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Flashcards in Pregnancy Complications Deck (102)
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1

Complications of Pregnancy

Spontaneous abortion
Ectopic pregnancy
Gestational trophoblastic disease
Placental abnormalities
Hyperemesis gravidarum
Premature rupture of membranes
DM
Thyroid disease

2

Define Spontaneous Abortion

Loss of a fetus at less than 20 weeks gestation
"Miscarriage"

3

Etiology of Spontaneous Abortion

Chromosomal defects (60%)
Maternal trauma
Infections
Dietary deficiencies
DM
Hypothyroidism
Anatomic malformations: incompetent cervix
Undetermined (25%)

4

Risk Factors for Spontaneous Abortion

Advanced maternal age
Previous spontaneous abortion
Maternal smoking

5

Symptoms of Spontaneous Abortion

Bleeding: bright red, heavy
Midline cramping
Low back pain
Open or close cervical os
Complete or partial expulsion of products of conception

6

Subtypes of Spontaneous Abortion

Threatened
Inevitable
Incomplete
Complete
Missed

7

Define Threatened Spontaneous Abortion

Os close
Unpredictable outcome: can have a viable pregnancy

8

Define Inevitable Spontaneous Abortion

Os open
Products of conception have not passed
Pregnancy can not be saved

9

Define Incomplete Spontaneous Abortion

Os open
Some products of conception have passed

10

Define Complete Spontaneous Abortion

Os open or closed
Products of conception have passed

11

Define Miss Spontaneous Abortion

Pregnancy didn't develop
+ pregnancy test, then heavy period week later

12

Threatened Abortion

Slight bleeding
Abdominal cramping
Cervical os closed
Uterine size compatible with dates
No products of conception are passed
Prognosis is unpredictable

13

Treatment Measures for Threatened Abortion

Best rest for 24-48 hours with gradual resumption of usual activities
No work, child care, or sexual intercourse
Rest in horizontal position except bathing & using toilet
Infection: antibiotics
Hydration
Explicit instructions when to report signs/symptoms
Definitive follow up date

14

Treatment Contraindications for Threatened Abortion

Hormonal therapy

15

Inevitable Abortion

Moderate bleeding
Moderate/severe uterine cramping
Low back pain
Cervical os is DILATED
Membranes may or may not be ruptured
Uterine size is compatible with dates
Products of conception are not passed but passage is inevitable
Prognosis poor

16

Incomplete Abortion

Heavy bleeding
Moderate/severe abdominal cramping
Low back pain
Cervical os is DILATED
Uterine size is compatible with dates
Some portion of the productions of conception remain in the uterus
Pregnancy cannot be saved

17

Missed Abortion

Pregnancy ceased to develop, products of conception have not been expelled
Symptoms of pregnancy disappear
Brownish vaginal discharge but no free bleeding
Pain does not develop
Cervix is semi-firm & slightly dilated
Uterus becomes smaller & irregularly softened

18

Treatment for Missed, Inevitable, and Incomplete Abortions

Counseling regarding fate of pregnancy
Assess Rh factor & administer immunoglobulin
Planning for elective termination

19

Elective Termination Strategies

D&C: empty all products of conception; prevent infection & hemorrhage
Insertion of laminar to dilate cervix follow by aspiration (missed)
Prostaglandin vaginal suppositories (alternate)

20

Complete Abortion

Bleeding may be heavy or minimal
Moderate/severe abdominal cramping
Low back pain
Fetus & placenta completely expelled
Pain ceases but spotting may persist
Cervical os open or closed
Uterus is normal pre-pregnancy size

21

Define Habitual Abortions

Recurrent pregnancy loss/habitual abortions if 3 previous pregnancies

22

Evaluation of Suspected Spontaneous Abortion

H&P
+/- fetal doppler
+/- transvaginal US
+/- labs: serum hCG, blood type & Rh factor

23

Workup for Recurrent Pregnancy Loss

Assessment of uterine structure*
Rule out lupus*
TSH*
Blood glucose
Genetic: maternal & paternal
Day 3 FSH levels
Progesterone levels

24

Follow Up of Spontaneous Abortion

GYN exam 2-3 weeks later
Contraception for 3 months to allow complete healing & regeneration of endometrial lining

25

Define Ectopic Pregnancy

Implantation of fertilized ovum outside of the uterine cavity

26

Locations for Ectopic Pregnancy

Fallopian tube (98%)
Cervix
Ovary
Abdominal cavity

27

Ectopic Pregnancy

Rupture inevitable
Potentially life-threatening
MAJOR CAUSE OF MATER DEATH DURING 1ST TRIMESTER

28

Risk Factors of Ectopic Pregnancy

History of genital infections*
History of infertility*
History of tubal pregnancy*
History of any ectopic pregnancy*
Intrauterine devices*
Abdominal or pelvic surgery
History of ruptured appendix
Intrauterine exposure to DES
Use of drugs that slow ovum transport

29

Natural History of Ectopic Pregnancy

Rupture: significant hemorrhage
Abortion: expulsion of products
Spontaneously resolve

30

Classic Presentation of Ectopic Pregnancy

1-2 months of amenorrhea
Morning sickness
Breast tenderness
Diarrhea, urge to defecate
Malaise & syncope
Lower abdominal/pelvic pain: sudden/severe, especially adnexal
referral of pain to shoulder