Complications of the Prenatal Period

Question 1

What are the classifications of HTN?

Answer 1

Chronic
Chronic with superimposed pre-eclampsia
Pre-eclampsia

Question 2

Chronic HTN

Answer 2

BP> 140/90 mm Hg prior to 20 weeks gestation

Elevated BP persists after pregnancy

Question 3

What are causes of chronic HTN?

Answer 3

Essential
Hyperthyroidism
Coarctation of the aorta
Hyperaldosteroinism
Cushings dz
Connective tissue dz

Question 4

What are maternal complications of chronic HTN?

Answer 4

CVA
Renal disease
Retinopathy
Abruption
Superimposed pre-eclampsia

Question 5

What are fetal complications of chronic HTN?

Answer 5

IUGR- infrauterine growth restriction

Fetal death

Question 6

What are the goals in therapy for chronic HTN?

Answer 6

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

Question 7

Pre-eclampsia

Answer 7

BP >140/90 after 20 weeks gestation
Proteinuria > 300 mg/24hr
Edema

Question 8

What is the incidence of pre-eclampsia?

Answer 8

mild: 5-8%
severe: 0.6-1.2%

Question 9

What are the maternal complications of pre-eclampsia?

Answer 9

CVA
Eclampsia
Acute renal failure
Pulmonary edema
Death

Question 10

What are the fetal and neonatal complications of pre-eclampsia?

Answer 10

IUGR
Fetal death
Anemia, neutropenia and thrombocytopenia

Question 11

What are the diagnostic criteria for severe pre-eclampsia?

Answer 11

BP> 160 or 110 mm Hg
Proteinuria > 5g
Oliguria <30ml/hr
Increased DTRs
Headache
Visual changes
Pulmonary edema
RUQ pain
Abnormal LFTs
Thrombocytopenia
IUGR

Question 12

What do you do if a mother is experiencing characteristics of severe pre-eclampsia?

Answer 12

deliver that baby

Question 13

What is the longest you wait to deliver a baby with severe or mild preclampsia at term?

Answer 13

48 hrs so you can give corticosteroids for fetal lumbar support

Question 14

Do you deliver the baby if the mother has mild pre-clampsia and the baby is pre-term?

Answer 14

No, observe

Question 15

Abruptio Placentae

Answer 15

premature separation of a normally implanted placenta

Question 16

What is the frequency of abruptio placentae?

Answer 16

1%

Question 17

What are the risk factors for abruptio placentae?

Answer 17

Age> 35 years
High parity
HTN
Smoking
Cocaine abuse
Multiple gestation
Uterine anomalies
Prior history of abruption

Question 18

What are the clinical manifestations of abruptio placentae?

Answer 18

Abdominal pain
Tetanic uterine contraction
Dark red vaginal bleeding
Coagulopathy
Abnormal fetal heart rate pattern

Question 19

How do you make a diagnosis of a abruptio placentae?

Answer 19

US

Clinical examination

Question 20

What is the management for abruptio placentae?

Answer 20

Delivery- usually by cesarean
Replacement of blood loss
Correction of coagulopathy

Question 21

How do we replace the blood lost?

Answer 21

isotonic crystalloid (3:1 rule)
Packed red cells

Question 22

Placenta Previa

Answer 22

Placenta is implanted over the internal cervical os

Frequency - 1%

Question 23

What are the risk factors for Placenta Previa?

Answer 23

Age > 35
Higher parity
Smoking
Uterine anomalies
Prior uterine scar
Multiple gestation
Prior history of previa

Question 24

What are the clinical manifestations of Placenta Previa?

Answer 24

painless, bright red vaginal bleeding
abnormal fetal heart rate tracing is less likely than with abruption
coagulopathy is also less likely

Question 25

What is the diagnostic technique for Placenta Previa?

Answer 25

US

Question 26

How do you manage Placenta Previa?

Answer 26

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

Question 27

Preterm delivery

Answer 27

<37 weeks

Question 28

What is the frequency of preterm deliveries?

Answer 28

10-12%

Question 29

What is the impact of preterm deliveries?

Answer 29

responsible for 75% of neonatal deaths, excluding anomalies incompatable with life

Question 30

What is the number one obstetrics problem?

Answer 30

preterm deliveries

Question 31

What is the number one factor that increases the risk of preterm deliveries?

Answer 31

preterm POM

Question 32

What are other factors that increase the risk of preterm deliveries?

Answer 32

``` 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) ```

Question 33

What are the four things that kill premature babies?

Answer 33

hyaline membrane disease IVH- intraventricular hemorrhage (less common after 32 weeks) NEC- necrotizing entero colitis Infection

Question 34

What is the number one killer of preterm babies?

Answer 34

hayline membrane disease

Question 35

What are additional complications of prematurity?

Answer 35

``` thermal instability poor feeding apnea and bradycardia PDA-patent ductus arteriosis hyperbilirubinemia hypoglycemia seizures ```

Question 36

How do we evaluate preterm labor?

Answer 36

``` 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 ```

Question 37

What is the management for preterm labor?

Answer 37

Tocolytics- forestall delivery Corticosteroids- reduce frequency of RDS, IVH, NEC Abx- prevent maternal and neonatal infection

Question 38

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?

Answer 38

nifedipine

Question 39

What is the most common cause of neonatal mortality?

Answer 39

preterm delivery

Question 40

What are two key criteria that determine the management of preeclampsia?

Answer 40

severity of Dz and the gestational age