Complications of Pregnancy Flashcards
What is a complication of pregnancy in any trimester?
Rh isoimmunization
What are 1st trimester (LMP date to 12 weeks) complications?
- Hyperemesis, bleeding, pregnancy loss
- Molar Pregnancy (Gestational Trophoblastic Neoplasia)
What are 2nd trimester (12-24 weeks) complications?
- Abnormal prenatal diagnostics, second trimester loss, bleeding
- Placenta Previa (not usually a problem in the 2nd TM, but often diagnosed here)
- Cervical Insufficiency
What are 3rd (24 weeks to term) trimester complications?
Preterm labor Preeclampsia Chorioamnionitis post dates pregnancy complications of DM placenta previa
Gestational Trophoblastic Neoplasia have the ability to convert into ___ if their tissue is not removed
malignancies
Gestational Trophoblastic Neoplasia is a spectrum of dz that includes (x5)
- complete molar pregnancy
- partial morlar pregnancy
- invasive molar pregnancy
- choriocarcinoma
- placental site trophoblastic tumor
What is more common, partial or complete molar pregnancies?
complete
Partial molar pregnancies (do/do not) have a fetus present?
Incomplete molar pregnancies?
partial do
complete do not
Molar pregnancies can have very high numbers of ____ (hormone)
HCG
What are common sx of molar pregnancies?
Hyperemesis B/l enlarged theca lutein cysts vaginal bleeding Uterine enlargement pregnancy induced HTN
What will you see on U/S of molar pregnancies
a bunch of grape like things
What are 2 important things you need to do for tx of molar pregnancies?
- evacuation of mole
- regular f/u to detect persistent trophoblastic dz
What situation causes Rh isoimmunization?
- child is Rh +, mother is -
- Rh+ blood cells cross placenta from fetus parent’s blood stream
- anti-Rh antibodies created against pregnancy
When is the mother most likely to be exposed to Rh+ stuff from baby?
after 28 wks and DELIVERY
~__% of pregnancies can detect fetal DNA in the maternal bloodstream.
They have been isolated in the ____, ____, ___
~6%
brain, kidney, liver
What medication can decrease risk of adverse outcomes from Rh- mother with Rh+ baby?
rhogam
When is rhogam given during pregnancy?
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)
What do you do if mother has anti- Rh antibodies?
Refer
Test child to see if it is a problem
If mother has anti-RH antibodies and child is tested and is Rh+ what do you need to monitor?
fetal RBC destruction
- hydrops
- fetal anemia
If mother has anti-RH antibodies and child is tested and is Rh+ what do you need to do?
fetal blood transfusions and early delivery
___ is placental implantation over the cervix
Placenta Previa
When should you be concerned for Placenta Previa?
whenever there is painless vaginal bleeing
What is contraindicated w/ Placenta Previa?
Vaginal delivery
___ occurs when the placenta covers the internal os
____ occurs when the placenta is next to but not quite covering surface
Complete Previa
Marginal previa
May see a marginal previa on early US, such as fetal survey at __-__ weeks
18-20
Placenta previa needs follow up, but as uterus grows what happens to the placenta?
Placenta almost always “moves up” w/ the uterine wall
GETS OUT OF THE WAY
Third Trimester Placenta Previa is at increased risk for what?
Vaginal bleeding
Placental abruption (marginal, partial, complete)
IUGR
Risk of placenta previa goes up w/ each ____
cesarean section
Multiple C/S also increase risk for ____ (placenta that has grown into the muscular part of the uterus and will not detach at delivery)
placenta accreta
**can cause maternal hemorrhage
___ is weakness of the cervix that results in cervical dilation/effacement in the second trimester in the absence of contractions
cervical insufficiency
Cervical insufficiency can cause early pregnancy loss in the ___ or ___ trimester
2nd
3rd
When is cervical insufficiency usually dx?
2nd trimester w/ painless dilation
What can cause cervical insufficiency?
previous cervical surgeries
infection
The strongest predictor of incompetent cervix is h/o ____ w/ hx consistent w/ incompetent cervix
2nd trimester pregnancy loss
How can you tx cervical insufficiency?
