Common Diseases of Pregnancy Flashcards
What is preterm delivery defined as?
Contractions that cause cervical change before 37 weeks of gestation
What are the some that can precipitate preterm delivery?
- previous preterm delivery (recurrence of 17-37%)
- infection
- uterine overdistention (polyhydramnions, multiple gestations)
- vaginal bleeding secondary to placenta previa or abruption
What are the risk factors for preterm delivery?
- Non-white race
- low socioeconiic status
- low BMI
- Smoking or cocaine use
- DES exposure
What is the leading cause of neonatal morbidity and mortality in developed countries?
Preterm delivery. Accounts for 60-80% of neonatal deaths not related to congenital anomalies
What is fetal fibronectin?
Fetal fibronectin is a protein that’s believed to help keep the amniotic sac “glued” to the lining of the uterus.
Fetal fibronectin is often present in vaginal discharge before week 22 of pregnancy. Fetal fibronectin also begins to break down and can be detected in vaginal discharge toward the end of pregnancy and can be used as an indication that labor in ineminent
What is the main goal of management of preterm labor?
Maintain a pregnancy long enough to ensure lung maturity via corticosteroid administration via tocolytic therpay, such as magnesium sulfate
What things can reduce the risk of a preterm delivery?
- •Weekly 17-alpha-hydroxyprogesterone injections between 16 and 36 weeks (40% reduction)
- •Tobacco cessation, improving nutritional status, treating infections
How does premature rupture of fetal membranes correlate to the inevitabilty of labor?
If PPROM occurs prior to 26 weeks, 50% will enter labor within 1 week, while
if PPROM occurs between 28-34 weeks, 50% will enter labor within 24 hrs while 80-90% will enter labor within 1 week
Risk factors for PPROM
pPROM is associated with significantly increased morbidity in both the mother and the fetus. How?
It can lead to preterm delivery and the sequelae associated with that, as well increased risk of chorioamnionitis and placental abruption, as well as:
umbilical cord prolapse and Potter sequence as a consequence of oligohydramnios
How should the evaulation of a woman with suspected pPROM begin?
You want to look for signs of infection like a febrile state or fundus pain on examination, which might be indications to go ahead and induce labor via C-section. If the mother appears stable, depending on the gestation period, different options must be advised.
How can ruptured membranes be confirmed?
A Nitrazine test-
This test involves putting a drop of fluid obtained from the vagina onto paper strips containing Nitrazine dye. The strips change color depending on the pH of the fluid. The strips will turn blue if the pH is greater than 6.0. A blue strip means it’s more likely the membranes have ruptured. OR
Fern testing to look for cervical fluid crystallization
What should be done if membranes rupture after 34 weeks?
usually just proceed with delivery. May give tocolytics to add steroids
What should be done if membranes rupture before 24 weeks?
Must advise the pt on the risks of birthing a child with effects of oligohydramnios, including Potter sequence or cerebral palsy or can offer termnation of the pregnancy
If pPROM occurs between 24-34 weeks, typically the pt. will be admitted, tocolytics will be given and birth will be allowed to commense
Is preeclampsia more common in first or subsequent pregnancies?
First
What are the risk factors for preeclampsia?
¨Nulliparous,
multifetal gestation,
obesity, chronic HTN, DM, renal disease
SLE, thrombophilia
family history of preeclampsia,
molar pregnancy
Describe HELLP syndrome
HELLP usually begins during the third trimester; rare cases have been reported as early as 21 weeks gestation. Often, a woman who develops HELLP syndrome has already been followed up for pregnancy-induced hypertension (gestational hypertension), or is suspected to develop pre-eclampsia (high blood pressure and proteinuria). Up to 8% of all cases occur after delivery
How might HELLP syndrome present?
Women with HELLP syndrome often “do not look very sick.”Early symptoms can include:
In 90% of cases, either epigastric pain described as “heartburn” or right upper quadrant pain develops.
In 90% of cases, malaise occurs.
In 50% of cases, nausea or vomiting happen.
Gradual but marked onset of headaches (30%), blurred vision, and paresthesia (tingling in the extremities) can occur.
Edema may occur, but its absence does not exclude HELLP syndrome. Arterial hypertension is a diagnostic requirement, but may be mild. Rupture of the liver capsule and a resultant hematoma may occur.
If a woman has a seizure or coma, the condition has progressed into full-blown eclampsia.
How can the seizures of eclampsia be prevented?
Magnesium sulfate is treatment of choice
What is Acute fatty liver of pregnancy (AFLP)?
A serious complication unique to pregnancy first described by Sheehan in 1940. It is characterized by microvesicular steatosis in the liver
What causes AFLP?
The foremost cause of AFLP is thought to be due to a mitochondrial dysfunction in the oxidation of fatty acids leading to an accumulation in hepatocytes. The infiltration of fatty acids causes acute liver insufficiency, which leads to most of the symptoms that present in this condition.
What pt pop are more at risk for AFLP?
There does not appear to be a predilection for any geographical area or race. It appears to occur more commonly in primiparous women than multiparous women
