Complications of the Prenatal Period Flashcards
What are the classifications of HTN?
Chronic
Chronic with superimposed pre-eclampsia
Pre-eclampsia
Chronic HTN
BP> 140/90 mm Hg prior to 20 weeks gestation
Elevated BP persists after pregnancy
What are causes of chronic HTN?
Essential Hyperthyroidism Coarctation of the aorta Hyperaldosteroinism Cushings dz Connective tissue dz
What are maternal complications of chronic HTN?
CVA Renal disease Retinopathy Abruption Superimposed pre-eclampsia
What are fetal complications of chronic HTN?
IUGR- infrauterine growth restriction
Fetal death
What are the goals in therapy for chronic HTN?
maintain BP < 140/90 mm Hg -alpha-methyldopa -labetolol -nifedipine monitor fetal growth-US monitor for evidence of utero-placental insuff. -NST -biophysical profile
**NO ACE INHIB. OR ARBS
Pre-eclampsia
BP >140/90 after 20 weeks gestation
Proteinuria > 300 mg/24hr
Edema
What is the incidence of pre-eclampsia?
mild: 5-8%
severe: 0.6-1.2%
What are the maternal complications of pre-eclampsia?
CVA Eclampsia Acute renal failure Pulmonary edema Death
What are the fetal and neonatal complications of pre-eclampsia?
IUGR
Fetal death
Anemia, neutropenia and thrombocytopenia
What are the diagnostic criteria for severe pre-eclampsia?
BP> 160 or 110 mm Hg Proteinuria > 5g Oliguria <30ml/hr Increased DTRs Headache Visual changes Pulmonary edema RUQ pain Abnormal LFTs Thrombocytopenia IUGR
What do you do if a mother is experiencing characteristics of severe pre-eclampsia?
deliver that baby
What is the longest you wait to deliver a baby with severe or mild preclampsia at term?
48 hrs so you can give corticosteroids for fetal lumbar support
Do you deliver the baby if the mother has mild pre-clampsia and the baby is pre-term?
No, observe
Abruptio Placentae
premature separation of a normally implanted placenta
What is the frequency of abruptio placentae?
1%
What are the risk factors for abruptio placentae?
Age> 35 years High parity HTN Smoking Cocaine abuse Multiple gestation Uterine anomalies Prior history of abruption
What are the clinical manifestations of abruptio placentae?
Abdominal pain Tetanic uterine contraction Dark red vaginal bleeding Coagulopathy Abnormal fetal heart rate pattern
How do you make a diagnosis of a abruptio placentae?
US
Clinical examination
What is the management for abruptio placentae?
Delivery- usually by cesarean
Replacement of blood loss
Correction of coagulopathy
How do we replace the blood lost?
isotonic crystalloid (3:1 rule) Packed red cells
Placenta Previa
Placenta is implanted over the internal cervical os
Frequency - 1%
What are the risk factors for Placenta Previa?
Age > 35 Higher parity Smoking Uterine anomalies Prior uterine scar Multiple gestation Prior history of previa
What are the clinical manifestations of Placenta Previa?
painless, bright red vaginal bleeding
abnormal fetal heart rate tracing is less likely than with abruption
coagulopathy is also less likely
What is the diagnostic technique for Placenta Previa?
US
How do you manage Placenta Previa?
preterm with reassuring maternal-fetal status: observation and corticosteroids
preterm with non-reassuring maternal-fetal status: cesarean delivery
term with non-reassuring maternal-fetal status: cesarean delivery
Preterm delivery
<37 weeks
What is the frequency of preterm deliveries?
10-12%
What is the impact of preterm deliveries?
responsible for 75% of neonatal deaths, excluding anomalies incompatable with life
What is the number one obstetrics problem?
preterm deliveries
What is the number one factor that increases the risk of preterm deliveries?
preterm POM
What are other factors that increase the risk of preterm deliveries?
multiple gestations polyhydramnios- excessive amniotic fluid uterine anomaly abruption previa fetal anomaly incompetent cervix smoking cocaine abuse trauma non-genital infection (pnumonia/pyeloneph) genital infection (upper/lower tract)
What are the four things that kill premature babies?
hyaline membrane disease
IVH- intraventricular hemorrhage (less common after 32 weeks)
NEC- necrotizing entero colitis
Infection
What is the number one killer of preterm babies?
hayline membrane disease
What are additional complications of prematurity?
thermal instability poor feeding apnea and bradycardia PDA-patent ductus arteriosis hyperbilirubinemia hypoglycemia seizures
How do we evaluate preterm labor?
physical exam CBC- left shift for lymphocytes Urine culture to rule out UTI Screen for lower genital tract infection Amniocentesis- assess for chorioamnionitis and fetal lung maturity US Fetal fibronectin
What is the management for preterm labor?
Tocolytics- forestall delivery
Corticosteroids- reduce frequency of RDS, IVH, NEC
Abx- prevent maternal and neonatal infection
What is a tocolytic that is a drug of choice and acts as a Ca+ blocker, given by mouth and has an adverse effect of hypotension?
nifedipine
What is the most common cause of neonatal mortality?
preterm delivery
What are two key criteria that determine the management of preeclampsia?
severity of Dz and the gestational age
