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OBGYB: Prego Complications
asdf
67
Anatomy
Pre-School
08/18/2010

Additional Anatomy Flashcards

 


 

Cards

Term

What infection is caused by caused by urinary stasis and glucosuria?

What is the patho behind the infection?

Definition

UTI

 

Stasis-caused by progesterone affect on the smooth muscle of the ureters, mechanical compression of ureters at the pelvic brim, and compression of bladder and ureteral orifices.

Term
pH of urine is increased secondary to _______ promotes bacterial growth in UTI infections
Definition
pH of urine is increased secondary to bicarbonate secretion promotes bacterial growth.
Term

What is the most common organism for UTI infections?

 

What are treatment options?

Definition

E. Coli

 

Treatment options

Ampicillin 500mg 500mg bid

Macrodantin 50 mg qid

Gantrisin 1g qid

 

Term

Why ar eyou treating all pregnant women with a UTI?

 

What are you concerned about?

Definition

Bc higher rate of premature babies and ruptured membranes

Term
What organisms are related to UTI infection?
Definition

Escherichia coli

Klebsiella

Proteus species

Group B streptococci (rare)

Term

What infection OTHER THAN UTI are you concerned about in pregnant woman?

 

What is the treatment?

 

Why are you concerned?

Definition

ACUTE PYELONEPHRITIS

Associated with premature labor

Hospitalization

IV antibiotics

fever, pain, getting dehydrated, when uterus (muscle) gets dehydrated could cramp up and lead to immature labor

Term

Pt presents with profuse, thin gray white discharge. You notice a very unpleasant fish-like odor.

 

Pt complains of itching too.

 

What could it be?

What is the organism causing symptoms?

How do you diagnose?

How do you treat?

Definition

What could it be? bacterial vaginosis

What is the organism causing symptoms? gardnerella vaginalis

 

How do you diagnose?

Pelvic exam

Wet mount clue cells

“Whiff Test” KOH

How do you treat?

Metronidazole 500 mg po BID x 7d or Metronidazole gel 0.75% intravaginally QD x 5

Clindamycin cream 2% intravaginally qhs x 7 or Clindamycin 300mg po BID x 7

 

Term

This medication:

 

need to wait till pregnany lady is in her second trimester to give?

Definition
Flagyl aka metronidazole
Term

If you see clue cells...

 

THINK what?

Definition
Bacterial vaginosis
Term

Pt complains of white, thick, curdy discharge. There is only pain when urine hits her vulva.

 

What could it be?

 

What do you think her pH probably is?

 

How do you diagnose?

Definition

 

What could it be? Candidiasis

 

What do you think her pH probably is? <4.5

 

How do you diagnose? Wet mount

Term
pt with gestational diabetes is more likely to develop what later in life?
Definition
Type II DM
Term

True or false.

 

Gestational DM is reversible.

Definition
True
Term

Lab work...

 

If patient has preexisiting DM...what lab do you need to do?

 

If you want to test for gestational DM- how do you test?

Definition

If patient has preexisiting DM...what lab do you need to do? Hgb A1C

 

If you want to test for gestational DM- how do you test?

Glucose challenge test non-fasting 50g Glucola, drawn after one hour at 24-28 weeks.

If ≥ 140mg/mL then 3 hour test after 100 g glucose load-fasting

 

Term
When do you have patient fast and not fast when doing gestational DM testing?
Definition

Glucose challenge test non-fasting 50g Glucola, drawn after one hour at 24-28 weeks.

If ≥ 140mg/mL then 3 hour test after 100 g glucose load-fasting

Term

When do you start insulin treatment in patient?

 

What does glucose level need to be?

 

What defines someone as having gestational DM?

Definition

105 mg/dL or > START INSULIN RIGHT AWAY

 

Defines gestational DM:

Two or more abnormal values = GDM (gestational DM)

Term

what is the management for pt with gestational DM?

 

What is diet (ie calorie intake)?

