Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

x REPRO > 4/14 Complications + Pathophysiology of Pregnancy > Flashcards

4/14 Complications + Pathophysiology of Pregnancy Flashcards

1
Q

causes of maternal mortality in us?

A
  • infection
  • Hemorrhage
  • HTN d/o of pregnancy
  • Venous thromboembolism
  • Indirect causes such cardiovascular disease and non-obstetric injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Puerperal fever in pregnancy?

A

defined as T ≥100.4°F (38°C) that occurs for ≥2 consecutive days during the first 10 postpartum days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are causes of puerperal sepsis?

complications?

A

causes:

  • endometritis (infection in the uterus)
  • perineal wounds
  • C-section wounds

complications:

  • risk of septic shock
  • pelvic thrombophlebitis
  • pelvic abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is endometritis and how does it occur?

A

endometritis (infection in the uterus)

  • occur due to ∆s at the placenta-maternal interface, where
    • alkaline amniotic fluid, blood, and lochia (vaginal discharge) neutralize vaginal pH allowing bacterial growth
      • normally, vagina acidity (pH 4-5) usually protects against overgrowth of bacteria
  • Necrotic endometrium and placenta fragments make the uterine cavity favorable for the growth anaerobic bacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the common pathogens of endometritis?

A

70% caused by mixed anaerobic organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

risk factors for endometritis?

A
  • Poor nutrition and hygiene
  • Premature or prolonged rupture of membranes
  • Chorioamnionitis
  • Prolonged labor
  • Numerous vaginal examinations or manual removal of placenta
  • C-section
  • Retained placental fragments or fetal membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the major causes of

ANTEPARTUM HEMORRHAGE?

POSTPARTUM HEMORRHAGE?

A

ante: placenta previa + placenta abruptio
post: uterine atony (80% of cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is placenta previa?

How do you tell if a woman has it?

A

“latin root of previa – going before”

placenta is partially or wholly in the lower uterine segment, over the cervical os

presentation: painless vaginal bleeding (70%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 4 types of placenta previa?

A
  • Total/complete - placenta covers internal os completely
  • Partial - placenta covers internal os partially
  • Marginal - lower edge of placenta reaches internal os, but does not cover it
  • Low-lying - Placenta is in lower segment, but the lower edge does not reach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors for placenta previa?

A
  • Multiparity/multi-gestation – women with a lot of babies
  • Older maternal age
  • Prior hx of placenta previa
  • Prior C-section (placenta may adhere to scarred uterus)
  • Tobacco use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you diagnose placenta previa?

A

US (transabdominal or transvaginal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is placenta abruptio?

How does a patient typically present?

A

premature separation of the “normally” implanted placenta due rupturing of maternal spiral arterioles in the decidua basalis, where it interfaces with the anchoring villi of the placenta; accumulating blood separates the decidua from its placental attachment to the uterus

presentation: painful vaginal bleeding, uterine tenderness and contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does Placental abruptio form?

A

hypothesized to be an underlying abnormality in how the placenta has attached to the decidua or an inherent weakness or abnormality in the spiral arterioles, or trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens if there is a complete placental abruptio?

A
  • fetal death - detached portion of the placenta is unable to exchange gases and nutrients; when the remaining fetoplacental unit is unable to compensate for this loss of function
  • placenta will also become infarcted since it’s not being perfused properly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 types of placental abruptio?

A
  • Concealed hemorrhage occurs when blood dissects upward toward the fundus without vaginal bleeding
  • External or revealed hemorrhage occurs when blood dissects towards the cervix; presents with vaginal bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Risk factors for placental abruptio?

A
  • Maternal HTN
  • Placental abruption in a prior pregnancy
  • Trauma (blunt, falls, MVC) – big risk factor
  • Polyhydramnios with rapid decompression – rapid ∆ of the placental shape -> shearing force
  • Premature rupture of membranes
  • Tobacco use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you diagnose placenta abruptio?

A

US (identifies abruption only 50% of the time!)

  • US is indicated to exclude previa, since abruptio may coexist with a previa
18
Q

When does postpartum hemorrhage usually occur?

how is it diagnosed?

A
  • usually occurs immediately following delivery
  • Hemorrhage criteria:
    • 10% drop in hematocrit
    • need for transfusion
    • signs/sx of acute anemia after a vaginal delivery or C-section
19
Q

Major cause of postpartum hemorrhage and how does it occur?

A

Uterine atony (80%) ****

  • Normally the myometrium contracts around the myometrial spiral arterioles and decidual veins of the intervillous spaces and acts as a physiologic “ligature” to cut off blood flow
  • failure of the uterus to contract after placental separation (atony) puts these vessels at risk of bleeding post-partum
20
Q

Other potential causes post-partum hemorrhage

A
  • Genital tract trauma/laceration during delivery
  • Cervix, vagina, perineum, extension of hysterotomy with laceration of uterine arteries
  • Retained placental tissue
  • Low placental implantation in the uterus
  • Uterine inversion –uterus inverts as the placenta is delivered
  • Coagulation disorders

UTERINE ATONY is the major cause

21
Q

Risk Factors of postpartum hemorrhage?

