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OB > 8. High Risk Pregnancy > Flashcards

8. High Risk Pregnancy Flashcards

1
Q

Three biggest risk factors for maternal mortality

A

PIH
PPH
PE

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2
Q

Hypertensive disorders of pregnancy (3)

A

o Pregnancy-Induced HTN (PIH)
o Pre-Eclampsia
o Eclampsia

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3
Q

PHI: Def

A

HTN in pregnancy with onset after 20 weeks gestation

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4
Q

Chronic HTN in pregnancy

A
  • Onset before 20 weeks

* Continuing past PP period (42 days)

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5
Q

HTN: Def (#s)

A

+ 140/90

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6
Q

Pre-eclampsia: Def

A

PIH with proteinuria

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7
Q

DIagnosis of PIH

A

Proteinuria on two separate tests at least 6 hours parat

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8
Q

Can pre-eclampsia occur postpartum?

A

Yes, up to 48 hours

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9
Q

Pre-eclampsia “triad” of symptoms symptoms (3)

A
  • HTN
  • Proteinuria
  • Edema
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10
Q

Pre-eclampsia 2ndary symptoms (4)

A
  • Headaches
  • Visual changes
  • Epigastric pain
  • Sudden excessive weight gain
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11
Q

Why would a pre-eclampsia patient experience headache and visual changes?

A

Vasoconstriction → Increased pressure

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12
Q

Why would a pre-eclampsia patient experience epigastric pain?

A

Decreased perfusion to the liver → Elevated liver enzymes

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13
Q

Diagnosis of mild preeclampsia
• 2 Diagnostic criteria
• 2 characteristics patient would have

A

o BP 140/90
o 2+ to 3+ protein

o Moderate puffiness
o Deep tendon relfexes are WNL

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14
Q

Diagnosis of severe preeclampsia
• 2 diagnostic criteria
• 4 other characteristics patient would have

A

o BP 160/110
o 3+ to 4+ protein

o Generalized edema and noticeable puffiness
o Hyperreflexive
o Symptomatic
o Oliguria

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15
Q

Management of mild preeclampsia

A

o Rest in LLP Periodically
o High protein and high calorie diet
o Fetal movement counting

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16
Q

Management of severe preeclampsia

A 
o	Hospital and bed rest
o	Decreased environmental stimulation
o	Is and Os
o	Fetal assessment (NST/BPP)
o	Magnesium sulfate
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17
Q

Eclampsia (def)

A

Pre-eclampsia with convulsions

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18
Q

Treatment of eclampsia

A

Magnesium sulfate therapy

BIRTH IS THE ONLY CURE

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19
Q

Mechanism of Magnesium sulfate in eclampsia

A

Blocks neuromuscular transmission, causes vasodilation

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20
Q

Loading dose of magnesium sulfate for eclampsia

A

IV piggyback 4-6 grams over 15-30 minutes

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21
Q

MAintenance dose of magnesium sulfate for eclampsia

A

2g/h

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22
Q

Safe magnesium serum levels

A

4-7 or 8

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23
Q

Signs and symptoms of magnseium toxicity (5)

A
  • Decreased respiratory rate
  • Decreased urine output (oliguria)
  • Feeling of warmth, nausea
  • Muscle weakness, decreased reflexes
  • Slurred speech
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24
Q

Risk factors for eclampsia (10)

A
  • Chronic renal disease
  • Chronic HTN
  • Diabetes
  • Obesity
  • Primigravity
  • Twin gestation
  • Family hx of PIH
  • History of Preeclampsia in past pregnancies
  • Maternal age < 19 or > 40 years old
  • Rh Incompatibility
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25
Q

HELLP Syndrome (def)

A

Life threatening occurrence that compromises 10% of people with PIH. Acronym for lab results.

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26
Q

What does HELLP stand for

A
  • H - Hemolysis
  • E - Elevated
  • L – Liver Enzymes
  • L - Low
  • P – Platelets
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27
Q

Platelet levels with HELLP

A

Typically below 100,000 (normal ~ 150,000 – 400,000); coagulants are all normal. Abnormal Clotting factor.

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28
Q

Causes of early pregnancy bleeding: (5)

A 
o	Spontaneous abortion
o	Molar pregnancy
o	Incompetent cervix
o	Ectopic Pregnancy
o	Implantation spotting
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29
Q

Spontaneous abortion

  • Definition
  • Criteria for “early”
  • Criteria for “late”
A
  • Def: Pregnancy that ends before 20 weeks
  • Early: Prior to 12 weeks
  • Late: 12-20 weeks
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30
Q

• _____% of clinically recognized pregnancies end in abortion
• ___% of this is related to
____________

A
  • 10-20%

* 50% related to chromosomal abnormalities

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31
Q

Complete abortion: def

A

Fetus and all of the products of conception have been expelled from the uterus

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32
Q

Incomplete abortion (def)

A

Loss of pregnancy; some but not all of the products of conception have been expelled from the uterus

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33
Q

Threatened abortion: Def

A

Possible loss of pregnancy with early signs and symptoms.

