3.4.1 Systemic Disorders in Pregnancy

Question 1

What is vasa previa?

Answer 1

Fetal vessels of a velamentous cord insertion cover cervical os

Clinical presentation: painless vaginal bleeding, nonreassuring fetal heart rate tracing

Question 2

What are some of the hypertensive syndromes in pregnancy?

Answer 2

Question 3

What lab findings support the diagnosis of preeclampsia?

Answer 3

Question 4

Who is at greater risk for preeclampsia?

Answer 4

People with chronic HTN -> leading to superimposed preeclampsia

Question 5

How long does a standard pregnancy last?

Answer 5

40 wks

Question 6

What are some of the possible complications of c section?

Answer 6

Question 7

What are some of the idications for C section?

Answer 7

Question 8

How often should visits be scheduled during pregnancy?

Answer 8

1st and 2nd trimester: every 4 wks

3rd trimester: every 2 wks

Last month: every wk

Question 9

What are the risk factors for placenta previa?

Answer 9

Question 10

What are the steps in a cesarean delivery?

Answer 10

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

Question 11

What is placenta previa?

Answer 11

Occurs when placental tissue covers the cervical os

Question 12

Name 4 risk factors for preeclampsia

Answer 12

Hx of preeclampsia

First pregnancy

Family Hx

Pre-existing medical conditons: pregestational diabetes, CHTN, antiphospholipid antibody syndrome, obesity, chronic kidney disease

Question 13

What symptoms support the diagnosis of preeclampsia?

Answer 13

Persistent headache, pulmonary edema

Question 14

How does one assess third trimester bleeding?

Answer 14

Question 15

What is a cesarean delivery?

Answer 15

Question 16

What is the differental diagnosis of third trimester bleeding?

Answer 16

Question 17

Answer questions

Answer 17

Diagnose: Urine or serum HCG levels

Question 18

How does a patient with preeclampsia get managed?

Answer 18

Question 19

What should be included in the initial patient counseling? (7)

Answer 19

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

Question 20

What are consistently checked throughout the course of the pregnancy?

Answer 20

FHR, fundal height, BP, check urine for protein and glucose

Anticipatory guidance

Question 21

What is used for seizure prophylaxis in patients with severe features of preeclampsia?

Answer 21

Magnesium sulfate

Question 22

What is placental abruption?

Answer 22

Seperation of the placenta from the wall of the uterus prior to delivery of the fetus

Question 23

What is the risk factor for vasa previa?

Answer 23

multiple gestations

Question 25

What are you concerned about?

Answer 25

Preeclampsia - send to L&D

Question 26

What are some of the initial diagnostic studies?

Answer 26

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

Question 27

What are some of the subsequent diagnostic evaluations

Answer 27

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

Question 28

How is gestational age established?

Answer 28

Ideally determined from first day of LMP and compared to early ultrasound