 

What type of home glucose monitoring?

 

What should medications be?

Definition

What is diet (ie calorie intake)?

 2300 – 2400 calorie diet

What type of home glucose monitoring?

AM fasting: 90 – 100 mg

2 hour post-breakfast:  <120 mg

 

 

What should medications be?

Insulin-combo NPH and regular

Glyburide 2.5 mg BID, max 10 mg BID

Term

What defines anemia during pregnancy? (ie. hct, hgb)?

 

what increases during pregnancy?

 

What is the most common type of anemia during pregnancy?

Definition

What defines anemia during pregnancy? (ie. hct, hgb)?

defined as a hematocrit less than 30% or a hemoglobin of <10g/Dl. 

 

what increases during pregnancy?

 plasma

 

What is the most common type of anemia during pregnancy?

Iron deficiency Anemia

Term

What is the cause of iron deficiency anemia in the pregnant lady?

 

When do you start tx?

 

What is important to ask pts?

 

What type of weird behavior may use see?

Definition

What is the cause of iron deficiency anemia in the pregnant lady?

 expansion of maternal red cell mass and fetal iron needs

When do you start tx?

 at start of diagnosis of pregnancy

 

What is important to ask pts?

dietary history imp to ask

 

What type of weird behavior may use see?

PICA

Term

What's the treatment for IDA?

 

What should you tell pt about their stool?

Definition

Treatment

Ferrous sulfate 325-mg twice per day.

Hematocrit doesn’t increase significantly, but stabilizes or increases only slightly.

 

Will make pt constipated- stool will be black and very hard; need to drink lots of water; more prone to hemorrhoids-imp to eat foods that will soften stools

 

Ferrous sulfate can be irritating to stomache so take with food. OJ can help with absorption

Term

The fetal and maternal growth during pregnancy requires _____mcg/day of folate

Where do you get folate (what type of foods?)

Definition

800 mcg

 

folate: dark, leafy vegetables

Term
What is the treatment for folate deficiency anemia?
Definition

1mg of folic acid daily-given at diagnosis of pregnancy.

This amount is contained in most prenatal vitamins.

Term

What are the five types of spontaneous abortions?

 

Definition

–Threatened

–Inevitable

–Complete

–Incomplete

–Missed

 

Term
What are risk factors for spontaneous abortion?
Definition

 

–Increasing maternal & paternal age

–Increased parity

Term

What type of spontaneous abortion is this describing?

 

–Bleeding from cervix & cervix is closed.

–Uterine size consistent with gestation

 

Definition
Threatened
Term

What type of spontaneous abortion does this describe?

 

–Cervix dilates & products of conception pass thru os or profuse bleeding

 

what will US show?

Definition

inevitable abortion

 

US will show no products of conception in uterus

Term

What type of spontaneous abortion does this describe?

 

–Part of POC are expelled, some remain in uterus

–Cervix dilated, bleeding.  Uterus enlarged

 

Definition
Incomplete
Term

What type of spontaneous abortion does this describe?

 

–Embryo dies, but POC not expelled

–Uterus smaller than gestational age

–Dark red or brown bleeding

 

Definition
Missed
Term

Pt who comes in and MAY be a spontaneous abortion:

 

what do you want to know?

 

What are you doing on PE?

 

What diagnostic studies?

Definition

what do you want to know?

–Sx of pregnancy & loss of symptoms

–Bleeding; degree & duration

–Cramps, pain, fever

–Attempts to induce miscarriage

 

 

What are you doing on PE?

•P.E.: vitlas, check abdomen, pelvic and bimanual

 

What diagnostic studies?

•Diagnostic Studies: beta quant (make sure number going up), UCG, US, transvaginal US (if very early in pregnancy), coag studies if bleeding a lot, CBC

Term

How do you control bleeding in spontaneous abortion (name the drug)

 

How do you prevent infection? (name the drug)

 

How long can you not have sex in threatened abortion?

 

How do you get fetal contents out of uterus?

