Complications Pregnancy

  1. What are the 3 primary causes of vaginal bleeding in the first trimester pregnancies?
    • 1. Spontaneous abortion
    • 2. Ectopic Pregnancy
    • 3. Gestational Trophoblastic disease
  2. This is is a group of conditions in which tumors grow inside a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. The placenta is the organ that develops during pregnancy to feed the fetus

  3. Fill in: Loss of pregnancy before fetus is viable is < __a__ weeks gestation. Or < __b__ gms.
    • a. 20 
    • b. 500
  4. This term occurs when chromosome pairs do not separate during gamete formation or when two sperm fertilize an ovum simultaneously. (an embryo with one or more extra sets of chromosomes.) 

    T or F: It usually results in early spontaneous abortion.
    Polyploidy: True
  5. List 4 complications of Spontaneous abortion
    • 1. hemorrhage
    • 2. infection
    • 3. RH factors
    • 4. DIC (disseminated intravascular coagulation)
  6. What are the six subgroups of Spontaneous abortions?
    • Complete
    • Recurrent
    • Inevitable
    • Incomplete
    • Threatened (50% will succeed)
    • Missed (no cramps/brownish discharge)
  7. What is considered an "early" and "late" abortion?
    • Early: abortion before 12 wk gestation
    • Late: abortion between 12-20 wk gestation
  8. Match abortion type definitions:

    1. All of the products (tissue) of conception leave the body.
    2. Only some of the products of conception leave the body
    3. The pregnancy is lost and the products of conception do not leave the body

    a. Inevitable
    b. Complete
    c. Incomplete
    • 1. b
    • 2. c
    • 3. a
  9. For therapeutic management of spontaneous abortions list interventions that will cover each:

    1. Tests
    2. Meds
    3. Physiological needs
    4. Psychological needs
    • 1. Ultrasound management
    • 2. Prostaglandin (cervical ripening)
    •  - Pitocin and/or Methergine (stimulate UCs)
    •  - abx prn
    • 3. Fluid and blood replacement prn
    •  - rest, hydration, assess s/s of infection
    • 4. support and educationi
    •  - grief counseling
  10. List causes of Ectopic Pregnancies?
    • Tubal occlusion/scarring secondary to PID/IUD
    • smoking
    • inflammation
    • high progesterone
    • surgery
    • douching
  11. T or F: IUD is a form of birth control that can increase the risk for PID (Pelvic Inflammatory Disease).
    True: it can also increase risk for spontaneous abortion
  12. A women who is pregnant shows with these s/s:

     - vaginal spotting (or bleeding)
     - abdominal, pelvic and R shoulder pain
     - Elevated hCG but lower than normal pregnancy
     - Breast tenderness
     - Sudden severe pain in the R or LLQ
    Ectopic pregnancy
  13. What are the diagnostic tests for ectopic pregnancy?
    • Transvaginal ultrasound
    • Serum hCG
  14. Will a surgical procedure (Salpingectomy) be done for an ectopic pregnancy if the fallopian tube is not intact?
    A fallopian tube segment is removed. The remaining healthy fallopian tube may be reconnected. Salpingectomy is needed when the fallopian tube is being stretched by the pregnancy and may rupture or when it has already ruptured or is very damaged.
  15. How is Methotrexate used during an ectopic pregnancy?
    The drug interferes with DNA synthesis and disrupts cell multiplication
  16. If a woman is on Methotrexate tx for an ectopic pregnancy, what will be needed for you to monitor?
    Look for a drop in hCG level, showing that the pregnancy is ending
  17. This disease is a group of conditions in which tumors grow inside a woman's uterus, and the abnormal cells start in the tissue that would normally become the placenta.

    A baby may or may not develop.

    How will hCG levels look compared to other normal pregnancies?
    Gestational trophoblastic disease: hCG extremely elevated d/t large amounts of chorionic villi multiplying
  18. What could these s/s indicate:

     - Red brownish discharge at 16th week
     - Uterus larger than expected
     - Elevated BP before 24 week gestation (early dev. of PIH)
     - Extremely elevated hCG (as high as 1-2 million IU; 300k normally)
    Gestational trophoblastic Disease
  19. What will be the diagnostic and tx for Molar Pregnancy (GTD)?
    • Diag.: Ultrasound
    • Tx: chest x-ray
    •  - Metabolic and blood chem
    •  - hCG tests
    •  - CBC, blood type and clotting factors
    •  - treat htn
    •  - possible evauation of mole by vacuum aspiration
    •  - follow up
  20. This term is a condition in which the placenta partially of fully blocks the uterus for normal delivery
    Placenta Previa
  21. These conditions in a women can all increase the risk factor for what?
     - multiparas
     - prior  c-sec
     - prior D&C
     - smoking and cocaine use
    Placenta Previa
  22. What do you want to avoid with a patient who has Placenta Previa?
    • Avoid cervical exams
    • Avoid administration of oxytocin or prostaglandins
  23. This term is a rare but serious complication in which the pacenta grows so deeply in the uterine wall that it is unable to detach after childbirth.
    Morbidly Adherent Placenta
  24. Match the type of MAP:

