Lecture 3 - 3rd Trimester Complications Flashcards
what is placenta previa?
attachment of placenta to lower uterine segment over cervical OS
can be complete, partial, marginal
placenta previa is associated with ____ ____-trimester bleeding
painless, 3rd
2 risk factors for placenta previa
multiparity, prior C section
placenta previa:
is placenta closer or farther away from cervical OS at at a early gestational age vs at birth?
closer when early; migrates from OS as age
placenta accreta:
defective ___ layer –> abnormal attachment and seperation after delivery. accreta is attachment to the _____
decidual;
myometrium
what is placenta increta?
what is placenta percreta?
increta = placenta penetrates into myometrium; percreta = penetrates through myometrium to uterine serosa
what is vasa previa?
fetal vessels run over or close to cervical OS
triad of vasa previa:
membrane rupture
painless vaginal bleeding
fetal bradycardia
classic difference between placental abruption and placenta previa?
placental abruption has abdoimnal pain and uterine contractions
placenta previa requires ____ delivery
C-section
supine hypotension syndrome:
compression of _____ –> decreased venous return/CO –> hypotension when ______
IVC;
lying down
Management of placenta previa:
administer ______ to help improve fetal lung maturity (if 24-34 weeks);
corticosteroids
3 risk factors for placenta accreta:
prior ______, _____, placenta _____
C-section, inflammation, previa
placental _____ is premature separation of placenta from uterine wall ____ delivery of infant
abruption, before
placental abruption:
presents as abrupt, ____ bleeding in the ____ trimester. ____ is rock hard and tender to palpation
painful (very), third;
uterus
placental abruption:
risk factors include _____, _____, hypertension, preeclampsia, ____ abuse
trauma, smoking;
cocaine
placental abruption:
when tissue factor is released from decidual cells, ____ is active and is a potent _____ agent.
thrombin;
uterotonic
placental abruption:
complications include ____ due to tissue factor release, maternal shock, and fetal distress due to decreased ______
DIC;
oxygen
placental abruption:
if blood has extravsated into the myometrium, therean increased risk of uterine ____ (called _____ uterus)
atony, couvelaire
pre-ecclampsia:
new onset HTN with either _____ or _____ after the 20th week of pregnancy
proteinuria, end-organ dysfunction
pre-ecclampsia:
caused by abnormal _____ _____ arterities –> endothelial dysfunction, vasocconstriction, ischemia –> ____ necrosis
placental spiral;
fibrinoid
what is the difference between gestional HTN and pre-ecclampsia?
no end-organ damage or proteinuria
eeclampsia is pre-ecclampsia + _____
maternal seizures
HELLP syndrome stands for….
Hemolysis, Elevated Liver enzymes, Low platelets
what is seen on blood smear with HELLP syndrome?
schistocytes
eeclampsia:
loss of protein causes peripheral and pulmonary _____, ____ failure
edema;
renal
pre-ecclampsia:
IV ____ ____ prevents seizure. what is the definitive treatment of pre-ecclampsia, ecclampsia, and HELLP?
magnesium sulfate;
delivery of fetus
what prophylactic treatment can be used in subsequent pregnancies in patients with preeclampsia?
baby aspirin
HELLP syndrome can lead to hepatic subcapsular ____ –> rupture –> severe ______
hematoma; hypotension
4 anti-Hypertensives that can be given to pregnant women
hydralizine, alpha methyldopa, labetalol, nifedipine
