High Risk Pregnancy & Early Pregnancy Complications Flashcards
Categories of High-Risk Pregnancies ?
Fetal
Maternal-Fetal
Maternal
High-Risk Pregnancies: Fetal ?
Structural or chromosomal abnormalities,
genetic syndromes,
multiple gestations,
infection
High-Risk Pregnancies: Maternal - Fetal ?
Preterm labor,
PROM,
cervical insufficiency,
intrauterine growth restriction (UGR),
abnormal placenta,
preeclampsia
High-Risk Pregnancies: Maternal ?
DM
HTN
cardiac or thyroid disease
infection
Maternal Leading Causes of Pregnancy-Related Deaths
Thromboembolic disease Hypertensive disease Hemorrhage Infection Ectopic pregnancy
____________ is leading cause of death of infants
Preterm birth
Defined as 28 weeks gestation through day 7 of life
Perinatal period
Prenatal Screening: Past OB Hx. ?
Recurrent AB (3+ losses)
Previous stillbirth
Previous preterm delivery
Rh or ABO incompatibility
Hx preeclampsia/eclampsia
Hx infant with genetic or
congenital d/o
Teratogen exposure – Drugs,
ETOH, infection, radiation
Half of all___________ are lost before pregnancy is even realized
conceptions
Another 15-20% of conceptions are lost in _______________ – half of these are due to abnormal karyotypes and cannot be saved
first trimester
Fetal Heart Rate Monitoring during labor options ?
Electronic vs. intermittent auscultation
Electronic use is increasing, but no trials to confirm it is better ( recording)
NL Fetal Heart Rates ?
110-160
FHR: below ____ is bradycardia and above _____ is tachy
110
160
Nonreassuring fetal status if either is seen
FHR: Accelerations weeks ?
32 weeks +
FHR: Accelerations - ↑ FHR of __ beats, lasting __ seconds
15
FHR: Accelerations - __ or more accelerations in a __ min period are reassuring
2
20
FHR: Accelerations - own notes ?
these are okay , good , variability to our HR
FHR: variability ?
Fluctuations in FHR of 2 cycles per minute
FHR: Decelerations - Early ?
mirror contractions, usually represent head compression
FHR: Decelerations - Late ?
Smooth ↓ in FHR, starting after contraction has started and ends after contraction is over.
Assoc with fetal hypoxemia, perinatal M&M
bad
contraction is starting and the FHR is going down
FHR: Decelerations - Variable ?
abrupt ↓ in FHR, return to baseline.
Usually represent cord compression.
Ominous when repetitive & severe
bad
**sudden drop after contraction has started = cord compression
these in a severe amount and repeatedly it is abd news **
FHR: Decelerations - Prolonged ?
↓ 15 beats below baseline, lasting 2-10 mins , decreased perfusion
bad
**FHR is staying down after many contractions **
FHR: Decelerations - Late is associated with ?
Assoc with fetal hypoxemia, perinatal M&M
FHR: Decelerations - Variable represents ?
cord compression
Early Pregnancy Complications ?
Hyperemesis Gravidarum Abortion Ectopic Pregnancy Gestational Diabetes Gestational Trophoblastic Diseases Hypertension Disorders in Pregnancy Preeclampsia Eclampsia HELLP syndrome Exposure to Fetotoxic Agents
Hyperemesis Gravidarum prevalence and etiology ?
0.3-2% of pregnancies
Etiology unknown
Hyperemesis Gravidarum sxs. ?
Severe N/V that may result in dehydration, weight loss
Psychological burden
Hyperemesis Gravidarum duration and timing ?
Usually starts at 3-5 weeks
resolves by 20 weeks
(some have symptoms until delivery)
Hyperemesis Gravidarum Tx. ?
Hydration, vitamin supplementation
Phenergan - makes you tired
Zofran? – off label use for severe cases
risk of cleft palate in fetus
Hyperemesis Gravidarum prognosis ?
80% will have it again in subsequent pregnancies
Spontaneous abortion: prevalence ?
15% of clinically evident pregnancies
50% of chemically evident pregnancies
urine based preggo tests
80% occur before 12 weeks
Spontaneous abortion increased risk with ?
Increased maternal age (30)
of previous spontaneous AB’s
Previous intrauterine fetal demise
Previous infant with malformations or genetic defects
Chromosomal abnormalities in mom or dad
Medical comorbidities
Spontaneous abortion less common causes ?
Infection
Anatomic defect of baby or mom
septate uterus
Endocrine factor in mother
Immunologic factor
Exposure to toxin
Trauma
Large percentage – unknown reason
Spontaneous abortion: maternal anatomic defect ?
septate - wedge of U tissue ( resect the wedge before she is preggo)
Ahermans syndrome - scarring interfere with implantation
Bicornate - 2 sepatete fundi, complete = 2 separate cervxi
Spontaneous abortion complications: development of ?
Severe or persistent bleeding
-not all products of conception are out
Infection
Intrauterine adhesions (Asherman’s syndrome) results and cause of a spontaneous abortion
Infertility
Subsequent D&C can:
- Perforate (0.5%) cause U wall is softened
- Cause cervical insufficiency
- incompetent cervix from dilation
50% of 1st trimester spontaneous AB’s, have ?
abnormal karyotype
Most common abnormality is trisomy
Threatened abortion: Defined as ? In a ?
1st trimester bleeding
- In a viable pregnancy
- Before 20 weeks gestation
- No cervical dilation - nothing has passed yet
- No passage of products of conception
TA: 25% of pregnant women have ?
1st trimester bleeding
TA: Usually caused by _____________ and it resolves
implantation
TA: At risk for subsequent ?
miscarriage,
PROM,
preterm labor
Inevitable abortion:
Uterine bleeding before 20 weeks
Dilated cervix
No expulsion of products of conception ( but going to happen cause it is dilated)
Complete abortion (CA) ?
Expulsion of all products of conception before 20 weeks
CA US ?
endometrial lining is thin, no products of conception in uterus
everything has left the building
CA Dx. ?
Complete abortion can only be diagnosed if a previous intrauterine gestation was documented on US and pathology specimen confirms products of conception
Otherwise, hCG levels must be followed to make sure it was not an ectopic
CA Tx. ?
observe for further bleeding. If none, no further tx needed.
Incomplete abortion (IA) ?
Before 20 weeks gestation
Passage of some, but not all, products of conception
Bleeding and cramping (sometimes severe) continue until complete ( or until D &C to get everything out )
Missed abortion ?
Embryonic or fetal demise
Nonviable pregnancy retained in the uterus
Requires D&C to remove it