    1. Placenta grows in the uterine lining
    2. Placenta grows into the muscular wall of the uterus
    3. Placenta grows through the wall of the uterus and in some cases into adjacent organs

    a. Increta
    b. Accreta
    c. Percreta
    • 1. b
    • 2. a
    • 3. c
  25. This term is the separation of the placenta before fetus is born
    Placental Abruption
  26. List steps if a mom is suspected of Abruptio Placentae. If stable? Unstable?
    • Hospitalization
    • Stable: bed rest, steroids for fetus
    • Unstable: Immediate delivery by c-sec
    • Replace fluid and blood PRN
  27. This is a rare condition that causes blood clots reducing blood flow and can block blood from reaching bodily organs. As condition progresses, platelets and clotting factors in the blood are used up and you will experience excessive bleeding.
    Disseminated Intravascular Coagulation
  28. What are 2 possible tx of DIC?
    • 1. Delivery of fetus and placenta
    • 2. Blood product replacement
  29. How can pre-eclampsia effect the placenta? 4
    • - infarctions increase risk of abruption and DIC
    •  - Premature aging (IUGR) or delayed growth
    •  - Thrombosis
    •  - Calcifications
  30. List 3 management interventions for severe Pre-eclampsia
    • 1. strict bed rest
    • 2. Annticonvulsant medication (magnesium sulfate) Lowered CNS
    • 3. Antihypertensive meds
  31. What 2 HTN meds are used for severe pre-eclampsia
    • Nifedipine
    • Labetalol
  32. What is HELLP stand for and which condition is it used for?
    • Severe Pre-Eclampsia
    • Hemolysis
    • Elevated Liver enzyme
    • Low Platelet count
  33. 90% of patients with severe pre-eclampsia experience this

    65% of these patients experience this

    31% experience this
    • Malaise: (general feeling of discomfort, illness, or uneasiness whose exact cause is difficult to ID)
    • Pain in the RUQ, lower chest or epigastric area
    • HA
  34. What are the 2 diagnostic tests for HELLP?
    CBC and LFT
  35. What are tx for HELLP?
    • Seizure precautions
    • Keeping BP <160/110
    • If close to term, deliver ASAP
    • Transfusion PRN
    • Corticosteroids for fetus PRN
  36. What seizure meds will be given for HELLP syndrome and why?
    Magnesium sulfate to lower CNS irritability
  37. What will be given if the baby is Rh+ and the mother is Rh-? When is it given?
    RhoGAM to prevent antibody formation: given at 28 weeks gestation and after birth if baby is Rh+
  38. Which increased human placental hormones in later pregnancy cause increased resistance to insulin and decreased glucose tolerance?
    • Lactogen
    • Prolacctin
    • Cortisol and glycogen levels also
  39. How is the Glucose screening done?
    • Glucose challenge test @24-28 weeks: 50 gram load - test 1 hour
    • If >140, schedule 3 hour oral glucose tolerance test
    •  - GTT: take BG after fasting, and then at 1, 2, and 3 hours after ingestion of a 100g oral glucose.
  40. State whether insulin requrements will increase or decrease in the stage of pregnancy:

