191b abnormal preg Flashcards
PTB
preterm birth < 37 weeks gestation
24 weeks - 50/50 survival
causes vast majority of death/morbidity
spontaneous and iatrogenic
PTL
spontaneous preterm labor
uterine contractions with cervical dilation
caused by infection or excessive stretch
PTL dx goal and rx
transfer to place with NICU
admin of antenatal corticosteroids –> reduces ARDS
treat for GBS
treat underlying causes - amniocentesis or infection antibiotics
tocolytics x 48 hours - stop labor, but bad (only work for a day or so)
prevention of PTB
17-hydroxyprogesterone caproate, vaginal progesterone, treat infections, >6 months b/w pregs
none are very effective
cervical insufficiency
dilation without contractions - usually in 2nd trimester
hourglass of amniotic bag through cervix –> can causes contractions or perforation
risk - hx of cervical insuff
rx - counsel on options; emergent cerclage - sow cervix shut - gain 4 weeks of pregnancy; termination of pregnancy
PROM vs PPROM
PROM - premature rupture of membrane prior to labor
PPROM - premature rupture of membrane while preterm
basic pH, vaginal pooling
rx - steroids and antibiotics (prolongs latency); deliver at >34 weeks
90% deliver within 7 days
iatrogenic PTB - placenta previa
placenta previa – implantation of placenta over cervix
bright red vaginal bleeding
risk - prior c section, old mom, twins
dx goal - c section at 37 weeks, avoid digital inspection; rule out placenta percreta or accreta
iatrogenic PTB - vasa previa
cord crosses cervix - kid can bleed out
vaginal bleeding from fetus
deliver early
dx with US or Apt test - fetal Hb resistance to lysis by alkaline solution
Iatrogenic PTB - placental abruption
premature seperation of placenta form uterine wall
vaginal bleeding w/ contraction
risk - maternal hypertension, trauma, smoking, cocaine
rx - steroids and delivery
iatrogenic ptb - fetal growth restriction
less than 10% for gestational age
causes - TORCH, aneuploidy, twins, uteroplacental insufficiency
dx - size<date on fundal height, US
rx - counsel, steroids
iatrogenic ptb - pre-eclampsia
new onset htn with proteinuria
severe if > 160/110, 24 hr urine > 5 g
risk - poor trophoblast remodeling of maternal spiral arterioles; increased sFLT-1 (anti-angiogenesis) from placenta
rx - delivery regardless of GA; MgSO4
iatrogenic ptb - Rh alloimmunization
Rh negative mom who has antibodies from previous preg Rh +
rx - immunoglobulins to Rh - moms at 28 weeks and 40 weeks or after delivery + trauma, bleeding, ectopic preg,
dx - fetal Rh genotype, fetal middle cerebral artery velocity –> higher velocity indicates anemia
transfusion of cord - 1% risk of death
