3.4.1 Systemic Disorders in Pregnancy Flashcards
What is vasa previa?
Fetal vessels of a velamentous cord insertion cover cervical os
Clinical presentation: painless vaginal bleeding, nonreassuring fetal heart rate tracing
What are some of the hypertensive syndromes in pregnancy?
What lab findings support the diagnosis of preeclampsia?
Who is at greater risk for preeclampsia?
People with chronic HTN -> leading to superimposed preeclampsia
How long does a standard pregnancy last?
40 wks
What are some of the possible complications of c section?
What are some of the idications for C section?
How often should visits be scheduled during pregnancy?
1st and 2nd trimester: every 4 wks
3rd trimester: every 2 wks
Last month: every wk
What are the risk factors for placenta previa?
What are the steps in a cesarean delivery?
Horizontal incision in the abdomen
Incise the fascia
Separate the rectus off of the fascia
Open the peritoneum
Create a hysterotomy
Flex fetal head to delivery baby through the incision
Close hysterotomy
What is placenta previa?
Occurs when placental tissue covers the cervical os
Name 4 risk factors for preeclampsia
Hx of preeclampsia
First pregnancy
Family Hx
Pre-existing medical conditons: pregestational diabetes, CHTN, antiphospholipid antibody syndrome, obesity, chronic kidney disease
What symptoms support the diagnosis of preeclampsia?
Persistent headache, pulmonary edema
How does one assess third trimester bleeding?
What is a cesarean delivery?
What is the differental diagnosis of third trimester bleeding?
Answer questions
Diagnose: Urine or serum HCG levels
How does a patient with preeclampsia get managed?
What should be included in the initial patient counseling? (7)
Screen for intimate partner violence
Tobacco, alcohol, and drug use
Weight gain recommendations
Exercise recommendations - 30min/day of moderate exercise
Dietary restrictions - raw dairy, deli meat, fish
Travel precautions
Encourage breastfeeding
What are consistently checked throughout the course of the pregnancy?
FHR, fundal height, BP, check urine for protein and glucose
Anticipatory guidance
What is used for seizure prophylaxis in patients with severe features of preeclampsia?
Magnesium sulfate
What is placental abruption?
Seperation of the placenta from the wall of the uterus prior to delivery of the fetus
What is the risk factor for vasa previa?
multiple gestations
What are you concerned about?
Preeclampsia - send to L&D
What are some of the initial diagnostic studies?
Blood and Rh typing
Ab screen
Hep B surface Ag
Rubella titers
HIV screening
Syphilis Ab screen
Chlamydia and Gonorrhea PCR
CBC
A1C or fasting glucose if high risk for DM
Cervical cancer screening if needed
Screening for hemoglobinopathies or CF if desired
Ultrasound to determine EDD, aneuploidy screening as desired
What are some of the subsequent diagnostic evaluations
Anatomic US survey at 20 wks
Flu vaccine during flu season
AFP b/t 15-21 wks
28 wks: screening for gestational diabetes, CBC, Ab screen, (Rhogram if needed - Rh-), Tdap, Syphilis
36 wks: Group B Strep rectovaginal swab
How is gestational age established?
Ideally determined from first day of LMP and compared to early ultrasound
