2nd Trimester Gestational Conditions Flashcards
Refers to the low
implantation of the
placenta
placenta previa
4 degrees of placenta previa
low (low implantation of placenta)
marginal implantation (placenta previa marginalis)
partial (placenta previa lateralis)
total (placenta previa centralis)
implantation in the lower rather than in the upper
portion of the uterus
low implantation of placenta
the placenta edge approaches that of the cervical os
placenta previa marginalis
implantation that occludes a portion of the cervical os
placenta previa lateralis
implantation that totally obstructs the cervical os
placenta previa centralis
placenta appears to have
been implanted correctly and occurs in about 10% of
pregnancies, most frequent cause of perinatal death from unknown cause
abruptio placenta or premature seperation of placenta
degree of seperation of abruptio placenta
0-3
No symptom of separation were apparent from maternal or
fetal side
0
Minimal separation but enough to cause vaginal bleeding and
changes in maternal vital signs; no fetal distress or
hemorrhage occurs
1
Moderate separation; there is evidence of fetal distress; uterus
is painful on palpation
2
Extreme separation; without immediate interventions,
maternal shock and fetal death will result
3
defined as one of the following:
1. One measurement of diastolic BP of 110 mmHg or more;
or
2. Two consecutive measurements of diastolic BP of greater
than 90 mmHg 4 hours or more apart
hypertension
defined as one of
the following:
1. Twenty four hours urine
sample collection with a total
protein excretion of 300mg or
more; or
2. Random clean catch urine
specimen with a 2+ or more
reagent strip
proteinuria
Is an idiopathic disorder of pregnancy characterized by
proteinuric hypertension.
* 2
nd largest cause of both direct maternal and perinatal
loss
pre-eclampsia
classification of hypertensive disorders in pregnanct
gestational
pre-eclampsia
chronic hypertension
Pre-eclampsia superimposed on chronic
hypertension
arising for the 1st
time after the 20th week of gestation in the absence
of proteinuria.
gestational hypertension
hypertension associated with
proteinuria arising after 20th week of gestation.
proteinuria
apparent prior to, in the 1st
half of, or persisting more than 6 weeks after pregnancy
chronic hypertension
chronic hypertension may be complicated
by preeclampsia, evolution of other S/S of preeclampsia
after 20th week gestation.
Pre-eclampsia superimposed on chronic
hypertension
A disorder characterized by three symptoms of
hypertension, edema and proteinuria appearing
after the 20th to 24 week of pregnancy and
disappearing 6 weeks after delivery.
PIH- pregnancy induced hypertension
symptoms of PIH
hypertension, proteinuria, edema
A test to assess the risk of
toxemia in pregnant women.
* A comparison of blood pressure
is made with the woman lying on
her left side and on her back.
* An excessive increase in blood
pressure when she rolls to the
supine position indicates
increased risk of toxemia.
roll over test
drug to be administered to prevent convulsion
Magnesium Sulphate – prevents convulsions
2. Hydralazine [apresoline]: monitor BP
3. Diazepam [valium] : monitor BP
4. Diuretics: Rare; now it is considered inappropriate as it
further decrease circulating volume resulting in
decrease renal, cerebral and uterine perfusion
5. Blood volume expanders
well-known variant of
pre-eclampsia pregnancy complication.
The syndrome was first described in 1982 as
characterised by hemolysis (H), elevated liver
enzymes (EL) and low platelet count (LP)
HELLP
HELLP meaning
hemolysis, elevated liver enzymes, low platelet count
is an
obstetric complication that is frequently
misdiagnosed at initial presentation. Many
investigators consider the syndrome to be a
variant of preeclampsia may also be first warning of preeclampsia
and the condition is misdiagnosed
hellp syndrome
levels in the syndrome are thought
to be secondary to obstruction of
hepatic blood flow
elivated liver enzymes
has been attributed
to increased consumption and/or destruction of
platelets.
thrombocytopenia
Laboratory Diagnostic Criteria for
HELLP syndrome: hemolysis
Abnormal peripheral smear : spherocytes, schistocytes, triangular cells
and burr cells
Total Bilirubin level > 1.2 mg/dL
Lactate dehydrogenase level > 600U/L
EL diagnostic
Serum aspartate amino transferase level > 70U/L
Lactate dehydrogenase level >600 U/L
low platelet count diagnostic
Platelet count < 150 000/mm3
appears
to be the most reliable
indicator of the presence of
HELLP syndrome
platelet count
class and count of platelet
class I, less than 50,000 per mm3
class II, 50,000 to less than 100,000 per mm3
class III, 100,000 to 150,000 per mm3
When considering termination of
gestation in a patient with HELLP,
determine these 4
Gestational age.
Maternal and fetal conditions.
Fetal presentation.
Cervical maturity
Management of labor and delivery
timing of delivery
–if > 34 weeks gestation,
deliver
Management of labor and delivery
timing of delivery
–if < 34 weeks gestation,
administer
corticosteroids, then deliver in 48
hours
Precise diagnosis and early treatment with ___________- such as__________- may help achieve favorable
maternal and perinatal results.
non-mineral corticosteroides , Dexamethasone
