OB Exam 4- Ectopic and Molar pregnancy

Incompetent cervix

cervix isn’t doing job it’s suppose to ->recurrent and premature dilation of the cervix, passive and painless dilation during the second trimester

Incompetent cervix etiology

history of cervical lacerations, excessive dilation for curettage or biopsy, DES from patients mother, short cervix <25mm, cervical funneling, effacement of internal OS

DES

diethylstilbestrol is a synthetic estrogen to prevent miscarriage and preterm labor that was discontinued in 1971 due to reproductive tract anomalies

Incompetent cervix management

bed rest, hydration, tocolysis, cerclage inserted at 10-14 weeks and removed at 37 weeks for vaginal delivery or c section

Cerclage risks

ROM, preterm, Chorio infection

Abdominal cerclage

Suture is placed at the junction of the lower uterine segment and the cervix to stitch it shut

Cerclage suture

suture around the cervix to "pinch" it and constrict the OS

Ectopic pregnancy

gestational sac is implanted outside the uterine cavity

Ectopic location

95%. in fallopian tube ampullar region, rest in abdominal cavity, ovary, or cervix

Ampullar region

place of conception, ectopic-> stays instead of going to uterus

Ectopic clinical manifestations

missed period, adnexal fullness and tenderness, unilateral pain, bleeding, referred shoulder pain d/t diaphragmatic irritation by blood in peritoneal cavity

Ectopic pregnancy risk factors

STI, PID, reversal of tubal

Ectopic treatment

surgical, tx of hypovolemia if applicable, methotrexate

Methotrexate for ectopic pregnancy

folic acid analog that destroys rapidly diving cells and has high success with low complications

Surgery for ectopic pregnancy

cut open tube and remove it, surgery scars can cause fertility problems and tubes may need to be removed completely

Hydatidiform/Molar Pregnancy

benign proliferative growth of the placental trophoblast in which the chorionic villi develop into edematous cystic transparent vesicles that hand in a grape like cluster

Molar pregnancy risk factors

ovulation stimulation such as clomid, early teens or over 40, history of miscarriage

Complete Molar Pregnancy

fertilization of an egg with a lost of inactivated nucleus resembling bunch of grapes, fluid filled vesicles that grow rapidly usually without fetus, placenta, amniotic membranes, or fluids

Complete molar pregnancy uterus size

bigger than expected

Complete molar pregnancy hemorrhage

hemorrhage into uterine cavity and vaginal cavity d/t no placenta to receive blood

Partial molar pregnancy

two sperm fertilized a normal ovum, have embryonic or fetal parts, and an amniotic space usually with congenital anomalies, 6% malignant transformation

Molar pregnancy clinical findings

normal pregnancy symptoms (bc HCG is present), late vaginal bleeding, prune juice color vaginal bleeding, large uterus

Molar pregnancy management

most abort spontaneously, suction curettage, no induction (increased risk of embolization), RhoGAM if needed, U/S, hCG, chemotherapy (to attack rapidly dividing cells)

Inducing labor with molar pregnancy can cause what

embolism