500g)
*Important to distinguish low birth weight from prematurity. Prematurity is manifested by low birth weight (500-2500g), physical signs of immaturity, and multisystem disorders |
|
|
*Prematurity vs IUGR/SGA infants
|
low birth weight, physically mature
NOT considered premature |
|
|
*Prematurity vs LGA infants
|
physically immature-infants of diabetic mothers
NOT considered premature |
|
|
*A major cause of preterm birth is
|
preterm labor
|
|
|
**Definition of Preterm Labor:
|
Regular contractions (2-4 per 10 mins) with progressive cervical dilation and effacement at less than 37 weeks gestation.
|
|
|
If have had a premature infant, what is the risk of recurrence?
|
*20-30% risk of recurrence
|
|
|
*Most cases of preterm labor due to?
|
*Most cases of preterm labor are idiopathic.
|
|
|
MCC of morbidity and mortality in newborns worldwide
|
Premature Delivery
|
|
|
Risk Factors for Premature Delivery:
|
**Infections (systemic or local), BV
Excess uterine enlargement (hydramnios, mult gestation) Incompetent cervix Uterine distortion/anomalies Placental abnormalities Fetal anomalies Dehydration Previous preterm or abortion Race(black), Low socioeconomic status, single parent Smoking/EtOH/Substance abuse Age (<18 or >40) Maternal disease Grand multiparity |
|
|
Maternal disease
Risk Factors for Premature Delivery |
HTN, preeclampsia, eclampsia, asthma, hyperthyroidism, heart disease, drug addiction, cholestasis, anemia (hgb less than 9 g/dl)
|
|
|
Complications of Preterm Birth:
|
• Death
• Small size • Increased risk of heart disease, diabetes, stroke Increased risks into adulthood |
|
|
Signs and Symptoms of Preterm Labor can be subtle and easily overlooked
|
*Early detection of premature labor is key to success.
|
|
|
Early signs of premature labor to educate pt about
|
Cramping (menses-like)
Low backache Pelvic pressure Incr vaginal discharge Incr frequency of urination Vaginal bleeding |
|
|
Monitoring of At-Risk Patients:
|
*Weekly cervical exams to detect subtle changes that may indicate onset of labor (plus test for GBS, Chlamydia/GC, BV)
*External electronic fetal monitoring *Ultrasound *Admit for cervical change or uterine irritability with cramping |
|
|
*The goals of management of pregnancies at risk are:
|
Detection of disorders associated with preterm labor
Identify those patients at risk Identify those patients at risk |
|
|
*Management of Preterm Labor:
Bottom line: no good treatment for preterm labor |
Hydration
Tocolytics (up to 36wks) Betamethasone (24-35wks; lung maturity) Bed rest; left lat decub Treat asymptomatic bacteriuria (7 days abx) *Tobacco cessation No sex Therapeutic amniocentesis |
|
|
1st step in treatment of preterm labor?
|
Hydration. often stops the contractions
dehydration stimulates ADH secretion, which mimics oxytocin (both secreted from post pit) |
|
|
Therapeutic amniocentesis for what?
|
if hydramnios starts causing contractions
Takes off about 500 mL |
|
|
Definition of Tocolytic:
|
A medication that can inhibit labor, slow down or halt the contractions of the uterus.
|
|
|
Tocolytics Available:
|
Beta-2 Adrenergic Agents: Terbutaline and Ritodrine
Magnesium Sulfate Investigational: Prostaglandin Inhibitors, CCBs |
|
|
Magnesium Sulfate:
MOA |
Competes with Calcium (thereby inhibiting muscle contraction).
|
|
|
Magnesium Sulfate:
Dose |
Give 1-3 g/hr after loading dose of 4g.
|
|
|
Magnesium Sulfate:
Antidote |
10 ml 10% calcium gluconate.
|
|
|
Magnesium Sulfate:
Side Effects |
SOB, respiratory depression
Also: pulmonary edema, decr reflexes |
|
|
Beta-2 Adrenergic Agents:
MOA |
Increases cAMP → decreased INTRAcellular calcium
Work by stimulation of beta-2 receptors, causing relaxation of muscle and cessation of contractions. |
|
|
Which Beta-2 Adrenergic Agent is approved by the FDA?
