04a: Abnormal Pregnancy Flashcards
There’s been a(n) (increase/decrease) in multifetal pregnancies, most likely due to:
Increase;
Women having pregnancies later in life (more likely to fertilize more than one egg)
The key major risk for multifetal pregnancy is:
Premature delivery (and the consequences tied to that)
T/F: Woman’s risk of aneuploidy doubles if she has twins.
True - esp if woman is at advanced age
Monoamniotic, monochorionic pregnancy: (1/2) fetuses, (1/2) placenta(s).
2 fetuses sharing same amniotic sac and same (1) placenta
High rates of stillbirth in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?
Mono; mono
Sharing amniotic sac causes umbilical cords to get tangled/compressed
(Earlier/later) split of zygote will increase chances that twins share amniotic sac/placenta.
Later
Notably high risk of poor growth/pre-term labor in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?
Di-di
Not enough room
Notably high risk of congenital malformations in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?
Di-mono and mono-mono (occur with shared placenta!)
Spontaneous abortion defined as loss of pregnancy before (X) weeks.
X = 20 (after that, “stillbirth”)
T/F: 80% of spont abortions occur in first trimester.
True
Trend of (X) hormone in pregnancy can be predictive of spontaneous abortion due to its chaotic ranges in the first few weeks.
X = hCG (normally doubles each day in early pregnancy, but all over the place/falls off in pts with spont abortion)
Recurrent abortion definition: (X) consecutive losses.
X = 2 in nulliparous woman; 3 in parous woman
Most, (X)%, of ectopic pregnancies are located in (Y)
X = 94 Y = fallopian tubes
Two main mechanisms of ectopic pregnancy:
- Delayed/prevented passage of zygote into uterine cavity (tubal pathology)
- Inherent embryo factors that cause early implantation (not karyotype)
Pre-term birth rates have (increased/decreased) and are defined as under (X) weeks gestation.
Decreased (all-time high in ‘06);
X = 37
Pt with pre-eclampsia at 36 weeks gestation. The physician decides to induce labor. Does this meet criteria for spont preterm birth?
No - SPB excludes “indicated” preterm birth
All RFs for spontaneous preterm birth are likely related to:
Glucocorticoids (placental CRH drives process)
History of which procedures put patient at risk for spont preterm birth?
Ones that dilate cervix:
- 2nd trimester abortion
- Cervical surg
36 week gestation pregnant patient presents with sudden onset severe abdominal pain and contractions. The thought is (X) until proven otherwise
X = abruptio placenta (without visible bleeding)
Placenta previa refers to situation in which:
Placenta attaches right over cervix
T/F: Patient with placenta previa must have C-section.
True - otherwise placenta will come out first and baby can’t breathe during delivery
Placenta accreta refers to situation in which:
Placenta attached abnormally (myometrial invasion)
How is placenta accreta managed?
Take out baby, don’t even try to take out placenta; then hysterectomy
(X) placental complication has high risk of maternal hemorrhaging and death post-partum.
X = placenta accreta
Placenta increta:
Abnormal placenta attachment where placenta invades more than 50% of myometrium
Placenta percreta:
Abnormal placenta attachment where placenta invades past uterine wall (ex: into bladder)
T/F: Switching from cigarette smoke to vaping will decrease risk of spont pre-term birth.
False - nicotine is the issue
Term labor timing is dependent on (X), unlike pre-term labor which is initiated by (Y).
X = placenta (fetus ready for birth) Y = mother (high cortisol)
Tocolysis:
Inhibition of uterine contractions
Tocodnamometer:
Instrument for measuring uterine contractions
List some agents used for tocolysis.
- CCB, Mg sulfate
- Beta agonists (interrupt myosin phosphorylation)
- COX inhibitors (decrease PGEs)
- Oxytocin antagonists
Fetal growth restriction is pathologic when which criteria are met?
Under 10th percentile for gestational age PLUS
- Decreased amniotic fluid OR
- Falling off growth curve OR
- Abnormal intrauterine blood flow
Maternal diabetes puts baby at risk of (hyper/hypo)-glycemia at birth.
Hypoglycemia (due to fetal hyperinsulinemia)
Notably high risk of twin-twin transfusion syndrome in (mono/di)-amniotic, (mono/di)-chorionic pregnancies. Why?
Di-mono (a-v malformations in shared placenta; one baby has much higher V of amniotic fluid than another; both die)
Infectious cause of fetal growth restrction
TORCHES (esp think of CMV, rubella, varicella, HIV)
Pre-eclampsia cured by:
Delivery of baby
Definition/diagnosis of pre-eclampsia:
- HT
2. Proteinuria
Which clinical/lab findings (aside from HT, proteinuria) may point toward pre-eclampsia diagnosis?
- Edema (ascites, pulm)
- HELLP (hemolysis, elevated liver enzymes, low platelets)
- Abdominal pain
- Oliguria/anuria
Sx of pre-eclampsia patient that suggests incoming seizure
HA, vision changes
T/F: Mulitparity is a RF for pre-eclampsia.
False - nulliparity is (never exposed to pregnancy/paternal Ag before)
T/F: Insulin resistance is RF for pre-eclampsia
True
RFs for pre-eclampsia are similar in their ability to:
Impact activation state of endothelium (ex: vascular disease, thrombophilias)
Placental ischemia: decrease in which molecules/factors?
- Prostacyclin
2. NO
Placental ischemia: increase in which molecules/factors?
- Thromboxane
- TNF-alpha
- IL1
Pre-eclampsia workup: after labs, (X) should be done.
X = ultrasound (fetal weight and amniotic fluid)
Pre-eclampsia workup: what are the indications to induce delivery?
- Term pregnancy
2. Severe disease
Pre-eclampsia: Rx for seizure prophylaxis
Mg Sulfate
Women with pre-eclampsia have later-life risk of which disease?
CV (equivalent to 2pack/d smoker!) - so monitor yearly BP, lipids, blood glucose