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34
Q

Four characteristics of a threatened abortion

A
  • Cervix beginning to dilate
  • Cramping
  • Bleeding
  • No POC has passed
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35
Q

Inevitable abortion: Def

A

Threatened loss of pregnancy that cannot be prevented or stopped.

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36
Q

Four characteristics of an inevitable abortion

A
  • Cramping
  • Bleeding
  • Os is opened
  • Usually ROM
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37
Q

Missed abortion: Def

A

Loss of pregnancy where the POC remain in the uterus.

• Your body missed the cue to get rid of it.

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38
Q

Risk factors for spontaneous abortion: 7

A
  • Endocrine Imbalance
  • Infection
  • Maternal structural problems
  • Immunological factors
  • Systemic disorders
  • Drug use
  • Inadequate nutrition
39
Q

What is a molar pregnancy?

A

When a hydatidiform mole forms instead of a fetus.

40
Q

Choriocarcinoma (def)

A

When a molar pregnancy becomes cancerous

41
Q

Gestational Trophoblastic Disease (def)

A

Problem with trophoblast cells early on. Instead of helping embryo attach, trophoblastic cells give rise to a tumor.

42
Q

Molar pregnancy: Complete v. Parital

A
  • Complete: Contains no genetic material

* Partial: Nonviable fetus

43
Q

Signs and Symptoms of a molar pregnancy (5)

A
  • Vaginal bleeding
  • Severe nausea and vomiting
  • Uterus is large for dates
  • No fetal heart tones or activity
  • hCG levels high and rising rapidly
44
Q

Treatment for molar pregnancy (4)

A
  • Bereavement counseling
  • Remove the fetus
  • hCG monitoring
  • Continued monitoring, no pregnancy for 1 year
45
Q

What should happen to hCG levels after molar pregnancy is removed?

A
  • Declines

* Should be undetectable by 3 weeks

46
Q

Incompetent Cervix (def)

A

Passive and painless dilation of the cervix in the 2nd trimester

47
Q

Risk factors for incompetent cervix (4)

A
  • Hx of previous cervical lacerations during childbirth
  • Excessive cervical dilation
  • Congenitally short cervix
  • Cervical uterine abnormalities
48
Q

Ectopic pregnancy: Def

A

Fertilized ovum is implanted outside of the cervix

49
Q

Where do most ectopic pregnancies occur?

A

95% are implanted in the AMPULE (the outer 3rd)

50
Q

Causes of late pregnancy bleeding (3)

A

o Placenta previa
o Placenta abruption
o Gestational Diabetes

51
Q

Placenta previa (def)

A

Placenta partially or completely covers the internal cervical os

52
Q

What is the difference in what the woman feels with a placenta previa versus a placenta abruption

A

Placenta previa is painless,

Placenta abrupta is painful

53
Q

Management of placenta previa (5)

A
  • Bed rest
  • NPV
  • Evaluate fetal well-being
  • NEVER do a vaginal exam
  • C-Section
54
Q

Risk factors for placenta previa: History (4)

A
  • Previous previa
  • Previous C-Section
  • Hx of Elective TOP (Termination of Pregnancy)
  • Closely spaced pregnancies
55
Q

Risk factors for placenta previa: Current Pregnancy (5)

A
  • Multiple gestation
  • Closely spaced pregnancies
  • Advanced medical age
  • Smoking – Vasoconstrictor
  • Cocaine use – Vasoconstrictor
56
Q

Placenta abruption (def)

A

Premature separation of the placenta from the uterine wall

57
Q

SxS of placental abruption

  • 2 Classic symptoms
  • 2 other symptoms
A

“Classic” S&S:
o Uterine-tenderness
o Board-like abdomen

  • Vaginal bleeding may be concealed
  • Abdominal pain w/ctx greater than expected; may be localized
58
Q

What does a “board-like abdomen” indicate?

