Complications of Pregnancy Flashcards
How GDM is screened?
1-hr (50g) oral glucose tolerance test (OGTT)
How is GDM diagnosed?
3-hr (100 g) OGTT
What does a reactive non-stress test indicate?
Indicates that the fetus’s heart rate increased normally in response to movement or contractions.
What does a non-reactive non-stress test indicate?
A non-reactive result means the fetus’s heart rate didn’t increase enough during the test.
What are the five components assessed during a Biophysical profile?
Scored from 0-10, with lower score being more indicative of issues/need to deliver:
- Fetal breathing
- Fetal tone (extension/flexion of limb, opening/closing fist)
- Fetal movement
- AFI (amniotic fluid index)
- Reactive non-stress test
What is the etiology of gestational diabetes (GDM)?
- Placenta produces too much hPL
- Makes insulin ineffective and glucose uptake is limited
- Too much glucose in the bloodstream causes it to cross into the placenta
- Glucose crosses placenta, insulin does not
- Placental hormones increase insulin resistance
What is GDM associated with?
- Polyhydramnios
- Increased rate of fetal death
- Macrosomic infant (>4000gms)
- Prematurity, RDS, hypoglycemia, polycythemia in the newborn
- Congenital heart defects
How is GDM managed?
- Universal screening between 24-28 weeks
- Early screening if pt has risk factors:
- history of GDM with prior pregnancy
- strong family history of diabetes
- obese
How is chronic hypertension characterized in pregnancy?
- The presence of hypertension prior to pregnancy or before 20 weeks gestation
- SBP ≥ 140 or DBP ≥ 90
How is gestational hypertension characterized in pregnancy?
- Development of hypertension after 20 weeks gestation
- SBP ≥ 140 or DBP ≥ 90
How is preeclampsia characterized in pregnancy?
- New onset hypertension which occurs most often after 20 weeks gestation
- SBP ≥ 140 or DBP ≥ 90 on 2 occasions, 4 hours apart
- Often accompanied by new onset of proteinuria
What are some severe features of preeclampsia?
- SBP ≥ 160 or DBP ≥ 110 on 2 occasions, 4 hours apart
- Oliguria
- Renal insufficiency
- Unremitting headache/visual disturbances such as blurry vision or spots/floaters
- Pulmonary edema
- Epigastric/RUQ pain
- Elevated LFTs > 2x normal
- Platelets < 100K
- Hyperreflexia
How is eclampsia characterized in pregnancy?
- Seizure manifestation of preeclampsia: often present with neuro symptoms
- New onset of tonic-clonic or focal seizures
How is chronic hypertension with superimposed preeclampsia characterized in pregnancy?
- Preeclampsia is diagnosed in a pregnant person with known hypertension
- New onset of proteinuria
- Elevated liver function/enzymes
- Thrombocytopenia
- Neurologic symptoms
- Highest rate of maternal and fetal/neonatal complications
How is HELLP syndrome characterized?
- Hemolysis (H)
- Eevated Liver Enzymes (EL)
- Low Platelets (LP)
often present with nausea, RUQ pain, malaise
How to ensure thorough assessment for hypertension in pregnancy?
- Accurate blood pressure (manual cuff preferred)
- Reflexes and clonus (preeclampsia disrupts communication between cerebral cortex and spinal cord)
- Neurological assessment
- Edema
- Intake/output
How to get proper fetal surveillance?
- Kick counts
- NSTs
- BPPs
What labs can be done for hypertension during pregnancy?
- CBC
- AST/ALT
- creatinine
- coagulation
- uric acid
- LDH
- 24 hour urine
What medications are used for hypertension in pregnancy?
- Severe HTN: labetalol, hydralazine IV
- Magnesium sulfate for seizure prevention (not effective at lowering BP)
Describe magnesium toxicity values.
- Therapeutic range : 5-8mg/dL
- Loss of DTRs: 9-12mg/dL
- Respiratory depression: 12-15mg/dl
- Cardiac arrest : >15mg/dl
What is the antidote for magnesium toxicity?
calcium gluconate
What is placenta previa and how is it diagnosed?
- Placenta covers cervix and results in bleeding
- painless, bright red vaginal bleeding
- Diagnosed via ultrasound
What are risk factors of placenta previa?
- previous cesarean delivery or uterine surgery
- advanced maternal age
- tobacco use
- multiple gestation
- multiparity
How to manage placenta previa?
- bed rest
- fetal surveillance
- pelvic rest
- patient education
- no cervical exams
- hospitalization (multiple bleeding episodes)
- c/s if doesn’t resolve
