6 - Complications of Late Pregnancy Flashcards
3 hypertensive disorders in pregnancy and how are they distinguished
chronic htn - present before conception, dx before 20 wks or persists > 6 wks post partum
preeclampsia - appears after 20 wks and assoc w/ proteinuria
gestational htn - appears after 20 wks w/ no other evidence of preeclampsia
diagnostic criteria for preeclampsia
BP > 140/90 (either one) AND proteinuria > 300 mg/d
epidemiology of preeclampsia
more common in: nulliparous maternal age 35 african americans low SES multiple gestations obesity
signs of severe preeclampsia
BP > 160/110 proteinuria > 5g/d serum creatinine > 1.2 inc LFTs thrombocytopenia pulm edema oliguria intra uterine growth restriction
guesses about preeclampsia pathogenesis
endothelial injury
“rejection” phenomenon
abnormal placentation
imbalance btwn prostaglandins
preeclampsia mgmt
delivery is only cure
control htn w/ hydralazine, labetolol, nifedipine
prevent seizures w/ parenteral MgSO4
1 killer of neonates
prematurity
when does the most change occur in rate or mortality of prematurity? (range)
24-30 wks
2 things that need to be going on for it to be preterm labor
painful uterine contractions
progressive cervical change
role of infxn in preterm labor
infxn > immune response makes prostaglandins > may stimulate uterine contractions / labor cascade
premature rupture of membranes - main problem and natural course
major inc susceptibilty to infxn
most will deliver w/ in 48 hrs
induction of fetal lung maturity
give mother corticosteroids
takes 48 hrs for optimal effect
how long are tocolytics given for preterm labor?
usually no longer than 48 hrs - cant hold them off much longer successfully and the 48 hrs gives you enough time for the steroids to help the fetus’s lungs
tocolytic agents
beta mimetics (beta 2)
MgSO4
CaCBs
prostaglandin synthetase inhibs (not given after 32 wks)
definition of stillbirth
antepartum or intrapartum death of fetus > 500 g
