Ob/Peds- Exam 1- Pregnancy Concerns

What is it when a fertilized egg implants outside the uterus

Ectopic pregnancy

Most common location for ectopic pregnancy

Fallopian tubes

Prevalence of ectopic pregnancy

1-2%

Ectopic pregnancy is what type of situation

Medical emergency

Patient presentation and common sympomts

Abdominal pain and vaginal bleeding

-sharp stabbing pain in pelvis or abdomen, shoulder pain, dizziness or fainting

Findings of ectopic pregnancy on physical exam

Tenderness in abdomen, particularly on one side and opposite cervical motion tenderness (chandelier sign)

Diagnostic tests for ectopic pregnancy

Ultrasound

Blood tests

Minimally invasive surgery to remove ectopic pregnancy

Laparoscopy

More extensive surgery if there is significant internal bleeding with ectopic pregnancy

Laparotomy

Spontaneous loss of pregnancy before the 20 week

Miscarriage

Prevalence of miscarriage

20%

Presentation and symptoms of miscarriage

Vaginal bleeding and abdominal pain

Cramping, back pain, passing tissue or clots from vagina

What do you find on physical exam for miscarriage

Cervical dilation and presence of tissue in vaginal canal

What is a pregnancy complicated by bleeding before 20 weeks gestation

Threatened miscarriage

What miscarriage is when the cervix has dilated but the products of conception have not been expelled

Inevitable miscarriage

What miscarriage is when all products of conception have been passed without need for surgical or medical intervention

Complete miscarriage

What miscarriage is when some, but not all, of the products of conception have been passed, retained produces may be part of the fetus, placenta or membranes

Incomplete miscarriage

A pregnancy in which there is a fetal demise but no uterine activity to expel the products of conception

Misses miscarriage

A miscarriage complicated by intrauterine infection

Septic miscarriage

Three or more consecutive pregnancy losses

Recurrent spontaneous miscarriage

High risk factors for miscarriage

Over 35 and previous miscarriages

Surgical procedure to remove tissues from the uterus after miscarriage

Dilation and Curettage (D&C)

What are 2 ways to remove uterine contents after miscarriage?

Dilation and Curettage (D&C)

Manual vacuum aspiration

Placenta partially or completely covers the cervix

Placenta previa

Placenta previa may cause?

Severe bleeding before or during delivery, requiring careful management

Placenta previa presentation and symphony's

Painless, bright red vaginal bleeding in 2nd or 3rd trimester

Sudden onset of bleeding, no pain or mild cramping

Risk factors for placenta previa

Previous C section

Multiple pregnancies

Ages 35 and older

Placenta detaches form the uterine wall before delivery

Placental abruption

Placental abruption can lead to?

Severe complications for both mom and baby

Heavy bleeding and preterm birth

Placental abruption presentation and symptoms

Sudden onset of abdominal pain, vaginal bleeding and uteri contractions

Severe abdominal pain, back pain, uterine tenderness, decreased fetal movement

What is a big thing in the patient history that is a concern for placental abruption to occur

Hypertension

What is the most common class of placental abruption?

Class 1

Biggest risk factor for placental abruption

Hypertension

Normal levels of amniotic fluid for 20-36 weeks

500-1000

Excessive amniotic fluid

Polyhydramnios

Insufficient amniotic fluid

Oligohydramnios

Symptoms of polyhydramnios

Rapid growth of uterus, discomfort, difficulty breathing, swelling of lower extremities

Patient history of polyhdramnios

Diabetes, multiple pregnancies or fetal abnormalities

Polyhdramnios findings of physical exam

Excessive uterine size for gestational age, difficulty palpating fetus

Symptoms of oligohydramnios

Decreased fetal movements, small uterine size, leaking of amniotic fluid, uterine constraint

Patient history of oligohyramnios

Rupture of membrane, maternal dehydration or fetal conditions

Oligohydramnios findings on examination

Smaller than expected uterine size, easily palpable fetal parts

Biggest thing to use Oligohydramnios

Drink lots of fluids, or IV if its severe enough

Pregnancy complications characterized by high blood pressure and signs of damage to other organ systems, often the liver and kidneys

Preeclampsia

What is the onset of seizures in a women with preeclampsia

Eclampsia

Preeclampsia symptoms

High blood pressure and prteinuria

Eclampsia symptoms

All preeclampsia symptoms plus seizures or convulsions

Risk factors for preeclampsia or eclampsia

First pregnancy

Increases risk in women younger than 20 or older than 40

Best thing to do for preeclampsia

Bed rest

Eclampsia requires

Emergency care

Diabetes that develops during pregnancy and usually resolves after delivery

Gestational diabetes

Symptoms of gestational diabetes

Excessive thirst, frequent urination, fatigue and blurred vision

Screening test for gestational diabetes

Glucose Challenge Test (GCT)

Oral glucose tolerance test (OGTT)

What is an initial screening test for gestational diabetes that is usually done between 24-28 weeks of gestation and a 1 hour long test

Glucose Challenge Test (GCT)

What is a follow up test for gestational diabetes if GCT is baronial and confirming the diagnosis, and requires fasting and takes up to 3 hours to do

Oral glucose tolerance test (OGTT)

Risk factors for gestational diabetes

Women over 25

Obesity

African American, Hispanic, Native American and Asian

Polycystic ovary syndrome (PCOS)

Gestational diabetes complications for the mother

Preeclampsia

Risk of type 2 diabetes

Increased risk of cesarean section due to large baby size

Gestational diabetes complications for the baby

Macrosomia (increased birth weight, increases risk of injury)

Hypoglycemia

Respirator Distress Syndrome

Increased risk of obesity and type 2 diabetes later

What helps regulate infant blood glues with gestational diabetes

Breastfeeding

Severe form of nausea and vomiting during pregnancy that can lead to dehydration, weight loss and electrolyte imbalances

Hyperemesis Gravidarum

Symptoms of hyperemesis gravidarum

Persistent and severe nausea and vomiting

Group of rare tumors that involve abnormal growth of cells inside a women's uterus (cells are multiplying but not differentiating)

Gestational tophoblastic disease (GTD)

Complete or partial testimonial tophoblastic disease (GTD)

Hydatidiform mole

Gestational tophoblastic disease that has molar tissues that invades the muscle layer of the uterus

Invasive mole

A fast growing cancer that can spread to other parts of the body

Choriocarcinoma

Rare form of gestational trophoblastic disease that arises from the placental implantation site

Placental-site trophoblastic tumor (PSTT)

Big symptom of gestational trophoblastic disease (GTD)

Vaginal bleeding

Finings of gestational trophoblastic disease on Physical exam

Larger or smaller than expected uterus, absence of fetal heart tones

Presence of ovarian cyst due to high hCG levels

Risk factors foe gestational trophoblastic disease

Women over 35 or under 20

Nutritional deficiencies (low carotene or vitamins A intake)

What do you see on ultrasound for diagnosis if hydatidiform mole and one other diagnostic feature

Vesicular or "snowstorm" pattern

HCG levels will be elevated compared to normal

When does a mom start to feel kicks

2nd trimester, 16-20 weeks

2nd trimester skin changes

Linea nigra

Melisma

Striagravidrum

Spider veins

Linea nigra

Melasma

Striae gravidarum

Spider veins

When does fetal drop occur? What is it and what does it cause

3rd trimester

Belly now sits a little bit lower

Causes more pressure on bladder

Accentuation of lordosis

Diaphragm may do what during pregnancy? What does this cause a higher risk of?

May sit 4cm higher

Increased risk of dyspnea

Blood increases how much during pregnancy

40-50%

Separation between the 2 sides of the recuts abdominals muscle

Diastasis recti