Obstetrics and Gynecology Study Guide PDF

5. Abnormal Pregnancy & loss Hydatidiform mole What is it? o Aka) a molar pregnancy o Part of the spectrum of interrelated conditions classified as gestational trophoblastic disease (GTD) o Occurs after aberrant fertilization o There’s two forms: 1) comple...

5. Abnormal Pregnancy & loss Hydatidiform mole What is it? o Aka) a molar pregnancy o Part of the spectrum of interrelated conditions classified as gestational trophoblastic disease (GTD) o Occurs after aberrant fertilization o There’s two forms: 1) complete molar pregnancy 2) Partial molar pregnancy Gestational trophoblastic disease (GTD) What is it? o Spectrum of interrelated conditions originating in the placenta w/ abnormal placental (trophoblastic) proliferation. Types of GTD: o Hydatidiform mole (molar pregnancy)- MC presentation usually benign o Invasive mole (extends into the uterus or vagina) o Choriocarcinoma- malignant transformation of hydatidiform mole o Placental site trophoblastic tumor (rare) o Epithelioid trophoblastic tumor (rare) Gestational trophoblastic neoplasia (GTN) ▪ Rare variation of preg, etiology unknown ▪ MC in women 35 yrs Types of Complete mole Hydratidifo o no fetal tissue, fertilization of egg w/ no DNA (cells that were meant to rm Mole become the placenta are abnormal) (HM) Partial mole o fetal tissue plus molar degeneration; fertilization of normal egg w/ 2 sperm (part of fetus forms while cells that were meant to become the placenta are abnormal) Presentation Both: vaginal bleeding uterine dates/size discrepancy absence of fetal heart tones +/- N/V, HTN Hyperthyroidism seen in 2nd trimester (tachy, warm skin, tremor) Dx Complete Mole: Ultrasound - * “snowstorm”, “cluster of grapes”, “Swiss cheese” appearance b/c of absence of embryo/fetus and amniotic fluid Quantitative Beta-hCG is extremely high (>100,000 mu/ml) Partial Mole: Ultrasound: difficult to dx (fetus may be present but growth = restricted)  - +/- amniotic fluid or decreased volume - Abnorm placenta - Increased diameter of gestational sac HCG many be elevated Rx Both: D&C with suction curettage Serial quantitative BhCG (to monitor for development) Contraception for 1 year (avoid pregnancy!!) Single-agent chemo for persistent gestational trophoblastic neoplasia (GTN) RhoGam for pts who are RhD (-) Prognosis Complete Mole: 1/5 of pts will develop Gestational trophoblastic neoplasia (GTN) Partial Mole: 1-5% of pts develop GTN [Most pts with either a complete/partial mole CAN have future normal pregnancies AFTER 1 yr] Choriocarcinoma: What is it? o malignant tumor that forms from trophoblast cells o Very vascular and very invasive o * MC after a complete mole SXS: o Abnormal uterine bleeding, * Elevated hCG levels DX: o Ultra sound; HcG; Physical Exam; CXR, CT scan, MRI- to assess metastasis. Rx: o Surgery: D&C, hysterectomy, chemo, radiation Pregnancy loss Ectopic pregnancy (extrauterine pregnancy) What is it? o Implantation outside the uterine cavity (98% fallopian tubes; 80% in ampulla) o We consider this in ANY female of reproductive age w/ abdominal pain, cramping, vaginal bleeding o If ruptured, can be life threatening! Risk Factors o History of PID or abdominal/tubal surgery (d/t scarring) o Previous ectopic preg o Use of fertility drugs/ART o Age after 35 of the mother o Smoking S/S of Ectopic Pregnancy: o Amenorrhea, vaginal bleeding, abdominal pain, +/- cervical motion tenderness (and 1/3 of women have adnexal mass on exam)  S/S of ruptured ectopic pregnancy o Sever abd/shoulder pain w/ peritonitis, syncope, orthostatic hypotension Dx of ectopic pregnancy o Urine and serum pregnancy test (HCG double every 1-2 days in early pregnancy; hCG rises much slower in abnormal pregnancies) o TVUS o Progesterone level (