high risk preganancy Flashcards
how is gestational mother manages
- diet and excercie ! 2. metformin 3. insulin (if drugs dont work) mother should also be checking her levels 4-6 times a day
management of baby post partum - diabteic
calcium gluocnate oxygen - to respiratory dextrose - for sugar levels monitor br levals babys have hyperbilriubineia
what thyroid problem is most common in preg
hypo because thyroixne levesl are more in demans ad also the fetus cannot make its won thyroid hormones until the so is completely reliant on the mother(especially in 2st triemtser) and slowly slowly it increases and increases
consequences of thyroid problems
growth of baby (thyrodi hormones cause growth_
metanl reatardation
thyroid importnat for brain +spinal cord
can cause miscarriage
us values for nuchal translucency and what it means
11-14 weeks can show risk for downs sytdormes
quickening
mothers perception of baby moveing between 16- 20 weeks
fetal kick
26 –28 weeks
what is a non stress test and the procedure
a test to check the babies HR and how it changes in relation to the baby moving. Its usually a little like a preliminary and if its dodgy (could mean hypoxia) then you do further tests
two belt-like devices around your abdomen. One will measure your baby’s heartbeat. The other will record your contractions.
Your provider will move the device over your abdomen until the baby’s heartbeat is found.
The baby’s heart rate will be recorded on a monitor, while your contractions are recorded on paper.
You may be asked to press a button on the device each time you feel your baby move. This allows your provider to record the heart rate during movement.
The test usually lasts about 20 minutes.
If your baby isn’t active or moving during that time period, he or she may be asleep. To wake up the baby, your provider may place a small buzzer or other noisemaker over your abdomen. This won’t harm the baby, but it may help a sleepy baby become more active. Your baby may also wake up if you have a snack or sugary drink.
what does non reactive mean and what test is it under
This means the baby’s heartbeat didn’t increase when moving, or the baby wasn’t moving much. this is part of the NST
IS NON reactive always bad
no could mean baby was asleep and hard to arouse
contraction stress test
his test checks for how your baby’s heart reacts when your uterus contracts. To make your uterus contract, you may be asked to rub your nipples through your clothing or may be given a medicine called oxytocin, which can cause contractions.
when the uterus contracts what should be the normal result
DECLERATIONS IN HR
risk factors for placental insufficiency
mother has hypertensive disorders primipay advanced maternal age drugs - antineoplastic /antiepilectics smoking/alcohol
complications of placental insufficiency
IUGR
still birth
preterm labour
preclampsia
causes of placental insuffiency
The underlying causes of placental insufficiency are typically a result of disturbances to the perfusion, or blood supply, of the placenta. Any restrictions in the placental blood flow can lead to hypoxemia, which activates proteins involved in the clotting of blood (i.e., coagulation factors) and promotes the deposition of fibrin (i.e protein circulating in the blood responsible for controlling bleeding) within the placenta. Under those circumstances, the transfer of nutrients to the developing fetus is minimized.
- diabetes, hypertension
- an aged placenta >40 weeks
- drug abuse cocaine
- placental abruption
- placenta not attached properly in the first
signs of placental insuffiency
doesn’t really come with overt symptoms! Fetuses that are not sufficiently nutritioned tend to move less, which can sometimes be identified either by the mother or the healthcare professional during physical examination. The most common signs of placental insufficiency include intrauterine growth restriction, prematurity (i.e., delivery before 37 weeks of pregnancy), and stillbirth.
the mother’s abdomen will be smaller because baby is smaller so if she is an experienced mother she may realise this
- if its bruption mother will see bleeding
How is placental insufficiency diagnosed?
Notably, measuring the blood flow of the uterine artery during Doppler screening has proven to be very sensitive in detecting severe IUGR and preeclampsia. NST
ultrasound - look at the size of the placenta, look for where its attached
How is placental insufficiency treated?
to deliver the baby but that is all but you have to consider the gestational age because if the baby is very premature then the chances of survival are low. so in stages where the baby is not viable then you can use aspirin (prevent clots) + heparin and antioxidants
signs of fetal distress
reduced movement, bradycardia trachycardia , variable decletrations (emergency) , meconium if the woman is in labour and you check the amniotic fluid
umbilcal cord compression rf
oligo /polyhdramnios
umbilical cord prolapse
abnormally long umbical cord (normal is around 50cm)
Typically, a knot in the umbilical cord is not problematic as the cord is made of a spongy material which prevents the knot from becoming too tight. However, as the baby moves around the womb, there is a risk that the knot will become tighter and this could cause cord compression.
what are the 5 parts to a biphysical profile
- NST
- baby moving
- baby tone
- baby breathing
- amniotic fluid
what is amniotic fluid index
he largest pocket of amniotic fluid is measured in each of the four quadrants of the mother’s abdomen using ultrasound. All four quadrants added together give the amniotic fluid index.
APgar score
out of 10 , done on 1 min and 5 min
pink baby
crying or not
muscle tone
grimace
how to determine the gesttaional age of baby
- size of uterus
2. us - look dor BPD, femur lenght
naegles rule
for calculating the estimated due date
A membrane sweep
This separation of the amniotic membranes from the uterus speeds up labor in pregnant people. Membrane sweeps help your body release chemicals called prostaglandins. Prostaglandins soften your cervix and prepare your body for labor. There is no guarantee a membrane sweep will kickstart your labor or start contractions
risi factor for placenta previa
previous previa
multiparity
previous cs
advanced age
classic symptom of PP
PAINLESS VAGINAL BLEEDING
is there an association with pp and abruption
yes some women who have pp can also have abruption about 10% of women of which there may be pain associtaed
diagnosi sof pp
ultrasound
how will you manage a patient with previa and delivery
CS !
SIGNS OF ABRUPTION
PAIN (unlike previa) abdomianl pain
vaginal bleeding but a lot of time is concealed as its retroplacental bleed so common to not think its serious as it is
increased uteine tone(rock hard belly)
whats more dangerous pp or pa
abruption
what is the most common cause of DIC in pregnancy (yotube)
abruption
complications of abruption
hemrrogaic shcok
renal failure
and aslo are at risk for developing post partum hemmrogahe
risk for abruption
HTN cocain users, smokers older women multiple gestations thrombophilia previous history PROM
causes of antepartum hemmrogae
previa, abruption, uterine rupture
whos more likely to die in abruption
FETUS and same in uterine rupture
signs of a uterine rupture
abdo pain, vaginal bleeding but the most common is sign IS FETAL BRADYCARDIA
RISK OF UTERINE RUPTURE
CS, trauma to abdomen, inapparptiate use of tonic agents to uteurs, grand multiparity , any surgery to uterus like myomectomy scar etc
how to measure placenta previa
In case of mild/moderate bleeding and immature foetus = bed rest, no penetrative sex (as trigger) tocolysis with MgSO4, spasmolytics, correction of any anaemia, daily monitoring of foetus.
if mother is rh - give anti d to aboid sensatisation
· In case of severe bleeding and worsening of mother’s hemodynamic status = immediate C-section
how does pp affect fetus
can lead to malpresentation due to abnormal plcament of placenta
previa vs abruptin
previa: painless and more bright , first episode tends to be light then becomes more heavy
abruption: painful and more dark , first episode tends to be heavy
when shoud previa be susepcted
in any woman with painless bleeding after 20/24 weeks
when is uterine ruepture most likely to happen
during labour
