High Risk Pregnancy Flashcards
Advanced maternal age
Defined - >35yo, >40 =ivf
Increased risk for:
- med conditions - HTn, dm, thyroid
- fibroids, preterm threatened labour ( PTL)
- congenital abnormalities - trisomy 13,18,21
- m/c , ectopics, stillbirth, IUGR, lbw
- placenta abruption
- placenta praevia
- dysfunctional labour - failure to progress
- increased risk of c/s
Obesity - risks to pregnancy
- anaesthesia risks - GA, EPIDURAL
- med risks - GDM, HTN, PET
- m/c, stillbirths, congenital abnormalities
- preterm labour, IUGR, IUFD,
- macrosomia - labour complications - shoulder Dystocia, cpd
- post term - increased risk of stillbirth
- 2-3x increased risk of c/s: dvt, PE, wound infection, chest infection, OSA
Grand multiparity
> p5
- very quick deliveries
- dysfunctional labour
- at risk of PPH
- mal presentations, unstable lie
Previous pph
- risk of repeat pph
- reasons for pph -
- active mx of 3rd stage labour :
- Hb
- group and hold
- cord clamping and controlled traction with fundal support and signs of sepation - lengthening of cord, gush of blood, uterus becomes globular, fundus rises.
- syntocinon vs syntometrine
Rh -ve blood grp
- 10-15% of pregnancies
- RISKS - with ISO-immunization - subsequent pregnancies - fetal hydrops
- bleeding antepartum : 12k =625 IU IMI (within 72hrs)
- antenatal prophylaxis: 28 and 34k 625IU
- post partum :cord blood - group and Coombs; maternal - kleihauer for feto-maternal hemorrhage; anti-D 625 IU
Depression
- 10% antenatally
- 20% postnatally
- baby blues vs PND
- poor sleep/diet
- poor bonding with baby
- psychological support, may need antidepressants,
Teenage pregnancies
10-19yo
- PET
- PTL
- anaemia
- SGA/IUGR
- barrier to ANC - concealed pregnancy
- social and psychological factors
- high risk group - STI, Poor contraception, barrier protection, substance abuse
- low breast feeding rates
- TOP/ adoption
Underweight
- poor diet, lifestyle
- malnutrition / deficiencies
- SFA, IUGR
- PTL
- anaemia
Drug use in pregnancy
- fetal ETOH syndrome
- IUGR
- socio-economic
- DOCS
- APH, Placental abruption
- PPROM, PTL
- preterm delivery
- IUFD, SIDS
- behavioural consequences
Previous C/S
- Reason for c/s
- uterine rupture
- repeat c/s vs VBAC
- placenta praevia
- placenta accreta
- ectopic in c/s scar
LGA
- weight gain
- GDM
- CPD
- shoulder Dystocia
- birth trauma - mother and baby
Twins
- monochorionic vs dichorionic
- m/c, congenital abnormalities
- PTL and delivery
- placenta praevia
- TTTS
- polyhydramnios
- cord prolapse
- malpresentation
- GDM, HTN, Anaemia
Indigenous pregnancy
SOCIAL AND Psycho issues Substance abuse and smoking Poor diet Maternal chronic diseases - DM, HTN, RENAL GHT, GDM, - poor compliance LBW Teenagers, grand multiparity High perinatal morbidity, mortality
Post term pregnancy
>42k Increased incidence of : - still birth - meconium - low AFI - placental insufficiency - non- reassuring CTG - assisted delivery - c/S
Antepartum haemorrhage
1) placenta praevia
- grade 1-4; minor or major
- 3% of pregnancies at term
- PAINLESS APH
- preterm delivery
- hysterectomy
2) vasa praevia
- 1/2500-5000 pregnancies
- fetal vessels run in membranes - APH =fetal hemorrhage
- high perinatal morbidity, mortality
- Preterm delivery
3) placental abruption
- premature separation of placenta prior to delivery of baby
- PAINFUL UTERUS, DARK CLOTS OR CONCEALED APH
- PPH , DIC
Diabetes
Increased incidence of:
- congenital abnormalities
- macrosomia, IUGR
- shoulder Dystocia
- c/s
- stillbirth
- neonatal hypoglycaemia
- MDT
- plan delivery
- follow up for GDM pt.s
Infections
Hepatitis - B &C, acute vs chronic, vertical transmission
Chlamydia
Viral - rub, Cmv, parvovirus, herpes
UTI - recurrent, pyelonephritis,
Gbs - universal screening 32-34k, rom
- Risk based mx : prev infant with eogbsd, gbs bacteriuria, prom
>18hrs, preterm birth <37k, gbs colonisation
- colonisation - asso with asymptomatic bacteriuria, cystitis, intra-amnio infection, endometritis
- benzylpenicillin
- infant pneumonia, speticemia meningitis
HTN
- pre-existing : change med; increased risk of PET
- GHT : 10-15% pregnancies; 140/90 on 2 separate occasions 6hrs apart
- complications : PET, IUGR, PLACENTAL ABRUPTION
- deliver at 38k
Pet
Rf: >40yo - 2x Obesity - 2x Mother had PET - 20-25% SISTER had PET - 35-40% primigravida - 2-3x Multiple preg - 2x Prev pet - 7x Long birth interval (10yrs) -2-3x New partner -
SLE/ autoimmune disorders
Increased risk PET
DRUGS
Renal disease
Deterioration of renal funciton
Ptb
IUFD
Clotting disorders
Claxane in pregnancy
Cardiac disease
MDT
TIMEd and controlled delivery
Thyrotoxicosis
1/500 pregnancies
If untreated - m/c, IUGR, ptl, perinatal mortality, fetal thyrotoxicosis, thyroid storm
