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Repro. Med 4 > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

1
Q

What is a complication of pregnancy in any trimester?

A

Rh isoimmunization

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2
Q

What are 1st trimester (LMP date to 12 weeks) complications?

A
  • Hyperemesis, bleeding, pregnancy loss

- Molar Pregnancy (Gestational Trophoblastic Neoplasia)

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3
Q

What are 2nd trimester (12-24 weeks) complications?

A
  • Abnormal prenatal diagnostics, second trimester loss, bleeding
  • Placenta Previa (not usually a problem in the 2nd TM, but often diagnosed here)
  • Cervical Insufficiency
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4
Q

What are 3rd (24 weeks to term) trimester complications?

A 
Preterm labor
Preeclampsia
Chorioamnionitis
post dates pregnancy
complications of DM
placenta previa
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5
Q

Gestational Trophoblastic Neoplasia have the ability to convert into ___ if their tissue is not removed

A

malignancies

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6
Q

Gestational Trophoblastic Neoplasia is a spectrum of dz that includes (x5)

A
  • complete molar pregnancy
  • partial morlar pregnancy
  • invasive molar pregnancy
  • choriocarcinoma
  • placental site trophoblastic tumor
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7
Q

What is more common, partial or complete molar pregnancies?

A

complete

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8
Q

Partial molar pregnancies (do/do not) have a fetus present?

Incomplete molar pregnancies?

A

partial do

complete do not

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9
Q

Molar pregnancies can have very high numbers of ____ (hormone)

A

HCG

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10
Q

What are common sx of molar pregnancies?

A 
Hyperemesis
B/l enlarged theca lutein cysts 
vaginal bleeding
Uterine enlargement 
pregnancy induced HTN
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11
Q

What will you see on U/S of molar pregnancies

A

a bunch of grape like things

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12
Q

What are 2 important things you need to do for tx of molar pregnancies?

A
  • evacuation of mole

- regular f/u to detect persistent trophoblastic dz

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13
Q

What situation causes Rh isoimmunization?

A
  • child is Rh +, mother is -
  • Rh+ blood cells cross placenta from fetus parent’s blood stream
  • anti-Rh antibodies created against pregnancy
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14
Q

When is the mother most likely to be exposed to Rh+ stuff from baby?

A

after 28 wks and DELIVERY

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15
Q

~__% of pregnancies can detect fetal DNA in the maternal bloodstream.
They have been isolated in the ____, ____, ___

A

~6%

brain, kidney, liver

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16
Q

What medication can decrease risk of adverse outcomes from Rh- mother with Rh+ baby?

A

rhogam

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17
Q

When is rhogam given during pregnancy?

A

Given at 24 weeks OR when ANY bleeding during pregnancy is noted.

Repeat Rhogam at time of delivery OR 12 weeks after prior dose (if given early)

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18
Q

What do you do if mother has anti- Rh antibodies?

A

Refer

Test child to see if it is a problem

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19
Q

If mother has anti-RH antibodies and child is tested and is Rh+ what do you need to monitor?

A

fetal RBC destruction

  • hydrops
  • fetal anemia
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20
Q

If mother has anti-RH antibodies and child is tested and is Rh+ what do you need to do?

A

fetal blood transfusions and early delivery

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21
Q

___ is placental implantation over the cervix

A

Placenta Previa

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22
Q

When should you be concerned for Placenta Previa?

A

whenever there is painless vaginal bleeing

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23
Q

What is contraindicated w/ Placenta Previa?

A

Vaginal delivery

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24
Q

___ occurs when the placenta covers the internal os

____ occurs when the placenta is next to but not quite covering surface

A

Complete Previa

Marginal previa

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25
Q

May see a marginal previa on early US, such as fetal survey at __-__ weeks

A

18-20

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26
Q

Placenta previa needs follow up, but as uterus grows what happens to the placenta?

A

Placenta almost always “moves up” w/ the uterine wall

GETS OUT OF THE WAY

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27
Q

Third Trimester Placenta Previa is at increased risk for what?

A

Vaginal bleeding

Placental abruption (marginal, partial, complete)

IUGR

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28
Q

Risk of placenta previa goes up w/ each ____

A

cesarean section

29
Q

Multiple C/S also increase risk for ____ (placenta that has grown into the muscular part of the uterus and will not detach at delivery)

A

placenta accreta

**can cause maternal hemorrhage

30
Q

___ is weakness of the cervix that results in cervical dilation/effacement in the second trimester in the absence of contractions

A

cervical insufficiency

31
Q

Cervical insufficiency can cause early pregnancy loss in the ___ or ___ trimester

A

2nd

3rd

32
Q

When is cervical insufficiency usually dx?

A

2nd trimester w/ painless dilation

33
Q

What can cause cervical insufficiency?

A

previous cervical surgeries

infection

34
Q

The strongest predictor of incompetent cervix is h/o ____ w/ hx consistent w/ incompetent cervix

A

2nd trimester pregnancy loss

35
Q

How can you tx cervical insufficiency?

A

Cervical cerclage
Purse-string suture placed in the cervix to add strength to the cervical tissue
**removed if labor ensues or near term

36
Q

What are risks of Cervical cerclage for tx of cervical insufficiency ?

