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408 Maternity Exam 1 > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

1
Q

How GDM is screened?

A

1-hr (50g) oral glucose tolerance test (OGTT)

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2
Q

How is GDM diagnosed?

A

3-hr (100 g) OGTT

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3
Q

What does a reactive non-stress test indicate?

A

Indicates that the fetus’s heart rate increased normally in response to movement or contractions.

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4
Q

What does a non-reactive non-stress test indicate?

A

A non-reactive result means the fetus’s heart rate didn’t increase enough during the test.

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5
Q

What are the five components assessed during a Biophysical profile?

A

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
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6
Q

What is the etiology of gestational diabetes (GDM)?

A
  • 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
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7
Q

What is GDM associated with?

A
  • Polyhydramnios
  • Increased rate of fetal death
  • Macrosomic infant (>4000gms)
  • Prematurity, RDS, hypoglycemia, polycythemia in the newborn
  • Congenital heart defects
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8
Q

How is GDM managed?

A
  • 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
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9
Q

How is chronic hypertension characterized in pregnancy?

A
  • The presence of hypertension prior to pregnancy or before 20 weeks gestation
  • SBP ≥ 140 or DBP ≥ 90
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10
Q

How is gestational hypertension characterized in pregnancy?

A
  • Development of hypertension after 20 weeks gestation
  • SBP ≥ 140 or DBP ≥ 90
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11
Q

How is preeclampsia characterized in pregnancy?

A
  • 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
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12
Q

What are some severe features of preeclampsia?

A
  • 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
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13
Q

How is eclampsia characterized in pregnancy?

A
  • Seizure manifestation of preeclampsia: often present with neuro symptoms
  • New onset of tonic-clonic or focal seizures
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14
Q

How is chronic hypertension with superimposed preeclampsia characterized in pregnancy?

A
  • 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
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15
Q

How is HELLP syndrome characterized?

A
  • Hemolysis (H)
  • Eevated Liver Enzymes (EL)
  • Low Platelets (LP)

often present with nausea, RUQ pain, malaise

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16
Q

How to ensure thorough assessment for hypertension in pregnancy?

A
  • Accurate blood pressure (manual cuff preferred)
  • Reflexes and clonus (preeclampsia disrupts communication between cerebral cortex and spinal cord)
  • Neurological assessment
  • Edema
  • Intake/output
17
Q

How to get proper fetal surveillance?

A
  • Kick counts
  • NSTs
  • BPPs
18
Q

What labs can be done for hypertension during pregnancy?

A
  • CBC
  • AST/ALT
  • creatinine
  • coagulation
  • uric acid
  • LDH
  • 24 hour urine
19
Q

What medications are used for hypertension in pregnancy?

A
  • Severe HTN: labetalol, hydralazine IV
  • Magnesium sulfate for seizure prevention (not effective at lowering BP)
20
Q

Describe magnesium toxicity values.

A
  • Therapeutic range : 5-8mg/dL
  • Loss of DTRs: 9-12mg/dL
  • Respiratory depression: 12-15mg/dl
  • Cardiac arrest : >15mg/dl
21
Q

What is the antidote for magnesium toxicity?

A

calcium gluconate

22
Q

What is placenta previa and how is it diagnosed?

A
  • Placenta covers cervix and results in bleeding
    • painless, bright red vaginal bleeding
  • Diagnosed via ultrasound
23
Q

What are risk factors of placenta previa?

A
  • previous cesarean delivery or uterine surgery
  • advanced maternal age
  • tobacco use
  • multiple gestation
  • multiparity
24
Q

How to manage placenta previa?

A
  • bed rest
  • fetal surveillance
  • pelvic rest
  • patient education
  • no cervical exams
  • hospitalization (multiple bleeding episodes)
  • c/s if doesn’t resolve
25
Q

What is Vasa Previa?

A

cord vessels implanted in fetal membranes cross or run near the cervix

26
Q

What are different types of Invasive Placenta?

A
  • accreta
  • increta
  • percreta
27
Q

What is Placenta accreta?

A

placenta attaches too deeply into uterine wall

  • chorionic villi invade beyond uterine lining and decidual basilis
28
Q

What is Placenta increta?

A

chorionic villi invade into the myometrium

  • placenta attaches into the uterine muscle
29
Q

What is Placenta percreta?

A

chorionic villi go past the myometrium, can attach to other organs such as bowel or bladder

  • placenta goes completely through the uterine wall
30
Q

What can invasive placenta lead to?

A

Significant risk of hemorrhage and need for hysterectomy

31
Q

What is placenta abruption?

A

Placenta separates from uterine lining prior to delivery of fetus

32
Q

What are signs and symptoms of placenta abruption?

A
  • dark red vaginal bleeding
  • abdominal pain
  • rigid abdomen
  • uterine contractions and tenderness
  • elevated uterine resting tone
  • non-reassuring fetal heart rate pattern
33
Q

What are risk factors for placenta abruption?

A
  • multiparity
  • history of abruption
  • hypertension
  • advanced maternal age
  • premature rupture of membranes (PROM)
  • cocaine use
  • tobacco use
  • polyhydramnios

408 Maternity Exam 1 (5 decks)

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