High risk pregnancies

Question 1

RhD isoimmunization- def

Answer 1

• Mother Rh negative with Rh positive fetus

- Presence of maternal IgG antibodies leads to increased risk fetomaternal hemorrhage

Question 2

HELLP Syndrome- Definition

Answer 2

• Severe form of preeclampsia
• Hemolysis
• Elevated Liver enzymes
• Low Platelets

Question 3

Preeclampsia-Sx

Answer 3

• Proteinuria
• HTN
• Hyperreflexia
• Edema in hands and face
• Blurred vision
• Scotomata
• Epigastric/ RUQ pain

Question 4

Mild preeclampsia- Eti & dx

Answer 4

> 140 or 90 on two occasions 6 hrs apart

• And >300 mg in 24 hr urine
• 2+ urine on dip

Question 5

Severe preeclampsia- Dx

Answer 5

> 160 or >110 on 2 occasions 6 hrs apar

> 5 gm protein over 24 hrs

Question 6

Intrauterine growth restriction- Definition

Answer 6

• 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)

Question 7

Intrauterine growth restriction- Management

Answer 7

• Monitor (non-stress test)
• Non-reactive stress test = bad
• Steroids if <34 weeks
• No smoking
• Delivery when fetal death risk exceeds neonatal death

Question 8

Gestational DM- Def

Answer 8

• Insulin resistance
• Unexplained stillbirth
• Higher risk for all complications
• Screen all women 24-28 wks

Question 9

Gestational DM- Mgmt

Answer 9

• 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)

Question 10

Placenta previa- Def

Answer 10

• Abnormal location of cervix
• Leading cause of 3rd trimester bleed
• Advanced maternal age
• Moderate to severe painless vaginal bleeding

Question 11

Placenta previa- Mgmt

Answer 11

• Do not do bimanual or cervix exam on known placenta previa
• Observation
• Steroids, RhoGAM
• Schedule c-section

Question 12

Abruptio placentae- Def

Answer 12

• 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

Question 13

Abruptio placentae- Mgmt

Answer 13

• Treat shock, stabilize hemodynamic

- C-sectaion

Question 14

Premature rupture of membranes- Def

Answer 14

• spontaneous rupture of membranes before labor

-

Question 15

Premature rupture of membranes- Mgmt

Answer 15

• Sign of infection = delivery
• No sign- admit and hope labor occurs within 24 hrs
• Preterm- manage with steroids, abx

Question 16

Postterm pregnancy- def

Answer 16

> 42 weeks

• Increased risk of stillbirth
• Meconium aspiration

Question 17

Postterm pregnancy- Mgmt

Answer 17

• Review dating of pregnancy

- Induction of labor at 41 wks

Question 18

RhD isoimmunization- Assessment

Answer 18

• Screen all pregnant women for ABO blood group & RhD antigen
• Antibody titer at 26-28 wks
• Fetal middle cerebral artery flow
• Indirect coombs test

Question 19

RhD isoimmunization- Tx

Answer 19

• Anti-D immunoglobulin prophylaxis

Question 20

RhD isoimmunization- Risks

Answer 20

• Hemolytic disease of newborn

- Kernicterus due to jaundice

Question 21

Pregnancy induced HTN- Eti

Answer 21

AKA: gestational HTN

• HTN detected for 1st time after 20 wks pregnancy
• Absence of proteinuria

Question 22

Pregnancy induced HTN- Dx

Answer 22

> 140 or > 90 on 2 occasions 6 hrs apart in absence of proteinuria
- Previously normotensive woman

Question 23

Pregnancy induced HTN- Tx

Answer 23

• Surveillance for progression to preeclampsia

- Monitor fetal growth

Question 24

Pregnancy induced HTN- Risks

Answer 24

• Transition to preeclampsia

- Recurrence in future pregnancies

Question 25

Preeclampsia- Tx

Answer 25

• Deliver as soon as possible
• Corticosteroids 48 hrs prior
• Severe: Initial delivery at 34 weeks

Question 26

Preeclampsia- Risks

Answer 26

• Preterm birth
• Placental abruption
• Growth restriction

Question 27

Eclampsia- Sx

Answer 27

Onset of seizures in preeclampsia

Question 28

Eclampsia- Tx

Answer 28

• Seizures self limiting, don’t medicate
• Prevent injury & aspiration
• Deliver once patient has stabilized
• Magnesium sulfate

Question 29

Preterm labor- Eti

Answer 29

Age >20 wks, <37 wks

• Regular uterine contractions at freq intervals
• Cervical change or dilatation & effacement

Question 30

Preterm labor- Sx

Answer 30

• More than 2 contractions in 1/2 hr
• Dilation & effacement of cervix
• Bloody show

Question 31

Preterm labor- Tx

Answer 31

• Corticosteroids
• Attempt to delay delivery by 48 hrs
• Tocolytic therapy- beta mimetics, CCBs, prostaglandin inhibitors
• Mg sulfate

Question 32

Preterm labor- Risks

Answer 32

• Wide variety, good survival with good preterm care

- Lower weight = lower survival

Question 33

Large for gestation age- Eti

Answer 33

• Maternal diabetes, obesity, large stature

Question 34

Large for gestation age- Sx

Answer 34

• Increased fundal height- >3cm

- Abdominal size

Question 35

Large for gestation age- Dx

Answer 35

EFW > 90th percentile on US

- Macrosomia = 4500 g regardless of age

Question 36

Large for gestation age- Risks

Answer 36

• Shoulder dystocia
• Prolonged labor
• postpartum hemorrhage
• Stillbirth

Question 37

Large for gestation age- Tx

Answer 37

• C-section for > 5000 g

- Normal delivery if possible