|
Ritodrine
but we use more terb |
|
|
Terbutaline
Dose |
0.25 mg SC every 30 mins
up to max of 6 doses then give oral maintenance of 5.0 mg Q 4-6 h |
|
|
Ritodrine
Dose |
IV. Continue 6-24 hrs after contractions stop.
Max IV dose 35 mg/min. then use oral ritodrine 10 mg Q 2-6 h |
|
|
Most common maternal side effects of beta-mimetics
|
Cardiovascular effects (increased heart rate, increase in systolic pressure, decrease in diastolic pressure)
|
|
|
**Maternal Side Effects of Beta-2 Adrenergic Agents:
|
• Tachycardia and palpitations
• Hypertension • Tremor • Nausea • Irritability • Hyperglycemia (esp diabetics -->ketoacidosis, insulin --> end result hypokalemia) • Hypokalemia • Hyperuricemia • Metabolic acidosis • Pulmonary edema-serious but rare |
|
|
How do Beta-2 Adrenergic Agents affect diabetics
|
• Hyperglycemia-all patients at risk but in a few cases, diabetics treated with beta- mimetics actually develop frank ketoacidosis. Circulating insulin levels rise due to hyperglycemia. Insulin drives potassium into the cells with the end result being hypokalemia.
|
|
|
**Contraindications to Beta-2 Adrenergic Agents:
|
Cardiac Dz
Severe ecclampsia or HTN Bleeding - uterine, placenta previa, abruptio placentae Intrauterine infection Hyperthyroid Uncontrolled DM IUGR |
|
|
**Fetal Side Effects of Beta-2 Adrenergic Agents:
|
Neonatal hypoglycemia, hypocalcemia and hypotension
|
|
|
Prostaglandin Inhibitors (PGI's)
in preterm labor |
ibuprofen or indomethacin-cause early closure of PDA
|
|
|
Calcium channel blockers in preterm labor
|
investigational tocolytic
verapamil, nifedipine |
|
|
Contraindications to Tocolytics (in general):
|
Advanced labor
mature fetus anomalies of fetus intrauterine infection signif uterine bleed abruption signif HTN |
|
|
Steroid Use in Preterm Labor:
Use? When? |
induce fetal lung maturity
Also helps decrease intraventricular hemorrhage, necrotizing enterocolitis Given at 24-35 weeks |
|
|
Labs to check lung maturity?
|
Check L/S ratio (greater than 2)
**or presence of phosphatidylglycerol |
|
|
Function of Amniotic Fluid:
|
produced continuously throughout pregnancy.
provides protection against infection, trauma, and umbilical cord compression. |
|
|
Definition of PROM (Premature Rupture of Membranes):
|
Rupture of the chorioamniotic membrane before the onset of labor.
can occur at term (PROM) or preterm (PPROM) |
|
|
Main risk of PROM?
|
preterm labor and delivery
|
|
|
PROM - etiology?
|
Cause of PROM is not clearly understood, but known that STD's play a role.
|
|
|
Complications of PROM:
|
Neonatal complications
Infection- chorioamnionitis Prolapsed umbilical cord Abruptio placentae Pulmonary hypoplasia (if PROM early <25 wks) Amniotic Band Syndrome |
|
|
**Amniotic Band Syndrome
|
series of findings associated with entanglement of fetal parts with amniotic membranes that can collapse around the fetus once ROM occurs. Can cause deformities, amputation of digits
|
|
|
Diagnosis of PROM:
|
1. Nitrazine paper
2. "Fern test" 3. Ultrasound |
|
|
Fluid passing from vagina - must r/o what?
|
Fluid passing through the vagina presumed to be amniotic fluid until proven otherwise.
|
|
|
Differential Diagnosis of PROM:
|
Urine incontinence
Incr vaginal secretions from pregnancy (physiologic) Incr cervical discharge Exogenous fluid (semen, douche) Vesicovaginal fistula |
|
|
Evaluation and Management of PROM:
|
Admit for initial exam
Sterile speculum exam - culture, ?dilation US - check age, position, amt amnio fluid ABX for intrauterine infections Electronic fetal monitoring Consider betamethasone |
|
|
Bacterial Vaginosis in Pregnancy:
Causative agents |
1. Gardnerella vaginalis (Gram neg bacillus)
2. Peptostrep 3. Bacteroides sp. 4. Mycoplasma hominis 5. Mobiluncus sp. |
|
|
Bacterial Vaginosis in Pregnancy:
Risk factors |
Race - black 3x
PMHx preterm labor Multiparity Age < 20 Low socioeconomic Single parenthood Pre-pregnancy weight less than 50 kg |
|
|
Low birth weight
|
< 2500 gm
|
|
|
Bacterial Vaginosis
signs/symptoms |
**Greater than 50% infected pregnant females asymptomatic
non-pruritic, malodorous vaginal discharge *Associated findings-fever, elevated WBC, elevated CRP, BV positive vaginal cultures |
|
|
Diagnostic Criteria for BV:
|
Vaginal pH > 4.5
Whiff test positive Presence of Clue cells Presence of thin, adherent, uniform discharge |
|
|
Why treat BV?