A

Indicates internal hemorrhage

59
Q

Risk factors for placental abruption (5)

A
  • PIH
  • Cocaine use
  • Trauma (Blunt force)
  • Smoking
  • Poor nutrition
60
Q

Gestational diabetes: Def

A

Physiologic glucose intolerance in pregnancy

61
Q

Gestational diabetes: Epidemiology

A

Occurs in 4% of all pregnancies

62
Q

Gestational diabetes: Prognosis

A

50% will develop glucose intolerance later in life

63
Q

Glucose testing in pregnant women: Screening

A

Glucose Challenge Test (GCT)

o 24-28 weeks

64
Q

Glucose testing in pregnant women: Diagnostic

A

Glucose Tolerence Test (GTT)

o Follow-up to evaluated GCT

65
Q

Gestational Diabetes Risk Factors: History (4)

A
  • Family history of IDDM: Maternal (esp insulin dependent)
  • Previous baby weighing >4000g
  • Previous unexplained stillbirth
  • Spontaneous abortion
66
Q

Gestational Diabetes Risk Factors: Current (5)

A
  • Maternal age >30
  • Obesity
  • Congenital anomalies
  • Sxs of diabetes
  • Recurrent glucosuria noted on dipstick
67
Q

Diagnosing Gestational Diabetes (2)

A

• GCT value of >200
OR
• 2 abnormal values on GTT

68
Q 
Abnormal values on GTT (4)
•	Fasting
•	1 hr
•	2 hr
•	3 hr
A

FASTING >/= 105 mg/dL
1 hour >/= 190mg/dL
2 hour >/= 165mg/dL
3 hour >/= 145mg/dL

69
Q

Big picture: What should you worry about with maternal glucose?

A

Stable vs Volitle

70
Q

Dietary treatment for gestational diabetes (6)

A
  • Standard diabetic diet
  • Small, frequent meals
  • High fiber meals
  • High fiber foods
  • Lower fat intake
  • Avoid sugar, concentrated sweets
71
Q

Lab goals for glucose control (3)

A
  • Fasting levels <120mg/dL

* Goal: 60mg/dL and 100 mg/dL

72
Q

“Size less than dates”: Causes (3)

A
  • Intrauterine Growth Restriction (IUGR)
  • Small for gestational age
  • Oligohydraminos
73
Q

What causes IUGR? (2)

A
  • Pathological process

* Decreased oxygen and nutritional availability to fetus

74
Q

IUGR: Symmetrical (2 char)

A
  • Represents chronic / long-term insult

* Small in all parameters including head development

75
Q

IUGR: Assymetrical (3 char)

A
  • Late occurring / short-term deprivation
  • “Head-sparing”
  • Typical small body, large head
76
Q

What is the difference between an “IUGR” diagnosis and a “Small for gestational age” diagnosis?

A
  • UGR is pathological

* SGA is non-pathological

77
Q

Oligohydraminos: Def

A

Abnormally small amount of amniotic fluid

Amniotic fluid index <5

78
Q

Normal amniotic fluid index

A

5-20cc

79
Q

Oligohydraminos is associated with _____

A

Marked perinatal mortality

80
Q

Factors that coincide with oligohydraminos (4)

A

o Congenital anomilies
o IUGR
o Early rupture of membranes
o Post-maturity

81
Q

Management of oligohydraminos (5)

A 
o	Bedrest
o	Hydration
o	Encourage good nutrition
o	Assess fetal well-being: FMC, AFV, BPP
o	Induction and delivery if severe and fetus is mature
82
Q

“Size Greater than Dates” Causes (6)

A
  • Macrosomia
  • Large for gestational age (LGA)
  • Multifetal preganancy
  • Fibroid uterus
  • Polyhydraminos
  • Post-term pregnancy
83
Q

Polyhydraminos: Def

A

Excessive amount of amniotic fluid

Amniotic fluid index >20cc

84
Q

Polyhydraminos: Characteristics (2)

A
  • Difficulty auscultating fetal heart tones and palpating fetus
  • Unstable fetal lie
85
Q

What do you have to rule out with polyhydraminos?

A

GDM and ABO/Rh Disease

86
Q

Risk factors for polyhydraminos (4)

A

o Multiples
o Uncontrolled GDM
o Fetal Malformations
o Chromosomal Abnormalities

87
Q

Complications of polyhydraminos (6)

A 
o	Fetal malpresentation
o	Placental abruption
o	Uterine dysfunction during labor
o	PP Hemorrhage
o	Cord prolapse
o	Preterm labor
88
Q

Post-term pregnancy: Def

A

Pregnancy that extends beyond the 42nd week gestation

89
Q

Clinical manifestations of post-term pregnancy (4)

A

o Maternal weight loss
o Decreased uterine size
o Meconium in the fluid
o Advanced bone maturation of the fetal skeleton with a hard skull

90
Q

Maternal risks involved with post-term pregnancy (5)

A 
o	Dysfunctional labor
o	Perineal trauma
o	PPH
o	Infection
o	Interventions (forceps, vacuum, c-section) are more likely to be necessary
91
Q

Fetal risks involved with post-term pregnancy (4)

A

o Macrosoma
o Birth trauma
o Distress
o Hypoxia / asphyxia

92
Q

Management of post-term pregnancy (3)

A

o Testing: BPP, NST, FMC
o Cervical assessment for ripeness
o Induction

93
Q

Normal platelet levels

A

normal ~ 150,000 – 400,000

OB (15 decks)

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