Pregnancy Complications - OB/GYN EOR

Y'all know how in fanfiction they put a like a signature song, well listen to Avenged Sevenfold lmao for this set of cards

Old maternal age (35+), prior loss, infection (Syphilis, B19, zika, etc), DM, obesity, thyroid disease, stress, factor V leiden, antiphospholipid syndrome, IUD, smoking, caffeine, EtoH, lead, arsenic, radiation

Risk Factors for spontaneous abortion

fetal chromosomal abnormalities (m/c), Maternal anatomical anomalies (fibroids, polyps, adhesions, septa, asherman syndrome), trauma, Rh immunization, malnutrition

Etiology for spontaneous abortion

Uncomplicated bleeding (patient is stable) and cramping

Typical clinical presentation of spontaneous abortion

Missed abortion

Lack of fetal development without cardiac motion on TVUS with NO dilation (dead baby, closed cervix)

Incomplete abortion

Lack of fetal development w/o cardiac motion with incomplete uterine emptying (Cervix, open, dead baby coming out)

Complete abortion

Lack of fetal development w/o cardiac motion with complete uterine emptying (open cervix, dead baby GONE)

Threatened Abortion

Vaginal bleeding and cramping + Fetal development with cardiac motion on TVUS + closed cervix

Thug

Treatment plan for SAB under 13 weeks - EVERYBODY gets RhoGAM

Mifepristone (softens the cervix), Misoprostol (induce contractions), if refractory D and C (1st trimester) or evacuation of the uterus (2nd trimester)

Treatment plan for SAB over 13 weeks or elective abortion - EVERYBODY gets RhoGAM

Septic abortion

An abortion that results in an infection of the uterus characterized by fever, chills, closed cervix, cervical motion tenderness, and foul brown discharge

D and E, Levofloxacin + metro

Treatment for septic abortion

Ectopic pregnancy

A pregnancy in which the egg implants in the wrong spot (usually the ampulla of the fallopian tubes)

previous ectopic, previous tubal surgery (tube is occluded) tubal ligation, tubal pathology, in utero DES exposure, IUD usage, IVF, previous cervicitis or PID, multiple partners, smoking, previous pelvic surgery, douching, early age of intercourse

Risk factors for ectopic pregnancies

Something delays the passage of the fertilized oocyte OR the embryo wants to implant too early

Patho for ectopics

ABD pain, hx of amenorrhea or + pregnancy test, vaginal bleeding

Triad of ectopics

SEVERE abd pain/shoulder pain (Kehr’s), SHOCK type shit (tachy, syncope, hypotension, n/v), look for free fluid on a FAST exam

Presentation of a ruptured ectopic

2 BhCG quant 48 hours apart (failure to double is suggestive), TVUS (diagnostic if you can visual the sac in the wrong spot)

Diagnostics for Ectopic Pregnancy

Discriminatory zone

The serum hCG level above which a gestational sac should be visualized by U/S exam in an intrauterine pregnancy (1500-2000 on TVUS, 6500 on transabdominal)

Methotrexate (2 doses), laparoscopic salpingectomy/salpingostomy, RhoGAM if Rh neg

Treatment for Ectopics

serial beta-hCGs to make sure there is a 15% decrease in 4-7 days

Follow up for ectopics

breastfeeding, immunodeficient, EtOH usage, allergy, lungs/bone marrow/liver/kidneys/stomach are fucked, hCG above 5,000, cardiac motion on U/S, mass over 3.5 cm

C/I for Methotrexate

unstable, impending rupture, C/I to methotrexate, coexisting intrauterine pregnancy, lack of follow up, desire for permanent contraception, failed medical

Surgical management indications for an ectopic

Gestational DM

What develops in pregnant people whose pancreatic beta-cell function is insufficient to overcome the insulin resistance associated with the pregnant state?

placental hormones such as HPL, progesterone, estrogen, and cortisol induce a progressive decline in maternal insulin sensitivity and the beta cells are unable to match the demand

Patho for Gestational DM

Hx of GDM, fam hx of DM, obesity, older maternal age, non-caucasians, PCOS, previous macrosomia

Risk factors for gestational DM

Fetal macrosomia (shoulder dystocia), stillbirth, maternal obesity, Preeclampsia, gestational HTN, polyhydramnios, neonatal hypocalcemia, neonatal jaundice

Fetal complications of gestational DM

24-28 weeks

Screening for Gestational DM occurs when?

50g 1 hr → 100 g 3 hour (140+ is positive for both)

How is gestational DM screened for?

Diabetic diet and exercise (1st line), Insulin, Metformin

Treatment of gestational DM

uncontrolled/macrosomia (38 weeks+), 40wks if controlled/no macrosomia

When is gestational DM an indication for labor induction - check glucose every 2-4 hrs in labor

Gestational Trophoblastic disease (molar preg)

A neoplasm the occurs due to abnormal placental development with trophoblastic tissue proliferation that arises from gestational tissue (non maternal)

Complete (M/C)

A molar pregnancy characterized by NO embryonic/fetal structures, 46XX (with only paternal chromosomes - got in a egg with no nucleus), higher risk of malignant development (choriocarcinoma)

Partial molar

A molar pregnancy characterized by focal trophoblastic proliferation, degeneration of the placenta, and identifiable structures; usually triploid (69XXX or XXY), fetal tissue is NEVER viable

Prior molar pregnancies, under 20 y/o, over 30 y/om Asian

Risk factors for molar pregnancies

Painless vaginal bleeding, pre-eclampsia type shit before 20 weeks, hyperemesis gravidarum, uterus is TOO big for date

Clinical presentation of Molar pregnancies - can be diagnosed at 8 weeks

Beta-hCGs are hella high, TVUS shows snowstorm or cluster of grapes (complete) or normal (partial)

Diagnostics for molar pregnancies

surgical uterine evacuation, weekly beta hCGs, CXR to check for metastasis

Management of molar pregnancies

Choriocarcinoma

A malignant transformation of trophoblastic tissue that appears red/granular when cut and rapidly invades the lung, vagina, CNS, liver, and kidneys

abnormal bleeding for 6 weeks after pregnancy, failure to regress after treatment of a molar

Presentation of Choriocarcinoma

Chemo (allows for future fertility), if nonmetastatic than 1 dose of methotrexate

Treatment of choriocarcinoma - score with FIGO

Incompetent cervix

The inability to maintain a pregnancy secondary to premature cervical dilation (usually in the second trimester)

previous cervical trauma/procedure (Leep or cone), DES exposure in utero, collagen disorder (Ehlers-Danlos, marfans)

Risk factors for an Incompetent cervix

pressure, braxton-hicks like contractions, bleeding/vaginal discharge, painless dilation and effacement of the cervix

Clinical manifestations of an Incompetent cervix - often asymptomatic

Cerclage performed at 14 weeks, bed rest, 17-alpha-hydroxyprogesterone (with history preterm birth hx)

Incompetent cervix management - HARD PASS BRO