A

Rupturing membranes while placing stitches
preterm labor because of foreign body in the cervix
infxn

37
Q

If a pt has a hx of cervical insufficiency, what can you do for the next pregnancy?

A 
Monitor w/ US
Cerclage for second trimester cervical change
Progesterone supplementation (vaginal) starting at 18-20 weeks
38
Q

Preterm labor is contractions w/ cervical change at __-___ weeks gestation

A

24-36 weeks

39
Q

What are fetal complications of preterm labor?

A 
Issues w/ the:
Brain
lungs (immature)
GI
Retina
Immune (immature)
Neuro-respiratory (apnea b/c of immaturity)
40
Q

What are fetal brain problems w/ pre-term labor?

A

Intraventricular hemorrhage

Hypoxemic injury

41
Q

What are fetal GI problems w/ pre-term labor?

A

Bowel immaturity resulting in necrotizing enterocolitis

42
Q

Why does retina issues occur in infants who are preterm?

A

O2 toxicity due to high ventilator O2 doses

43
Q

At 24 weeks the ‘average’ fetus weighs ___ lb ___ oz
mortality = ___%
major morbidity = ___%

A

1 lb 6 oz
30-45%
90%

44
Q

At 28 weeks the ‘average’ fetus is __ lb ___oz

A

2 lb 4 oz

45
Q

What are causes of preterm labor? (x8)

A
  • Cervicitis
  • Abdominal trauma
  • Infxns like UTI’s
  • Placental abruption
  • Drug use (cocaine, alcohol –> an old-time tx for preterm labor!)
  • Dehydration
  • Polyhydramnios (too much amniotic fluid)
  • Multiple gestation
46
Q

How can you dx pre-term labor?

A

Fetal fibronectin swab (FFN)

  • Negative test = low risk of preterm birth
    • test = may or may not have preterm birth

Cervical length US– cervical length > 3.5 cm correlates well w/ NOT delivering in next 1-2 weeks

47
Q

What should you check for when working up a pt in preterm labor?

A
  • cervicitis (tx)
  • ruptured membranes (changes management)
  • urine tox screen
48
Q

How do Corticosteroids work in Preterm Labor?

A
  • Betamethasone crosses placenta to fetus

- causes type II pneumocytes to produce surfactant

49
Q

How do you tx preterm labor?

A 
Bedrest
Nifedipine
Terbutaline
Indomethacin
IV Mg sulfate
50
Q

What preterm labor med is most commonly used due to low side effect profile?

A

oral nifedipine

51
Q

what side effects may occur with use of terbualine for preterm labor?

A

pulmonary edema

tachycardia

52
Q

How does indomethacin work to prevent preterm labor and what are its side effects?

A

Anti-prostaglandins decrease contractions

Premature ductus closure
Persistent ductus after delivery

53
Q

What are side effects of magnesium sulfate when treating preterm labor?

A

flushing
N
hyporeflexia

54
Q

is contractions without cervical changes considered preterm labor?

A

No

55
Q

If a woman has a hx of preterm labor, what can you give her to reduce the chances of this happening again?

A

progesterone supplementation (Vaginal gel or IM injxn)

  • Start around 18 weeks
  • Weekly to 34-36 weeks
56
Q

what fetal monitoring is required for gestational DM

A

NST/AFI weekly (non-stress tests)

- risk of polyhydramnios and placental insufficiency around week 32

57
Q

what is NST (non-stress test)

A

Watch fetal HR and movements for 20 mins.
if HR drops after contraction, you worry
**If NST is a negative predicted value, stillbirth is less than 99.8%

58
Q

what is the triad of dx for preeclampsia?

A

edema
proteinuria
HTN

59
Q

what cures pre-eclampsia

when does it never occur

A

delivery

before 20 wks

60
Q

Mild preeclampsia
Systolic range: _____
Diastolic Range: ____
Protein range: ____

A

systolic: 140-160
diastolic: 90-110
protein bt 3-5

61
Q

Severe Preeclampsia
Systolic range: _____
Diastolic Range: ____
Protein range: ____

A

systolic: >160
diastolic: >110
protein: >5

62
Q

is a baby at risk for Macrosomia or IUGR with preeclampsia?

A

IUGR

63
Q

what may contribute to preeclampsia

A

Placental pressures
umbilical flow
Spasm of spiral arterioles

64
Q

placental _____ probably cause the maternal vasospasm associated with preeclampsia

A

thromboplastins

65
Q

what are S/S of preeclampsia (severe sxs)

A 
HA (confusion) 
Blurred vision
edema
decreased urine output
N/V
66
Q

what may you see on PE on a pt with mild preeclampsia

A
  • swelling of hands, face and extremities
  • hyperreflexia
  • oliguria
67
Q

how do you treat pre-eclampsia

A 
Magnesium sulfate (protect agaisnt sz)
delivery child
68
Q

postpartum pre-eclampsia typically happes within __ hrs after delivery.

A

24

**tx with MgSO4 to protect against sz

69
Q

what is HELLP syndrome

A

associated with pre-eclampsia
H: Hemolysis
EL: elevated liver enzymes
LP: low platelet count

Repro. Med 4 (7 decks)

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