Definition

How do you control bleeding in spontaneous abortion (name the drug) methergine

 

How do you prevent infection? (name the drug) doxy

 

How long can you not have sex in threatened abortion? 2-3 weeks

 

How do you get fetal contents out of uterus? dilation and curretage or dilation and excavation

Term

What is this called:

 

What is the patho behind?

Pregnancy that is implanted outside the endometrial cavity

Definition

Ectopic pregnancy

 

Patho:

–Separation of the decidua from endometrium as ectopic pregnancy dies

–Direct bleeding from site of e.p.

 

Term

What are the five risk factors for ectopic pregnancy?

 

 

Definition

–Previous ectopic

–Tubal repair

–Previous pelvic / tubal infections (due to scar tissue, can narrow)

–IUD users

–Maternal age (extremes of age)

Term

Pt presents with the following..what could it be?

 

–Missed menses

–Bleeding

–Pelvic pain

–Positive hCG

–Low grade or absent fever

–Hypovolemia

–Uterus – normal to slightly enlarged

–Adnexal mass if pregnancy is in ovary or tube

 

Definition
Ectopic pregnancy
Term
how do you diagnose ectopic pregnancy? (4)
Definition

–Quantitative beta-hCG’s (levels should be doubling if not could be ectopic)

–Serum progesterone

–Ultrasound; absence of gestational sac/ will be able to see in tube

–Laparoscopy (peritoneal signs)/severe abdominal pain

Term
What are two ways to manage an ectopic pregnancy?
Definition

–Laparoscopic surgical removal

–Methotrexate used for very early pregnancies  (essentially chemotherapy)

Term

The premature partial or complete separation of the placent from its normal implantation..

 

 

What is this?

Definition
Abruptio Placenta
Term
What are risk factors for abruptio placenta?
Definition

–Maternal HTN

–Trauma

–Previous abruption

–Multiple gestation

–Poor nutrition

–Drug abuse (ETOH, cocaine)

–Advanced maternal age (35)

–Uterine anomalies

–Preeclampsia

–Thrombophillia

–Cigarette smoking

Term
Why does this abruptio placenta thing happen?
Definition

–Separation is initiated by bleeding into decidua basalis.

–The decidua splits and the placenta is sheared off.

Term
What is the management for abruptio placenta?
Definition

–Mild abruption- no tx may be necessary

–Follow closely until fetal maturity; may be confused with premature or early labor; expect vaginal delivery.

–After abdominal trauma, patients should be observed closely for at least 24 h., put pt on monitor

Term

Uh oh...

 

What do you do: three things!

 

Moderate to severe cases- of abruptio placenta with fetal distress, loss of fetal heart tones, or maternal signs of shock!!!!

 

Definition

–emergency c-section and resuscitation.

         –Type and cross for 4-6 units

        –Repeat coags and CBC- R/O DIC

Term

Uh oh---

 

Pt has abruptio placenta with

–Moderate to severe cases without fetal distress or maternal hypotension


What do you do? two things

 

Definition

–Vaginal delivery may be attempted with gentle induction with Pitocin

–Monitor for complications post-delivery ie. hemorrhage for the mother

Term

What is this:

 

Defined as implantation of the placenta in lower uterine segment over or near the cervical os. (INTERNAL)

Results in complete or partial coverage of the cervix ahead of the presenting fetal part.

Definition
Placenta previa
Term

What are causes of placenta previa?

 

(6)

Definition

–Implantation affected by:

–Previous uterine surgery (c-section)

–Prior endometrial trauma (D&C, D&E)

–Abnormality of endometrial vascularity

–Delayed ovulation

–Multiparity

–Advanced age

Term

Pt comes in and says they are spotting during the first and second trimseter.

 

They are now in their third trimeser and bleeding again, but they say it's PAINLESS

What could it be?

What would you expect to find on bimanual exam?