|
Assoc with preterm labor
|
|
|
*Treatment of BV in Pregnancy:
|
First Trimester-Clindamycin po daily for 7 days
After first trimester-Metronidazole (Flagyl) or Clindamycin po daily for 7 days Oral formulation for 7 days is first-line therapy; single dose oral prep and topical preps are second line treatment. |
|
|
Ectopic Pregnancy:
*Definition: |
Any gestation occurring outside the uterine cavity.
|
|
|
Ectopic Pregnancy:
Most common site? |
*Most common site is fallopian tube (95%). Ampulla 55%
*Other sites include: ovary, cervix, abdominal cavity. |
|
|
Ectopic Pregnancy:
Medical Emergency |
Leading cause of first-trimester pregnancy related deaths
1 in 200 pregnancies |
|
|
Risk Factors Ectopic Pregnancy:
|
**Pelvic Infection
IUD Usage Previous Ectopic Increased maternal age PMHx infertility/Infertility treatment Uterotubal anomalies |
|
|
Most common pathological finding in ectopic pregnancy?
|
**Chronic salpingitis most common pathologic finding in fallopian tube
|
|
|
*Chronic PID
|
*Chronic PID involves both tubes.
Most common cause of PID is STDs: Chlamydia, gonorrhea |
|
|
Causes of Narrowing of the Fallopian Tube:
|
Congenital defects
Benign tumors, cysts Uterine fibroids at uterotubal junction Endometriosis Tubal adhesions (pelvic or abd sx) Surgical repair |
|
|
Signs and Symptoms of Ectopic Pregnancy:
Most common symptom? |
*The most common symptom of ectopic pregnancy is pain, specifically, abdominal pain (90-99%). Unilateral pelvic pain-knifelike and stabbing or dull and not well defined.
*Intra-abdominal hemorrhage and blood under the diaphragm may present with shoulder pain. |
|
|
Signs and Symptoms of Ectopic Pregnancy:
|
*Pain
Hx amenorrhea *Bleeding (Usually 7-14 days after missed period; Major hemorrhage is uncommon) Tissue passage from the vagina S/S of pregnancy |
|
|
Signs and Symptoms of Ruptured Ectopic Pregnancy:
|
hypotension, tachycardia, dizziness, syncope, distended and tense abdomen (late signs and symptoms)
|
|
|
Clinical Presentation of Ectopic
|
*Ectopics may occur with an acute, subacute or chronic presentation
50% palpable Bleeding and pain may be interpreted as threatened abortion |
|
|
Pregnancy test and Ectopic
|
*Standard urine pregnancy tests negative in 50% of patients with ectopics
|
|
|
Diagnosis of Ectopic Pregnancy:
|
*Index of Suspicion
Esp in pt with abnormal bleeding, pelvic pain or Hx PID, pelvic surgery. |
|
|
What do you do if you have a high index of suspicion for ectopic, and a shocky pt?
|
*If internal bleeding is very heavy and patient is shocky, must do laparscopy or laparotomy.
|
|
|
DDX ectopic pregnancy
|
Adnexal torsion
Acute appendicitis Incomplete or threatened abortion Bleeding Corpus Luteum of normal pregnancy Acute salpingitis Gastroenteritis Endometriosis |
|
|
DDX
Torsion/Appendicitis vs Ectopic |
neither produce amenorrhea, syncope, anemia, and early shock.
