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38 Cards in this Set

  • Front
  • Back
Risk factors for Ectopic Pregnancy
1. h/o STIs or PID
2. prior ectopic preg
3. tubal surgery
4. previous pelvic or abd surgery
5. endometriosis
6. preg with IUD in place
7. preg resulting from assisted repro
8. DES exposure in utero--congenital abn
Signs and symptoms of ectopic preg
lower abd pain (often unilateral), vaginal bleeding, adnexal mass, uterine size small for gestational age
At what BhCG level should fetal cardiac activity be seen?
> 5000mIU/mL
Ddx for bleeding in the first trimester
1. spontaneous abortion
2. postcoital bleeding
3. ectopic pregnancy
4. vaginal or cervical lesions or lacerations
5. extrusion of molar pregnancy
6. non-pregnancy causes
incompetent cervix vs preterm labor
cervical incompetence- painless dilation and effacement of the cervix

preterm labor- contractions leading to cervical change occurring at <37 weeks gestation
common findings in incompetent cervix
infection, vaginal discharge or bleeding, and rupture of membranes
(may have mild cramping or pressure in the lower abd--caused by cervical dilation and exposed membranes)
risk factors for cervical incompetence
1. h/o cervical surgery such as cone bx or dilation of the cervix
2. h/o cervical lacerations with vaginal delivery
3. uterine anomalies
4. h/o DES exposure in utero
Tx of incompetent cervix
1. If previable (<24 weeks gestation)-- elective termination is an option
2. viable-- betamethasone and bedrest
3. previable-- emergent cerclage placement
cerclage
-- tx for cervical incompetence-- suture placed vaginally either at the cervical-vaginal junction (McDonald cerclage) or at the internal os (Shirodkar cerclage) to close the cervix.
comp- infection, preterm labor, ROM
How long is a cerclage left in place?
until 36-38 weeks

(if electively placed-- then usually done at 12-14 weeks)
When are transabdominal cerclages placed? How should these women deliver?
TAC are placed after one or both types of vaginal cerclage have failed. patients need to deliver by c/s
recurrent pregnancy loss
three or more consecutive spontaneous abortions (incidence is < 1% of pop)
Risk of SAB after 1 SAB? two consecutive SABs? 3 consecutive SABs?
after 1 - 20-25%
after 2- 25-30%
after 3- 30-35%
ddx for recurrent pregnancy loss
1. chromosomal abns
2. maternal systemic disease
3. maternal anatomic defects
4. infection
4. antiphospholipid antibody syndrome (15%)
5. luteal phase defect (lack adequate progesterone levels to maintain a pregnancy)
Work-up for recurrent pregnancy loss?
1. karyotype of both parents as well the product of conceptus from previous abortion if possible
2. hysterosalpingogram (HSG)
3. if HSG non-dx or abnormal then laparoscopic exploration
4. screening for hypothyroidism, DM, SLE, hypercoaguability (factor V leiden, prothrombin G20210A, protein c or s deficiency. antithrombin III deficiency, ANA, anticardiolipin ab, russell viper venom
5. check level of serum progesterone in the luteal phase of the menstrual cycle
6. cultures of cervix, vagina and endometrium
1. tx of antiphospholipid antibody syndrome during pregnancy?
2. thrombophilia?
1. low dose aspirin
2. subQ heparin or LMWH
abortus
fetus lost before 20 weeks gestation, <500 g, or <25cm
complete abortion
complete expulsion of all products of conception (POC) before 20 weeks gestation
incomplete abortion
partial expulsion of some but not all POC before 20 weeks gest
inevitable abortion
no expulsion of POC, but vaginal bleeding and dilation of the cervix such that a viable pregnancy is unlikely
threatened abortion
any vaginal bleeding before 20 weeks, without dilation of the cervix or expulsion of any POC
missed abortion
death of the embryo or fetus before 20 weeks with complete retention of POC
D&C vs D&E
dilation and curretage
dilation and evacuation- - perofrmed between 16-24 weeks. requires aggressive dilation with laminaria (small rods of seaweed placed in the cervix the day before that expand as they absorb water)
what is the most common disease causing genetic mutation in caucasians
cystic fibrosis- delta 508
1 in 29 are carriers
what disease should all pregnant african americans be screened for?
sickle cell disease-- hemoglobin electrophoresis- AR
symptoms of tay sachs?
first develop after 3-10 months: decreased alertness, hyperacusis, cherry red macula-- 1 to 3 months later may have myoclonic or akinetic seizures
eventually paralysis, blindness and dementia with death by age 4
management of placental abruption
depends on the extent
- if severe-- delivery by c/s
- monitor vitals, IVF
-kleihauer betke to determine amount bleeding has taken place ( thus how much rhogam needed and need for fetal transfusion)
- Rhogam if Rh -
Couvelaire uterus
purple or blue appearance of uterus due to severe penetrance of blood into uterus secondary to placental abruption
Coagulation abnormalities associated with placental abruption
1. inc PT and PTT
2. dec serum fibrinogen
3. dec platelet counts
4. DIC (rare)
most common cause of coagulopathy during pregnancy?
placental abruption
vasa previa
passage of fetal blood vessels over the internal os below the presenting part of the fetus
2 ways vasa previa can occur
1. velamentous insertion-- fetal blood vessels insert into membranes between amnion and chorion instead of into placenta-- not protected by warton's jelly
2. there is a accessory/succenturiate lobe across the os from the main placenta
succenturiate lobe of placenta
a second or third placental lobe that is much smaller than the largest lobe- often has areas of infarction or atrophy
-The membranes between the lobes in such placenta can be torn during delivery, and the extra lobe can be retained after rest of the placenta has been delivered, with consequent postpartum bleeding.
1. incidence of vasa previa?
2. fetal mortality if vasa previa undetected before delivery
1. 1 in 2500
2. 60%
What must be done prior to AROM to prevent bleeding?
feel for pulsating vessels at the os to ensure there is no vasa previa
Apt test
test performed to distinguish maternal from fetal blood
- blood specimen mixed with water to cause hemolysis and then centrifuge -- take off supernatant (liquid above packed cells at bottom of tube)-- mix with NaOH
- fetal blood remains pink and maternal blood turns yellow-brown
uterine rupture
spontaneous complete transection of the uterus from the endometrium to serosa
- if peritoneum remains intact- then referred to as partial rupture or uterine dehiscence
- most commonly at the site of previous c/s
incidence of fetal mortality in complete uterine rupture with fetal expulsion into abdomen?
management
50-75%, survival depends on if placenta remains attached to the uterine wall
-stabilize, c/s imperative