Obstetrics: Complications of Pregnancy for USMLE
This module focuses on common and critical complications of pregnancy, essential knowledge for success on the USMLE. We will cover conditions that can arise during gestation, impacting both maternal and fetal well-being. Understanding these scenarios is crucial for diagnosis, management, and patient care.
Hypertensive Disorders of Pregnancy
Hypertensive disorders are a leading cause of maternal morbidity and mortality worldwide. They encompass a spectrum of conditions characterized by elevated blood pressure during pregnancy.
| Condition | Onset | Key Features | Management Focus |
|---|---|---|---|
| Gestational Hypertension | After 20 weeks | New-onset hypertension without proteinuria or end-organ dysfunction | Close monitoring, antihypertensives if severe |
| Preeclampsia | After 20 weeks | Hypertension + proteinuria or end-organ dysfunction | Delivery is the definitive treatment; antihypertensives, seizure prophylaxis (magnesium sulfate) |
| Eclampsia | After 20 weeks | Preeclampsia + seizures | Immediate seizure control (magnesium sulfate), delivery |
| HELLP Syndrome | Often after 20 weeks | Hemolysis, Elevated Liver enzymes, Low Platelets | Delivery is the definitive treatment; supportive care |
Delivery of the fetus and placenta.
Gestational Diabetes Mellitus (GDM)
Gestational Diabetes Mellitus is a form of diabetes that develops during pregnancy and usually resolves after childbirth. It poses risks to both mother and baby.
Remember: GDM increases the risk of future type 2 diabetes for the mother and can lead to macrosomia (large baby), neonatal hypoglycemia, and respiratory distress syndrome in the infant.
Placental Abnormalities
Abnormalities of the placenta can significantly impact pregnancy outcomes, affecting nutrient and oxygen transfer to the fetus and posing risks during labor and delivery.
| Condition | Description | Key Risks |
|---|---|---|
| Placenta Previa | Placenta implants over or near the internal cervical os. | Painless antepartum hemorrhage, risk of severe bleeding during labor, requires C-section. |
| Placental Abruption | Premature separation of the placenta from the uterine wall. | Painful vaginal bleeding (can be concealed), uterine tenderness, fetal distress, DIC, emergency delivery. |
| Placenta Accreta Spectrum | Abnormal placental adherence to the uterine wall (accreta, increta, percreta). | Severe antepartum hemorrhage, high risk of hysterectomy, difficult to separate from uterine wall. |
Painless vaginal bleeding.
Preterm Labor and Birth
Preterm labor is defined as regular uterine contractions that cause cervical change before 37 weeks of gestation. It is a major cause of neonatal morbidity and mortality.
Other Important Complications
Several other complications require careful consideration during pregnancy.
Hyperemesis Gravidarum is a severe form of nausea and vomiting during pregnancy, leading to significant weight loss, dehydration, and electrolyte imbalances. It is distinct from typical morning sickness. Management involves aggressive antiemetics, fluid resuscitation, and nutritional support. In severe cases, parenteral nutrition may be required. The pathophysiology is complex and may involve hormonal factors, genetic predisposition, and psychological influences.
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To promote fetal lung maturity and reduce the risk of respiratory distress syndrome.
Review and Integration
Mastering these complications requires integrating knowledge from various medical disciplines, including physiology, pharmacology, and pathology. Practice with clinical vignettes and board-style questions is essential for solidifying your understanding and applying it effectively on the USMLE.
Learning Resources
Provides comprehensive, patient-friendly information on preeclampsia, including causes, symptoms, and management from a leading professional organization.
Offers detailed information on gestational diabetes, including risk factors, diagnosis, and management strategies from the Centers for Disease Control and Prevention.
Explains the causes, risks, and current research on preterm labor and birth, providing a solid overview of this critical complication.
A clear explanation of placenta previa, its symptoms, causes, and potential complications from a reputable medical institution.
Details placental abruption, including its signs, symptoms, risks, and treatment options, presented by a leading healthcare provider.
Provides an overview of hyperemesis gravidarum, differentiating it from morning sickness and outlining diagnostic and management approaches.
While a paid course, Kaplan offers extensive free resources and often has introductory videos or sample content that can be invaluable for USMLE prep in OB/GYN.
OnlineMedEd provides free, high-yield video lectures covering various medical topics, including OB/GYN, which are excellent for quick reviews and understanding key concepts.
Osmosis offers animated medical videos that simplify complex topics. Search their channel for specific complications of pregnancy for visual learning.
A highly authoritative clinical resource used by physicians. While often behind a paywall, it provides in-depth, evidence-based information on all aspects of pregnancy complications.