Ectopic does |
|
|
DDX
Abortion vs Ectopic |
Abortion: external bleeding much more severe than pain
Ectopic: reverse, pain seems out of proportion to bleeding |
|
|
Diagnostic Testing in suspected Ectopic
|
*Quantitative/Serial testing of hCG
Pelvic/Vaginal US Culdocentesis Laparoscopy Endometrial Histology |
|
|
*Quantitative/Serial testing of hCG B-subunit
in ectopic |
Watch rate of rise
In normal pregnancy, doubles every 60 hrs Ectopics plateau very sensitive |
|
|
Use of US in ectopic
|
Vaginal US can detect intrauterine sac at about 6 weeks
Pelvic US at 7 weeks |
|
|
Culdocentesis
|
Determines presence of free blood in peritoneal cavity. Insert needle behind uterus into cul-de-sac.
|
|
|
Culdocentesis in ectopic
|
good for pts with acute pelvic pain, abnormal bleeding, syncope or shock
Presence of non-clotting or previously clotted (defibrinogenated) blood in syringe is diagnostic of free blood in peritoneal cavity→ectopic pregnancy High predictive value but rarely used because of improved US and beta HcG |
|
|
Gold std diagnostic in Ectopic?
|
Laparoscopy
|
|
|
Endometrial Histology - what indicates ectopic
|
D&C done for suspected spontaneous abortion
Decidua in endometrial sample without chorionic villi indicates ectopic. |
|
|
Management of Ectopic Pregnancy:
|
Oxygen, treat hemorrhagic shock
Labs -type and cross, CBC, PT/PTT, quantitative HcG, +/-progesterone level (low levels bad sign), urinalysis Rhogam if appropriate |
|
|
Treatment of Ectopic Pregnancy: Gold std?
|
Surgery
|
|
|
Salpingo-oophorectomy
|
surgical removal of affected ovary/tube
|
|
|
*Salpingectomy
|
most common treatment for ectopic pregnancy. Best treatment for ruptured ectopic because of bleeding.
|
|
|
Salpingostomy
|
if pregnancy at midpoint of tube, tube opened and ectopic removed.
Not usually closed after removal |
|
|
Options for Treatment of Unruptured Ectopic Pregnancy besides Salpingo-oophorectomy and Salpingectomy
|
"Milking" procedure- high recurrence rate
Salpingostomy Segmental resection of tube Medical Approach - Methotrexate |
|
|
Unruptured Ectopic Pregnancy:
Medical Approach |
Methotrexate with leucovorin rescue (folic acid)
-small unruptured ectopic pregnancies. Methotrexate is folic acid antagonist that blocks folate metabolism and thus affects rapidly dividing cells. Complications→ acute bleeding from site 1-2 weeks later; may require laparotomy. |
|
|
Complications of Ectopic:
|
Rupture
Hemorrhage Shock DIC |
|
|
Prognosis of Ectopic:
|
*40% of patients with ectopic, NEVER conceive again. Those who do conceive have a 12-15% chance of recurrence or spontaneous abortion
|
|
|
Definition: Induced Abortion:
|
Therapeutic/ elective/ intentional termination of a pregnancy
By means of dilating the cervix and evacuating the uterus by medication or instrumentation. |
|
|
Definition: Spontaneous Abortion:
|
Abortion occurring naturally, without apparent cause.
Before 20th completed week of gestation. Expulsion of any or all of placenta or membranes and an immature, nonviable fetus |
|
|
Early Abortion:
|
Before 12 wks
|
|
|
Late Abortion:
|
Btw 12 and 20 wks
|
|
|
Complete Abortion:
|
Abortion where the total products of conception have been expelled and identified. Uterine contractions, bleeding and dilation of the cervix.
|
|
|
Incomplete Abortion:
|
Expulsion of some, but not all of products of conception before 20th week gestation.
Bleeding, cramp-like pain and cervical dilation. |
|
|
Threatened Abortion:
|
The appearance of signs and symptoms of possible loss of the fetus.
Vaginal bleeding, +/- pain before the 20th week. Cervix remains closed |
|
|
Inevitable Abortion:
|
Profuse intrauterine bleeding with cramp-like lower abdominal pain before the 20th week gestation. The cervix is typically dilated
Ultimately results in expulsion of uterine contents |
|
|
Missed Abortion:
|
Retained POC in uterus following the death of the fetus for at least eight weeks.