Cervical cerclage
Purse-string suture placed in the cervix to add strength to the cervical tissue
**removed if labor ensues or near term
What are risks of Cervical cerclage for tx of cervical insufficiency ?
Rupturing membranes while placing stitches
preterm labor because of foreign body in the cervix
infxn
If a pt has a hx of cervical insufficiency, what can you do for the next pregnancy?
Monitor w/ US Cerclage for second trimester cervical change Progesterone supplementation (vaginal) starting at 18-20 weeks
Preterm labor is contractions w/ cervical change at __-___ weeks gestation
24-36 weeks
What are fetal complications of preterm labor?
Issues w/ the: Brain lungs (immature) GI Retina Immune (immature) Neuro-respiratory (apnea b/c of immaturity)
What are fetal brain problems w/ pre-term labor?
Intraventricular hemorrhage
Hypoxemic injury
What are fetal GI problems w/ pre-term labor?
Bowel immaturity resulting in necrotizing enterocolitis
Why does retina issues occur in infants who are preterm?
O2 toxicity due to high ventilator O2 doses
At 24 weeks the ‘average’ fetus weighs ___ lb ___ oz
mortality = ___%
major morbidity = ___%
1 lb 6 oz
30-45%
90%
At 28 weeks the ‘average’ fetus is __ lb ___oz
2 lb 4 oz
What are causes of preterm labor? (x8)
- 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
How can you dx pre-term labor?
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
What should you check for when working up a pt in preterm labor?
- cervicitis (tx)
- ruptured membranes (changes management)
- urine tox screen
How do Corticosteroids work in Preterm Labor?
- Betamethasone crosses placenta to fetus
- causes type II pneumocytes to produce surfactant
How do you tx preterm labor?
Bedrest Nifedipine Terbutaline Indomethacin IV Mg sulfate
What preterm labor med is most commonly used due to low side effect profile?
oral nifedipine
what side effects may occur with use of terbualine for preterm labor?
pulmonary edema
tachycardia
How does indomethacin work to prevent preterm labor and what are its side effects?
Anti-prostaglandins decrease contractions
Premature ductus closure
Persistent ductus after delivery
What are side effects of magnesium sulfate when treating preterm labor?
flushing
N
hyporeflexia
is contractions without cervical changes considered preterm labor?
No
If a woman has a hx of preterm labor, what can you give her to reduce the chances of this happening again?
progesterone supplementation (Vaginal gel or IM injxn)
- Start around 18 weeks
- Weekly to 34-36 weeks
what fetal monitoring is required for gestational DM
NST/AFI weekly (non-stress tests)
- risk of polyhydramnios and placental insufficiency around week 32
what is NST (non-stress test)
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%
what is the triad of dx for preeclampsia?
edema
proteinuria
HTN
what cures pre-eclampsia
when does it never occur
delivery
before 20 wks
Mild preeclampsia
Systolic range: _____
Diastolic Range: ____
Protein range: ____
systolic: 140-160
diastolic: 90-110
protein bt 3-5
Severe Preeclampsia
Systolic range: _____
Diastolic Range: ____
Protein range: ____
systolic: >160
diastolic: >110
protein: >5
is a baby at risk for Macrosomia or IUGR with preeclampsia?
IUGR
what may contribute to preeclampsia
Placental pressures
umbilical flow
Spasm of spiral arterioles
placental _____ probably cause the maternal vasospasm associated with preeclampsia
thromboplastins
what are S/S of preeclampsia (severe sxs)
HA (confusion) Blurred vision edema decreased urine output N/V
what may you see on PE on a pt with mild preeclampsia
- swelling of hands, face and extremities
- hyperreflexia
- oliguria
how do you treat pre-eclampsia
Magnesium sulfate (protect agaisnt sz) delivery child
postpartum pre-eclampsia typically happes within __ hrs after delivery.
24
**tx with MgSO4 to protect against sz
what is HELLP syndrome
associated with pre-eclampsia
H: Hemolysis
EL: elevated liver enzymes
LP: low platelet count