Definition

Placenta Previa

–Usually soft, non-tender uterus

–Patients with no prenatal care may present with severe vaginal bleeding

–Most previas are discovered early in prenatal care (US between 12th and 20th week)

Term

What diagnostic studies do you do for placenta previa?

 

What do you NOT do?

Definition

–Pelvic US – to localize placenta

–A 2nd or 3rd US is needed to establish the degree of previa (placenta may migrate)/need to know if covering Os

–CBC

–Coags

–Amnio (lung maturity)

–Clinical examination is to be avoided  May precipitate hemorrhage

Term
How are pts treated with placenta previa with 1-2 episdoes of mild bleeding?
Definition

bed rest, pelvic rest, and tocolytics

 

–Follow closely and monitor CBC

–Steroids for fetal lung maturity

–Delivery by C-section.

 

Term

Post partum hemorrhage:

Bleeding in excess of _____ mL with vaginal delivery or >____ mL with C-section.

 

Definition

Bleeding in excess of 500 mL with vaginal delivery or >1000 mL with C-section.

Term

What is the most common cause of post partum hemorrhage?

 

Other causes?

Definition

Uterine atony – most common cause; uterus is unable to contract and control bleeding

–Severe vaginal or perineal tears, uterine rupture, placenta accreta (deep attachment through endometrium an dinto myometrium- depending on how deep may be cause for post partum hemorrhage), uterine inversion

–Congenital bleeding disorders- von Willebrand’s etc

–DIC (caused by preeclampsia or amniotic fluid embolus)

Term

Pt presents after delivery with the following symptoms:

 

what could it be?

 

Hypovolemic shock – pale, clammy skin; low BP; thready rapid pulse

 

How do you diagnose?

Definition

POST PARTUM HEMORRHAGE

–Vitals

–CBC

–Periphreal blood smear

–PT, PTT, Fibrin split products, fibrinogen

–Type and cross

 

Term

What do you do for the following situations?

 

–Uterine Atony-

–Cervical/vaginal tears-

–Placenta Accreta-

–Uterine Rupture-

–Congenital bleeding dyscrasias-

–DIC-

–All conditions require

 

Definition

–Uterine Atony- Pitocin and bimanual pressure until uterus contracts on its own.

–Cervical/vaginal tears- repair laceration

–Placenta Accreta- uterine artery ligation, hysterectomy or both

–Uterine Rupture- surgical repair or hyst

–Congenital bleeding dyscrasias- consult hematology

–DIC- treat underlying cause, replace clotting factors

–All conditions require volume replacement and control of bleeding

Term
What are three types of HTN seen in pregnancy?
Definition

–Transient / Gestational hypertension

–Preeclampsia

–Eclampsia

Term

•Defined as hypertension present before the 20th week of gestation or beyond 6 weeks postpartum. What is this?

•Blood pressure ____

•Placental size and function _____

•What could happen to baby?

Definition

•Defined as hypertension present before the 20th week of gestation or beyond 6 weeks postpartum. CHRONIC HTN

•Essential

•Blood pressure 140/90 mg Hg or >

•Placental size and function decreased

•What could happen to baby? Fetal hypoxia, malnutrition, and IUGR

Term

Pre-Eclampsia:

 

HTN associated with ____ or ________

 

More common in who (5)

Definition

•HTN with proteinuria or pathologic edema (or both)

•More common in young, primigravida females with twin or molar pregnancies, family Hx, smokers

Term
What's the difference btw mild and severe pre-eclampsia?
Definition

•Mild

–No evidence of end-organ damage

–Normal m.s.e, DTR’s, abdominal exam, LFT and coag studies

•Severe

–Systolic > 160, diastolic > 100

–Proteinuria 2+ or more on dipstick

–CNS effects

–Abnormal liver fx and renal fx

Term

What labs do you want to do for mom with pre-eclampsia?

 

What type of labs for the fetus?

