High risk pregnancies Flashcards
RhD isoimmunization- def
- Mother Rh negative with Rh positive fetus
- Presence of maternal IgG antibodies leads to increased risk fetomaternal hemorrhage
HELLP Syndrome- Definition
- Severe form of preeclampsia
- Hemolysis
- Elevated Liver enzymes
- Low Platelets
Preeclampsia-Sx
- Proteinuria
- HTN
- Hyperreflexia
- Edema in hands and face
- Blurred vision
- Scotomata
- Epigastric/ RUQ pain
Mild preeclampsia- Eti & dx
> 140 or 90 on two occasions 6 hrs apart
- And >300 mg in 24 hr urine
- 2+ urine on dip
Severe preeclampsia- Dx
> 160 or >110 on 2 occasions 6 hrs apar
> 5 gm protein over 24 hrs
Intrauterine growth restriction- Definition
- At or below 10th percentile for gestational age
- Includes healthy and constitutionally small babies (70%) of this group
- Increased complication & death when <3rd percentile
- Most common cause is HTN & smoking
- Measured by fundal height & ultrasound (abd circumference)
Intrauterine growth restriction- Management
- Monitor (non-stress test)
- Non-reactive stress test = bad
- Steroids if <34 weeks
- No smoking
- Delivery when fetal death risk exceeds neonatal death
Gestational DM- Def
- Insulin resistance
- Unexplained stillbirth
- Higher risk for all complications
- Screen all women 24-28 wks
Gestational DM- Mgmt
- Check CBG 4x per day
- Fasting (70-95)
- 1 hr post prandial <120
- ADA diet, 1800-2400 cals
- Exercise
- All pts with gestational DM must be checked 6 weeks postpartum (2 hr 75g glucose)
Placenta previa- Def
- Abnormal location of cervix
- Leading cause of 3rd trimester bleed
- Advanced maternal age
- Moderate to severe painless vaginal bleeding
Placenta previa- Mgmt
- Do not do bimanual or cervix exam on known placenta previa
- Observation
- Steroids, RhoGAM
- Schedule c-section
Abruptio placentae- Def
- Premature separation of implanted placenta
- 2nd or 3rd trimester bleeding
- External or concealed hemorrhage
- Abd trauma, stimulant use
- Presentation: painful bleeding, abd pain, rigid abdomen
Abruptio placentae- Mgmt
- Treat shock, stabilize hemodynamic
- C-sectaion
Premature rupture of membranes- Def
- spontaneous rupture of membranes before labor
-
Premature rupture of membranes- Mgmt
- Sign of infection = delivery
- No sign- admit and hope labor occurs within 24 hrs
- Preterm- manage with steroids, abx
Postterm pregnancy- def
> 42 weeks
- Increased risk of stillbirth
- Meconium aspiration
Postterm pregnancy- Mgmt
- Review dating of pregnancy
- Induction of labor at 41 wks
RhD isoimmunization- Assessment
- Screen all pregnant women for ABO blood group & RhD antigen
- Antibody titer at 26-28 wks
- Fetal middle cerebral artery flow
- Indirect coombs test
RhD isoimmunization- Tx
- Anti-D immunoglobulin prophylaxis
RhD isoimmunization- Risks
- Hemolytic disease of newborn
- Kernicterus due to jaundice
Pregnancy induced HTN- Eti
AKA: gestational HTN
- HTN detected for 1st time after 20 wks pregnancy
- Absence of proteinuria
Pregnancy induced HTN- Dx
> 140 or > 90 on 2 occasions 6 hrs apart in absence of proteinuria
- Previously normotensive woman
Pregnancy induced HTN- Tx
- Surveillance for progression to preeclampsia
- Monitor fetal growth
Pregnancy induced HTN- Risks
- Transition to preeclampsia
- Recurrence in future pregnancies
Preeclampsia- Tx
- Deliver as soon as possible
- Corticosteroids 48 hrs prior
- Severe: Initial delivery at 34 weeks
Preeclampsia- Risks
- Preterm birth
- Placental abruption
- Growth restriction
Eclampsia- Sx
Onset of seizures in preeclampsia
Eclampsia- Tx
- Seizures self limiting, don’t medicate
- Prevent injury & aspiration
- Deliver once patient has stabilized
- Magnesium sulfate
Preterm labor- Eti
Age >20 wks, <37 wks
- Regular uterine contractions at freq intervals
- Cervical change or dilatation & effacement
Preterm labor- Sx
- More than 2 contractions in 1/2 hr
- Dilation & effacement of cervix
- Bloody show
Preterm labor- Tx
- Corticosteroids
- Attempt to delay delivery by 48 hrs
- Tocolytic therapy- beta mimetics, CCBs, prostaglandin inhibitors
- Mg sulfate
Preterm labor- Risks
- Wide variety, good survival with good preterm care
- Lower weight = lower survival
Large for gestation age- Eti
- Maternal diabetes, obesity, large stature
Large for gestation age- Sx
- Increased fundal height- >3cm
- Abdominal size
Large for gestation age- Dx
EFW > 90th percentile on US
- Macrosomia = 4500 g regardless of age
Large for gestation age- Risks
- Shoulder dystocia
- Prolonged labor
- postpartum hemorrhage
- Stillbirth
Large for gestation age- Tx
- C-section for > 5000 g
- Normal delivery if possible