    1. Early pregnancy
    2. Second Trimester
    3. End of Pregnancy
    • 1. decreased
    • 2. Increased
    • 3. May double or quadruple
  41. T or F: Insulin does not cross the placental barrier
    True: Fetus starts producing insulin at 10 weeks.
  42. Fill in:
    The fetus starts producing insulin at ___ weeks.
  43. What happens to the fetus if it is exposed to high levels of glucose?
    It produces excessive insulin which acts as a growth hormone: Macrosomia
  44. List the risks of pregnancy with diabetes
    • Hydramnios (10-20%) with PROM
    • Pre-eclampsia
    • UTI & vaginitis
    • Labor dystocia (difficult or slow labor)
    • Birth injury to maternal tissue
  45. List 4 screening and assessment for a fetus/neonate
    • 1. Glucose challenge test @24-28 weeks 
    • 2. Oral glucose tolerance test
    • 3. Urine dip
    • 4. Obtain baseline; ECG and opthalmic exam
  46. What is the most common complication of pregnancy that is associated with preterm labor and low birth weight in extreme cases?
    Iron deficiency anemia
  47. What is iron deficiency anemia defined as in a pregnancy (lab value)
    Hgb <11g/dL
  48. List complications of anemia in pregnancy
    • 1. More susceptible to infections
    • 2. Delayed healing of wounds
    • 3. Fatigue
    • 4. PP hemorrhage
    • 5. Pre-eclampsia
    • 6. LBW
  49. What is the supplement dose for anemia to start?
    • 30mg/day: give wth OJ
    • Folate supplements as high as 1mg/day
  50. What are adolescent pregnant moms have a higher risk for?
    • Preterm
    • LBW
    • Pre-eclampsia
    • Iron deficiency anemia
    • CPD (when baby's head or body is too large to fit through mom's pelvis)
  51. Will Hydatidiform mole (Molar pregnancy) have high or low hCG levels?
    Extremely high (1-2 million IU; normal = 300k)
  52. What can a sudden onset of painless uterine bleeding in the latter of pregnancy indicate?
    Placenta Previa
  53. Fill in: What do you want to avoid doing with a placenta previa? (2)
    • Avoid cervical exams
    • Avoid admin of oxytocin or prostaglandins
  54. What are the different types of MAP? (morbidly adherent placentas)
    • Accreta: invasion of trophoblastic cells into superficial layers of uterus 
    • Increta: invasion into the myometrium
    • Percreta: involves invasion beyond uterine serosa
  55. T or F: Placenta abruption is painful, and placenta previa is painless
  56. T or F: Placenta abruptions can lead to rapid labors
  57. What can these s/s indicate:
    abdominal and back pain
    frequent contractions
    non-reassuring FHR
    Abruptio Placentae
  58. Define: anticoagulation and procoagulation factors are stimulated at the same time. This results in a decrease in clotting factors and an increase in anticoagulants, leaving the mom unable to clot
    DIC: dessiminated intravascular coagulation
  59. What a risk of doing a c-sec on a mom who has a deceased fetus?
    DIC: best to induce mom and deliver fetus and placenta vaginally
  60. Pre-eclampsia is defined as...
    • >140/90 after 20 weeks
    • Proteinuria
  61. What is the difference between pre-eclamp vs. gestational hypertension
    No proteinuria AFTER 20 WEEKS
  62. What is IUGR (intrauterine growth restriction) associated with?
    Pre-eclampsia: placental insufficiency d/t pre-elcmapsia
  63. What are nutritional recommendations for pre-eclampsia?
    Protein and calcium increase d/t nutritional deficiencies of the fetus
  64. What can genrelized edema indicate: face, hands, chest
    Pre-eclampsia: Lower extremity edema can be normal findings
  65. What labs to look at with pre-eclampsia?
    • CBC with platelets <10%
    • Uric acid
    • BUN
    • Cr
    • LFTs (hepatic edema with high AST)
  66. How does pre-eclampsia effect the placenta? 4
    • 1. infarctions increasing risk of abruption and DIC
    • 2. Premature aging - IUGR
    • 3. Thrombosis
    • 4. Calcifications
  67. Which antihypertensive medications are used for severe pre-eclampsia? Which for seizures?
    • Nifedipine
    • Labetalol
    • anticonvulsant: Mag sulfate
  68. This acronym is a severe form of pre-clampsia with multiple organ damage
    • HELLP
    • Hemolysis
    • Elevated Liver enzymes
    • Low Platelet count
  69. Why are corticosteroids used for HELLP?
    For fetus who is preterm and needs it for lung maturity
  70. What does HPL do in late pregnancy?
    Increased resistance to insulin and decreased glucose tolerance
  71. What weeks do you screen for HPL?
    28 weeks: human placental lactogen for GDB
  72. What does it mean for a fetus to develop Macrosomia?
    LGA d/t increase insulin production from high levels of glucose exposure. Insulin acts as growth hormone.
  73. Hgb below this defines anemia.
    11 g/dL
  74. GBS can cause this in the newborn which can be fetal
  75. s/s of pre-eclampsia
    • BP
    • Proteinuria
    • Brisk DTR
    • HA
    • Visual disturbances
    • Epigastric pain
    • decreased UO
    • Edema and rapid weight gain
  76. What do these s/s indicate:

    vaginal bleeding: red/brown at 16 weeks
    Uterus larger than expected
    Elevated BP before 24 gestation (PIH)
    Extremely high hCG  
    Severe n/v
    Hydatidiform Mole (Molar Pregnancy) or Gestational Trophoblastic Disease
  77. At what weeks do moms deliver who have gesstational diabetes?
    39 weeks
  78. Which anticoagulant if needed is used during pregnancy?
    Heparin because it doesn't cross the placenta
Card Set
Complications Pregnancy
Lecture notes