Term
| What is the risk of non-obstetric surgery in pregnancy? |
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Definition
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Term
| What are the most common surgical diseases in pregnancy? |
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Definition
1. Appendicitis - 0.1-1.4:1000
2. Biliary colic & cholecystitis - 1:1600-10000
3. Acute intestinal obstruction - 1-3:10000 |
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Term
| How is the natural history of appendicitis altered in pregnancy? |
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Definition
| 25% chance of rupture (2-3 times higher than normal). |
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Term
| How is the clinical picture of appendicitis changed in pregnancy? |
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Definition
| 25% of patients are afebrile, atypical pain patterns are common. |
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Term
| What is the most common misdiagnosis of appendicitis in pregnancy? |
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Definition
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Term
| What is the chance of preterm labor in appendicitis? |
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Definition
| 25% in the 2nd trimester patients, 50% in the 3rd trimester. |
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Term
| What are the maternal and fetal mortality rates of appendicitis in pregnancy? |
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Definition
Uncomplicated appendicitis: 0-1.5% perinatal loss (maternal death is negligible).
Ruptured appendicitis: 30% fetal loss, 4% maternal mortality. |
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Term
| What is the treatment of appendicitis in pregnancy? |
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Definition
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Term
| What percentage of pregnant women have gallstones? |
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Definition
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Term
| What is the diagnostic accuracy of U/S for gallstones in pregnancy? |
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Definition
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Term
| What is the treatment of gallbladder disease in pregnancy? |
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Definition
Initial treatment is nonoperative (IV fluids, analgesia, NPO, correction of electrolyte imblanaces).
If not given routinely, Abx are started after 12-24hrs w/o improvement. |
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Term
| What are the four indications for surgery in gallbladder disease in pregnancy? |
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Definition
1. Pancreatitis
2. Failure of medical therapy
3. Choledocholithiasis
4. Recurrence - 2nd event in pregnancy |
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Term
| What is the chance of recurrence of biliary disease in pregnancy? |
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Definition
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Term
| What is the incidence of acute pancreatitis in pregnancy? |
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Definition
| 1:1000-5000, unaffected by pregnancy. |
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Term
| How is the clinical presentation of acute pancreatitis change in pregnancy? |
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Definition
| Patients may present with little of no abdominal pain. |
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Term
| How are amylase levels interpreted in pregnancy? |
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Definition
| In pregnancy, levels as high as twice the normal upper limit are considered normal. |
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Term
| What are the acute complications of acute pancreatitis? |
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Definition
| Hemorrhagic pancreatitis (hypotension + hypocalcemia), ARDS, pleural effusion, pancreatic ascites, abscess, liponecrosis. |
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Term
| What is the treatment of acute pancreatitis in pregnancy? |
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Definition
| Similar to treatment of the non-pregnant patient: NPO, IV fluids, analgesia. Abx may be given in evidence of acute infection. |
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Term
| What are the perinatal and maternal mortality rates of acute pancreatitis in pregnancy? |
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Definition
| Perinatal mortality - 3-20%, maternal mortality - <1%. Increased risk of preterm labor. |
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Term
| How is the natural history of PUD (peptic ulcer disease) affected by pregnancy? |
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Definition
| 90% of patients experience significant improvement during pregnancy. Half will have recurrence within 3 months postpartum. |
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Term
| How is the treatment of PUD (peptic ulcer disease) altered in pregnancy? |
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Definition
| H2-receptor antagonists are preferable to PPIs. Triple therapy for H. Pylori is controversial - risks of not treating are low and risk of teratogenicity is not insignificant. Empiric treatment of H Pylori is not recommended. |
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Term
| What is the classic triad of acute intestinal obstruction? |
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Definition
| Abdominal pain, vomiting, obstipation |
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Term
| What cause, uncommonly encountered in the non-pregnant patient, is more common in pregnancy women with acute intestinal obstruction? |
