B8.018 High Risk Pregnancies Flashcards
symptoms concerning for preeclampsia
headache visual disturbances neuro deficits chest pain/ dyspnea N/V RUQ pain
why are the above symptoms associated with HTN/ preeclampsia?
swelling/vasoconstriction within in the brain
-posterior reversible encephalopathy syndrome (PRES)
most serious complication of preeclampsia
stroke
mostly hemorrhagic and preceded by severe headache and severe and fluctuating blood pressure levels
def of HTN in pregnant mother
SBP >140
DBP >90
2 separate occasions, 4 hours apart
hyperreflexion as a symptom of HTN
associated with intracranial hypertension
fundoscopic exam in HTN
constriction or spasm of retinal arterioles
if severe: changes associated with hypertensive retinopathy may occur
why is there proteinuria with preeclampsia
impaired integrity of glomerular filtration barrier and altered tubular handling of filtered proteins (hypofiltration) leading to increased protein excretion
why is serum Cr elevated in preeclampsia
severe end of a disease spectrum
AKI
normal Cr changes in pregnancy
physiologic increase in GFR during normal pregnancy results in decrease in serum Cr concentration
why thrombocytopenia in preeclampsia
microangiopathic endothelial injury and activation result in formation of platelet and fibrin thrombi in the microvasculature
accelerated platelet consumption leads to thrombocytopenia
why hemolysis in preeclampsia
vasoconstriction w microthrombi resulting in RBC destruction and schistocytes
hemoconcentration in preeclampsia
reduction of plasma volume due to capillary leaking
elevated hematocrit as a result
why are liver enzymes elevated in preeclampsia
reduced hepatic blood flow which results in ischemia and periportal hemorrhage
HELLP
hemolysis
elevated liver enzymes
low platelets
what is the source of trouble in HELLP syndrome?
the placenta!!
management of HELLP before delivery
- corticosteroids (22-37 wks)
2. magnesium sulfate
why does risk of aneuploidy increase in AMA
as age of eggs increases, so does the risk of a random error occurring during meiosis
main risks of AMA pregnancy
aneuploidy early onset gestational diabetes (insulin resistance increases w age) gestational HTN preterm delivery stillbirth
options for trisomy screening
US eval: 1st and 2nd trimester
maternal blood work
-quad screen: 15-22 wks
-cffDNA: 10 wks til delivery
pros of maternal blood work screening tests
most accurate screening
no risk to baby
cons of maternal blood work screening tests
only screens for a small amount of chromosome problems
invasive diagnostic tests
chorionic villus sampling: biopsy of placenta between 11-14 wks
amniocentesis: anytime after 15-16 wks
pros of invasive tests
most accurate
cal look at full karyotype and evaluate for microdeletions/duplications
cons of invasive tests
risks of pregnancy loss
adverse pregnancy outcomes with diabetes
preeclampsia polyhydramnios macrosomia fetal organomegaly meternal and infant birth trauma operative delivery perinatal mortality
does insulin cross placenta
no
risks of glyburide
larger babies, increased maternal and newborn hypoglycemic episodes
crosses placenta and enhances pancreatic B cell production of insulin
-insulin potent growth hormone in babies
-B cell hypertrophy can result in hypoglycemic episodes postnatally