A
  • Prolonged labor, augmented labor, or rapid labor
  • History of postpartum hemorrhage
  • Overdistended uterus (macrosomia, twins, hydramnios) – uterus doesn’t have the ability to contract down well
  • Operative delivery
  • Magnesium sulfate (agent used to relax smooth muscles)
  • Infection
  • Chorioamnionitis
22
Q

What are the major hypertensive d/o of pregnancy?

A

pre-eclampsia + eclampsia

23
Q

How often does hypertensive d/o in pregnancy occur?

A

occurs in 7-10% of pregnancies; accounts for ~20% of maternal deaths in US (usually due to maternal-cerebrovascular accidents)

24
Q

What are the characteristic features of pre-eclampsia?

A

HTN, proteinuria, edema (leads toweight gain)

25
Q

When does pre-eclampsia occur?

A
  • usually in the FIRST pregnancy (unusual in subsequent pregnancies)
  • usually 3rd trimester problem
26
Q

How is pre-eclampsia theorized to form?

A
  • Imbalance of decr. angiogenic (VEGF, PGF) and incr. anti-angiogenic factors (sFlt1, endoglin)
  • abnormal cytotrophoblast invasion and remodeling of uterine spiral arterioles at the time of implantation leads to placental hypoxia/ischemia
  • Endothelial dysfunction leads to an imbalance of vasoactive substances -> vasoconstriction
    • decr. PG-E2 and prostacyclin (vasodilators)
    • decr. Endothelial NO - (vasodilator and platelet-aggregation inhibitor)
    • incr. PG-F and thromboxane (vasoconstrictors)
    • incr. Endothelin-1 (vasoconstrictor and activator of platelets aggregation)
27
Q

Risk factors for pre-eclampsia?

A
  • pre-existing HTN
  • Glucose intolerance of pregnancy
  • Baseline thrombophilia
  • More trophoblast (twins/triplets)
28
Q

systemic effects of pre-eclampsia: cardiovascular

A

incr. SVR, HTN -> edema

29
Q

systemic effects of pre-eclampsia: renal

A

afferent arteriolar constriction -> decr. GFR , GBM injury -> HTN, proteinuria, oliguria, or ARF

30
Q

systemic effects of pre-eclampsia: GI system

A

hepatic vasoconstriction with periportal necrosis and hemorrhage, incr. LFT, RUQ pain, and rarely hepatic hematoma, capsule rupture

31
Q

systemic effects of pre-eclampsia: CNS

A

cerebral vasoconstriction -> incr. resistance of cerebral vascular blood flow, decr. cerebral O2 delivery, HA, vision hallucinations, seizures, hyperreflexia, encephalopathy, stroke

32
Q

systemic effects of pre-eclampsia: respiratory

A

incr. capillary permeability -> pulmonary edema

33
Q

systemic effects of pre-eclampsia: reproductive

A

incr. uterine artery vascular resistance, decr. placental blood flow, nutrient/O2 delivery, abruptio placentae

34
Q

systemic effects of pre-eclampsia: Fetal and neonatal complications

A

growth restriction, prematurity, and perinatal

35
Q

What is the difference between mild + severe pre-eclampsia?

A
  • MILD Preeclampsia
    • New-onset HTN after 20 wks; systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg
    • New-onset proteinuria > 300 mg/ 24 hrs (2+) after 20 weeks
  • SEVERE Preeclampsia
    • Systolic ≥ 160 mmHg or diastolic ≥ 110 mmHg on two occasions at least 6 hr apart
    • Proteinuria > 5 g/24 hr or qualitative value of 3+ in urine dips 4 hr apart
    • Oliguria <500 mL in 24 hr
36
Q

What is SEVERE Preeclampsia most at risk for?

A

seizures (eclampsia)

37
Q

What is HELLP?

What is it caused by?

A

HELLP syndrome - variant of severe preeclampsia w/ high morbidity

Hemolysis

Elevated Liver enzymes

Low Platelet count

problem: general activation of thecoagulation cascade

  • fibrin -> MAHA (microangiopathic hemolytic anemia)
  • periportal necrosis - main site where this occurs
  • consumption of platelets -> DIC + thrombocytopenia
38
Q

How would you treat a patient with pre-eclampsia early in the pregnancy? late in the pregnancy?

A
  • Hydrate
  • treat HTN
  • anti-seizure Rx prophylaxis
  • if later in the term: delivery to get rid of placenta (remember, this is a placental problem!)
39
Q

What are the characteristic features of eclampsia?

when does it occur?

A

(tonic clonic) SEIZURES + hypertension, proteinuria, edema

Timing is variable with most cases < 24 hours following delivery

40
Q

What’s going on in these two pictures?

A

Top: normal – myometrium + decidua is ready for implantation. Trophoblasts invade maternal blood vessels (spiral arteries) and make them bigger so that the placenta is adequately perfused

Bottom: Pre-eclampsia – no remodeling of spiral arteries (no invasion of trophoblasts) -> underperfusion of placenta

x REPRO (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions