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OBS GYN PATHOLOGY
Gestational Hypertension
New-Onset Hypertension
> 20 Weeks Gestation
Risk Factors
Nulliparity
Obesity
African American Females
> 35 years Old
Multiple Gestations
Family History of Gestational HTN (or Preeclampsia)
Complications
IUGR
Prematurity
Abruptio Placentae
Management
Fetal Monitoring
Alpha-Methyldopa
Beta-Blockers (Labetalol)
Calcium Channel Blockers
Hydralazine
4 mins
Preeclampsia Assessment
After 20 Weeks of Pregnancy
Mild
Hypertension > 140/90
Proteinuria or End-Organ Dysfunction
Severe
Hypertension > 160/110
Progressive Renal Insufficiency
Vision Changes
HELLP Syndrome
Pulmonary Edema
2 mins
Preeclampsia Interventions
Side Lying Position and Bedrest
Antihypertensives
Magnesium Sulfate
Labor Induction
1 min
Eclampsia
Mechanism of Action
Increased Central Nervous System Irritability
Signs and Symptoms
Hyperreflexia
Positive Ankle Clonus
Headaches
Visual Disturbances
Epigastric or RUQ Pain
Seizures
Coma
Considerations
Don't Leave Bedside
Magnesium Sulfate
2 mins
Severe Preeclampsia
Mechanism of Action
Vasospasm and Decreased Organ Perfusion
Intravascular Coagulation
Increased Permeability and Capillary Leakage
Signs and Symptoms
Hypertension
Proteinuria or End-Organ Dysfunction
HELLP Syndrome
Hepatic Dysfunction and Hemolysis
Elevated Liver Enzymes
Low Platelet Counts
3 mins
Hyperemesis Gravidarum
Signs and Symptoms
Excessive Vomiting
Significant Weight Loss
Dehydration
Hypotension
Electrolyte Imbalance
Interventions
Antiemetics
Frequent Small Meals
IV Therapy
2 mins
Chorioamnionitis
Fever
Maternal or fetal tachycardia
Leukocytosis
Foul Odor to Amniotic Fluid
Treatment: Antibiotics
Monitor uterine tenderness, contractions and fetal activity
Monitor maternal vital signs & FHR
2 mins
Spontaneous Abortion Overview
Assessment
Bleeding < 20 weeks Gestation
Interventions
Identify Type
Bed Rest
Monitor for Hemorrhage
Save Pads and Linens
RhoGAM
Dilation and Curettage (DandC)
Cerclage
Emotional Support
2 mins
Spontaneous Abortion Types
Missed Abortion
No Fetal Heartbeat, No Cervical Dilation, No Bleeding
Threatened Abortion
No Cervical Dilation and Minimal Bleeding
Inevitable Abortion
Bleeding and Cervical Dilation with No Loss of Products of Conception
Incomplete Abortion
Bleeding and Cervical Dilation with Loss of Some Products of Conception
Complete Abortion
Bleeding with No Cervical Dilation, with Loss of All Products of Conception
2 mins
Hydatidiform Mole (Molar Pregnancy)
Cause/Mechanism
Abnormal Fertilization
Assessment
Symptoms of Pregnancy
Elevated hCG
Vaginal Bleeding
Inappropriate Uterine Growth
No Fetal Heart Rate (FHR)
Interventions
Dilation and Curettage (D&C)
Emotional Support
Considerations
No Pregnancy 1 Year
Hysterectomy
3 mins
Complete Hydatidiform Mole
Characteristics
Gestational Trophoblastic Disease
Fertilization of Enucleated Egg
Diploid Fetal Karyotypes
Hydropic Chorionic Villi
Presentation
Vaginal Bleeding
Preeclampsia
Diagnosis
Increased Beta hCG
"Snowstorm" / "Bunch of Grapes" Appearance
Theca Lutein Cysts
Considerations
Dilation and Curettage (D&C)
Methotrexate
Increased Risk of Choriocarcinoma
3 mins
Gestational Diabetes
Signs and Symptoms
Usually Asymptomatic
Fetal Macrosomia
Polyhydramnios
Diagnosis
Glucose Intolerance After 24 Weeks Gestation
3-hr 100g Glucose Tolerance Test
Treatment
Diet and Exercise
Close Glucose Monitoring
Insulin
Ultrasound (or Nonstress Test (NST))
Delivery
2 mins
Fetal Macrosomia
Pathophysiology
Increased Birth Weight
> 4500 g
Causes
Maternal Obesity
Gestational Diabetes
Diagnosis
Weigh Newborn at Birth
Ultrasound
Hadlock's Formula
Complications
Birth Canal Trauma
Neonatal Hypoglycemia
Shoulder Dystocia
Treatment
Planned Cesarean Section
2 mins
Polyhydramnios
Pathophysiology
Increased Amniotic Fluid
Causes
Duodenal Atresia (or Gastrointestinal Atresias)
Maternal Diabetes
Multiple Gestations
Anencephaly
Hydrops Fetalis
Diagnosis
Ultrasound
Amniotic Fluid Index (AFI) > 25 cm
Treatment
Weekly Nonstress Test (NST) and Biophysical Profile (BPP)
More Likely to Develop Hypoglycemia than Hyperglycemia
Third Trimester
Double or Quadruple Insulin
Early Delivery
Postpartum
Drastically Decrease Insulin
Monitor Neonate for Hypoglycemia
3 mins
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