(No tissue passed, pain unusual, cervix closed. May have brownish vag discharge) |
|
|
Recurrent/Habitual Abortion:
|
Three or more successive spontaneous abortions, at about the same level of development.
|
|
|
Infected Abortion:
|
Abortion accompanied by infection of the genital tract from retained material with resultant febrile reaction.
|
|
|
Septic Abortion:
|
Abortion associated with serious infection of the uterus and endometrial lining of the uterus from retained products of conception leading to generalized infection.
|
|
|
Partial Birth Abortion:
|
A lay term for a second or third trimester abortion, sometimes referred to as “dilation and extraction”. The cranial contents of the fetus are evacuated prior to the removal of the fetus from the uterus.
|
|
|
*Factors Affecting Spontaneous Abortion:
|
- Advanced age of couple
- Number of previous spontaneous abortions, stillbirths, and previous infants with malformations - *Medical complications (DM, hyperthyroid) |
|
|
MCC of Spontaneous Abortion in the 1st trimester
|
Trisomy
|
|
|
Causes of Spontaneous Abortion:
|
*Abnormal POCs; chromosomal abnormalities
*Unknown *Infections Anatomic defects Endocrine factors Immunologic factors *Maternal systemic disease Trauma Environmental factors (EtOH, radiation) Older age Hx: previous abortion, stillbirth, malformations |
|
|
Infections causing spontaneous abortion
|
Listeria monocytogenes, Mycoplasma hominis, Ureaplasma urealyticum, toxoplasmosis, rubella, CMV
|
|
|
major cause of second-trimester abortion
|
Anatomic defects; congenital abnormalities
|
|
|
Laboratory Findings in spontaneous abortion
|
*Pregnancy test - falling/abn low plasma levels of β-hCG
CBC - bleeding/anemia, WBC/infection, elevated sed rate ABO and Rh - mandatory US - high accuracy in diagnosis (XRays useless) |
|
|
β-hCG in spontaneous abortion?
|
falling or abnormally low plasma levels of β-hCG are predictive of spontaneous abortion
|
|
|
Threatened Abortion:
Treatment Prognosis |
Tx: Bed rest and close observation
Prognosis: Good once all abnormal s/s disappear and pregnancy progresses. |
|
|
Abortion inevitable when 2 or more of the following are noted:
|
Moderate effacement
Dilatation >3 cm ROM Bleeding >7 days Persistence of cramps despite narcotic analgesics Other signs of termination (expulsion of POC) |
|
|
Incomplete Abortion:
Treatment |
Type and cross - blood transfusion (hgb less than 10 g/dl)
5% dextrose in LR with oxytocin D&C remaining tissue Rh immune globulin if indicated |
|
|
Complete Abortion:
Treatment Prognosis |
Tx: Observe patient for further bleeding
Prognosis: Excellent when all POC removed, and r/o molar gestation and choriocarcinoma Important to examine conceptus for completeness and for trophoblastic disease. |
|
|
Missed Abortion:
Treatment |
US, then evacuate uterus
Coagulation problems may develop so check fibrinogen levels weekly until POC removed |
|
|
Septic Abortion:
S/S |
Fever (100.0-105.0F)
Malodorous discharge pelvic/abd pain with suprapubic tenderness peritonitis signs CMT Watch for endotoxic shock --> may have hypothermia Look for trauma to cervix or vagina --> poor attempt to induce abortion |
|
|
Septic Abortion:
Labs |
CBC, UA, UC, culture of discharge, blood cultures, chem profile, coag studies, ABG, CXR, Abd x-ray (look for free air in peritoneal cavity)
|
|
|
Septic Abortion: Minor endometritis
Treatment |
Can be managed outpatient in some patients
antibiotics, oxytocin, fluid replacement |
|
|
Septic Abortion:
Treatment |
*MUST hospitalize ill patients or anyone with ? of sepsis. IV antibiotics and close observation. May need to transfuse. IV oxytocin as necessary. Monitor urinary output.
*D & C to make certain all of products of conception removed. Consider hyst with certain infections (Clostridia) |
|
|
Differential Diagnosis of Spontaneous Abortion:
|
Ectopic
Dysmenorrhea Prolonged hyperestrogenism Hydatidiform mole Cervical neoplasia Ruptured tubo-ovarian abscess |
|
|
Complications of Spontaneous Abortion:
|
*Severe or persistent hemorrhage
Sepsis - usually after self-induced abortion or in women who are immediately sexually active |
|
|
Prevention of Spontaneous Abortion:
|
*Most abortions cannot be prevented. Early OB care and treatment of maternal disease can help.