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Definition
| Volvulus (25% of pregnant bowel obstructions). |
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Term
| What is the maternal and perinatal mortality in acute intestinal obstruction in pregnancy? |
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Definition
| Perinatal 20%, maternal 6%. |
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Term
| How is the treatment of IBD changed in pregnancy? |
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Definition
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Term
| What relationship does pregnancy bear with hemorrhoids? |
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Definition
| Pregnancy is the most common cause of symptomatic hemorrhoids. 9-35% of pregnant women suffer from hemorrhoids. |
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Term
| What relationship does rupture of a splenic artery aneurysm have to pregnancy? |
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Definition
| 0.1% of adults have a splenic artery aneurysm (more in women). 6-10% of these will rupture. 25-40% of ruptures occur in pregnancy. Maternal mortality is 75%, perinatal mortality - 95%. |
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Term
| What is the prevalence of adnexal mass in pregnancy? |
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Definition
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Term
| What is the risk of malignancy in a persistent adnexal mass? |
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Definition
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Term
| What are the 5 indications for surgery of an adnexal mass? |
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Definition
1. Persistent post-14wks
2. Growing in size
3. Solid and complex components, internal papillae
4. Abdominal ascites
5. Symptomatic |
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Term
| In relation to pregnancy, what are the common times for torsion of an adnexa? |
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Definition
| Between 6-14 weeks and in the immediate puerperium |
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|
Term
| Which ovary is more susceptible to torsion (in pregnancy)? |
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Definition
|
|
Term
| How common are uterine leiomyomas in pregnancy? |
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Definition
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Term
| How do uterine leiomyomas affect pregnancy? |
|
Definition
Increased risk of C/S, and the 5 P's:
Presentation (breech)
Position (malposition)
Preterm delivery
Placenta previa
PPH, severe |
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Term
| What are the 5 most common malignancies diagnosed in pregnancy (in the order of frequency)? |
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Definition
1. Cervical cancer (26%)
2. Breast cancer (26%)
3. Leukemias (15%)
4. Lymphomas (10%)
5. Malignant melanomas (8%) |
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Term
| Does pregnancy affect prognonsis for women with cervical cancer? Is the fetus affected by the disease? |
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Definition
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Term
| Are cervical cancer and pre-malignant lesions contraindications for vaginal delivery? |
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Definition
| Patients with cervical dysplasia and carcinoma in situ can be delivered vaginally. Patients with invasive carcinoma should be delivered via C/S. |
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Term
| How is the surgical treatment of breast cancer different during pregnancy? |
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Definition
| Modified radical mastectomy is preferred over breast-conserving surgery, due to the need for adjuvant RT. Breast-conserving surgery possible in late 2nd and 3rd trimester, with RT delayed till after delivery. |
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Term
| How is the non-surgical treatment of breast cancer different during pregnancy? |
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Definition
Radiotherapy and hormone therapy are CI.
Chemotherapy is CI only in the 1st trimester, and should be stopped after 35weeks gestation to decrease the risk of neonatal neutropenia. |
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Term
| What percentage of malignant melanoma patients are pregnant? How does this affect the fetus? |
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Definition
0.1-1%.
Malignant melanoma is the tumor that most frequently metastasizes to the placenta or fetus, accounting for more than half of all tumors with fetal involvement. |
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Term
| What are the common causes of intracranial hemorrhage in pregnancy? |
|
Definition
Aneurysm (70%)
AVM (25%)
Others: eclampsia, coagulopathy, trauma, tumors. |
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Term
| How frequent is trauma in pregnancy? What are the common traumas? |
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Definition
7% of pregnancies are complicated by trauma.
Motor vehicle accidents (40%)
Falls (30%)
Direct assault (20%)
Other (10%) |
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Term
| What is the most common non-obstetric cause of death in pregnant women? |
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Definition
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Term
| How long should women with trauma during pregnancy be monitored? |
|
Definition
At least 4 hours.
Monitoring should be extended to 24-48 hours if:
1. Severe trauma
2. Uterine contractions
3. Abdominal or uterine tenderness
4. Vaginal bleeding
5. Postural hypotension
6. Fetal heart rate abnormalities |
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