Definition

Mom

 

–CBC

–Platelet count

–PT, PTT

–LFT’s

–RF studies

–24 hour urine for creatinine clearance

–Baseline magnesium

 

Fetal

–ultrasound

–Fetal weight & growth

–Amniotic fluid volume

–Placental status

–NST

–Biophysical Profile

Term
What is NST?
Definition

NST with ultrasound- fetal breathing, fetal movement, quali amniotic fluid level,

Normal 8-10

Equivocal 6

<4 needs intervention

Term

What is the management for mild preeclampsia?

 

What is managemetn for severe preeclampsia?

Definition

•Management: Mild preeclampsia & immature fetus

–Bedrest

–Daily weight, fetal movement & BP readings

–Pt education & instructions

–hospitalization

 

•Management:  Severe preeclampsia / eclampsia

–Hospitalization

–Magnesium sulfate-seizure prophylactic, 4g loading dose IV over 20-30 min., then 1-3g/hr. infusion, frequent eval of respirations and patellar reflex

–Anti-hypertensive-Hydralazine, Nifedipine, Labetalol

–Fetal monitoring

–Steroids

–Delivery: this is the cure!

Term

What is HELLP syndrome?

 

What is it associated with?

Definition

Associatd with Pre-eclampsia

 

•HELLP syndrome (always check CBC and monitor platelets)

–Hemolysis

–Elevated liver enzymes

–Low platelets

•PT, PTT and fibrinogen levels all normal

 

 

Term
Pregnant woman presents with hyper-reflexia, generalized edema and marked proteinuria. What could  that be?
Definition
Eclampsia
Term
What is eclampsia?
Definition

The occurrence of seizures in the woman with criteria of preeclampsia.

Term
What are risk factors for developing eclampsia? (4)
Definition
Headache, n/v, visual disturbances, mean arterial pressure >161 mmHg
Term

True or false.

 

–•Eclamptic seizures may occur 2-10 days post-partum

•Permanent CNS damage may occur

Definition
TRUE
Term

How do you manage pt with eclampsia?

 

 

Definition

–O2, IV access

–Magnesium sulfate 4g IV over 20-30 min.

–Diazepam may be given, not first line

Term
What antihypertensives can be used in pregnancy?
Definition

•Thiazide

•Methyldopa

•Hydralazine

•Propranolol

•Labetalol

•Nifedipine

Term

What should be avoided if you suspect preterm, premature, rupture of membranes?

 

What should be performed?

 

What shoudl be given?

 

What should be signed?

Definition

•Digital vaginal examinations should be avoided.

Ultrasonography should be performed to confirm gestational age, estimated fetal weight, presentation, amniotic fluid index, and fetal anatomy if not already fully evaluated.

Antibiotics need to be given based on present evidence.

Corticosteroids should be given to accelerate lung maturity between 24 and 34 weeks.

Informed consent should be obtained for expectant management versus delivery with careful documentation in the chart.

Term
How do you assess a ruptured membrane?
Definition

taking a proper medical history, a GYN exam using a speculum, nitrazine, cytologic (ferning) tests, and ultrasound. Amniotic fluid, when dried for 10 minutes on a slide and then viewed under a microscope, shows a characteristic fernlike pattern. Cervical mucus can also show ferning, but the fern-like shapes are usually smaller.

Term

What should be performed daily in PPROM?

 

What should happen after 34 weeks to the mother?

 

What should happen at term?

Definition

•Fetal monitoring should be performed at least daily until delivery, and fetal well being and growth should be evaluated periodically with ultrasonography.

•After 32 weeks and certainly after 34 weeks' gestation, the appropriateness of expectant management of PPROM should be reevaluated individually for each case.

•PROM at term should be managed by delivery unless reasons exist to consider waiting for spontaneous labor. Large enough studies to document neonatal safety of expectant management of PROM at term do not exist.

Term
What are maternal factors (2) and fetal factors (4) for developing PPROM?
Definition

•Maternal chorioanmionitis or sepsis. Fetal factors include prematurity, infection, cord prolapse, or malpresentation.

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