*Coitus and douches are contraindicated after abortion, and pelvic rest (no sex) will decrease incidence of post-abortal infections. |
|
|
Habitual Abortion:
|
THREE consecutive spontaneous abortions before 20 weeks with a fetus weighing less than 500 g.
|
|
|
Recidive Abortion:
|
TWO consecutive spontaneous abortions before 20 weeks gestation with fetus weighing less than 500 g.
|
|
|
Recurrent Abortion: Etiology
|
*No etiologic factor identified approx 50% of the time
Genetic Anatomic abnormalities of reproductive tract. Hormonal abnormalities (thyroid, progesterone, DM) Infections Immunologic Factors Systemic Diseases |
|
|
Infections implicated in Recurrent Abortion
|
include Mycoplasma, Ureaplasma urealyticum, Toxoplasma gondii, Neisseria gonorrhoeae, Chlamydia, Listeria monocytogenes, HSV, Treponema pallidum, Brucella and CMV
|
|
|
Antiphospholipid Antibody Syndrome (APS):
|
Acquired, multi-system, prothrombotic disorder.
Presence of circulating auto-antibodies against phospholipids compounds. |
|
|
Antiphospholipid Antibody Syndrome (APS):
Is the most common what? |
Most common acquired blood protein defect associated with venous and/or arterial thrombosis.
|
|
|
Presentation of APS:
|
Presence of antibodies
Thrombocytopenia *Recurrent fetal loss Other findings-migraines, Raynaud’s, hemolytic anemia |
|
|
Diagnosis of APS
|
Diagnosis by presence of lupus anticoagulant or titer of IgG anticardiolipin antibodies.
|
|
|
Gestational Trophoblastic Disease (GTD):
|
Abnormal growth of placental trophoblastic tissue.
Appears to result from defective fertilization. Cause is unknown; occurs more frequently in Asians. |
|
|
Gestational Trophoblastic Disease (GTD): Prognosis
|
Rare, but curable disease, even if advanced.
Most GTN is benign and remits spontaneously. |
|
|
Gestational Trophoblastic Disease (GTD): Types
|
1. Complete (hydatidiform/molar) or partial moles
2. Invasive moles (chorioadenoma destruens)-malignant 3. Choriocarcinoma-malignant 4. Placental-site trophoblastic tumor |
|
|
Complete (hydatidiform/molar) or partial moles
benign or malignant? |
Benign
|
|
|
Molar Pregnancy: More common in what race?
|
Asian
|
|
|
Molar Pregnancy: Risk Factors:
|
Previous spontaneous abortions
Use of oral contraceptives Age < 20 y.o. or > 40 y.o. |
|
|
Molar Pregnancy: signs and symptoms
|
Bleeding in first half of pregnancy
Lower abdominal pain Preeclampsia before 24 wks Hyperemesis gravidarum Uterus "large for dates" Expulsion of grape-like “vesicles” from vagina; blood clots Tachycardia, tachypnea and hypertension |
|
|
Signs/Symptoms of Partial molar pregnancy
|
similar to spontaneous or threatened abortion-vaginal bleeding, non-tender uterine fundus, fetal parts may be palpable and fetal heart tones audible, elevated β-hCG.
|
|
|
Which is more severe? partial or complete molar pregnancy?
|
Complete
|
|
|
Diagnosis of Molar Pregnancy:
|
US - "snowstorm" pattern - diagnostic
CXR - can invade other organs Serum β-hCG higher than normal pregnancy values |
|
|
Snowstorm pattern on US is diagnostic of what?
|
Molar Pregnancy
|
|
|
Treatment of Molar Pregnancy:
|
Evacuation with suction curettage or hysterectomy.
+/- chemotherapy if high risk for persistent disease F/u with Serum β-hCG levels, contraception |
|
|
surveillance period of treatment of Molar Pregnancy:
|
F/u with Serum β-hCG every 1-2wks until 3 consecutive samples fall in normal range. Then monthly sample until 6 consecutive normal samples.
Patient to remain on contraception during surveillance period. |
|
|
Persistent Gestational Trophoblastic Neoplasia (GTN):
|
molar tissue or choriocarcinoma; usually non-metastatic but locally invasive
Presentation-uterine bleeding and high β-hCG. Treatment-chemotherapy, hysterectomy |
|
|
Hydatidiform mole
(not from Lord's notes) |
Over-production of the tissue that is supposed to develop into the placenta
Abnormal placental growth, No fetus -often d/t sperm + empty egg (diploid karyotype of solely paternal origin and a complete absence of fetal tissue) |
|
|
Partial Molar Pregnancy
(not from Lord's notes) |
There is an abnormal placenta and some fetal development
-can be d/t egg + 2 sperm or sperm with doubled chromosomes. (triploid karyotype of both maternal and paternal origin and the presence of fetal/embryonic tissue) |
