LECTURE - High Risk Pregnancies Flashcards
amniotic fluid
intrauterine medium for fetus
primary link between fetus and mother
placenta and umbilical cord
hCG doubling
every ~2days up to 8 wks
GTD
gestational trophoblastic disease (e.g. molar pregnancy)
HELLP
hemolysis, elevated liver enzymes, low PLTs
pregnancy-related spectrum of cellular proliferations arising from trophoblasts
gestational trophobastic disease
trophoblasts
= provides nutrients to developing embryo; lining from blastocyst;differentiates to form placenta (first cells to differentiate from egg)
ectopic pregnancy
- implantation of fertilized egg in a non-uterine site
- most commonly = fallopian tube; 97%
- tube rupture is a potentially life-threatening bleed
pelvic inflammatory disease
chronic inflammation due to infection
- chronic salpingitis endometriosis, or appendicitis
symptoms of ectopic pregnancy
- present at 6-10 weeks
- spotting/bleeding
- pelvic pain
detection of ectopic pregnany
- US = must be large enough to detect (abnormal)
- lab: low or slowly increasing hCG (serial 48 h tests)
treatment of ectopic pregnancy
- pharmacological (methotrexate) or surgery
- after treatment = watch for hCG drop, stay low, and disappear
spontaneous abortion
- loss of pregnancy naturally before 20 wks gestation
- symptoms: vaginal bleeding and abdominal cramping
- similar presentation to ectopic pregancy
Lab hCG for spontaneous abortions
decreased hCG doubling times (similar to ectopic pregnancy)
lab serum progesterone (spontaneous abortion)
often low in mothers with an abnormal pregnancy
>50 mmol/L in healthy pregnancy
this can damage many organs
pre-eclampsia
- affects baby and mom (high BP can slow fetal growth, low birth weight, preterm labour, or stillbirth)
clinically utility of hCG testing
- early pregnancy
- ectopic pregnancy
- miscarriages
- gestational trophoblastic disease
- germ cell tumours (AFP)
- maternal prenatal screen for fetal chromosomal anomalies
- pituitary adenomas
molar pregnancy
- GTD; can be complete or partial
- pre-malignant hydatidiform mole invades uterine wall but stays within uterus
- usually identified before signs and symptoms develop; 1st trimester
> vag bleeding, nausea/vomit; excessive uterine size (complete mole)
malignant gestational trophoblastic neoplasia
- invasive moles; invade beyond uterus
- choriocarcinoma = malignancy of placenta; 15-29% complete mole, <1% partial
- placental-site trophoblastic tumor
- epithelioid trophoblastic tumor
diagnosis of molar pregnancy
- chemistry: hCG higher than average (complete mole > partial)
> monitor hCG for persistent neoplasia (hCG level > 100 000 U/L)
> karyotype to determine if complete mole (diploid) or partial mole (triploid) - histology: immunostain for maternal expressed genes = p57, PHLDA2
> negative is complete mole; positive is partial
treatment for molar pregnancy
- uterine evacuation with suction curettage
> preserve reproductive function - hysterectomy
monitor treatment of molar pregnancy (complications)
- anemia, hyperthyroidism
- measure hCG
> weekly until undetectable
> monthly until undetectable for 6 months
can have persistent neoplasia after molar pregnancy
hypertension
- systolic BP > or equal to 140 mmHg and/or
- diastolic BP > or equal to 90 mHg
average of at least 2 measurements, taken at least 15 mins apart
pre-existing hypertension
hypertension that develops in pregnancy at <20 wks gestation
gestational hypertension
- hypertension that develops for the first time at >20 + weeks gestation
- no proteinuria
- 5-6%
pre-eclammpsia
- restricted blood flow to the placenta maybe? so hypertension
- gestational hypertension plus new proteinuria or
> one or more adverse conditions or
>one or more severe complications - 1-2%
proteinuria in preeclampsia
screen for renal disease and preeclampsia if at risk
- urine dipstick of at least 1+ (high FPs and FNs)
- urine total protein (quantitative) = 24 hr urine sample required; significant proteinuria
- urine total protein to creatinine ratio = don’t need 24 hr
T or F. Preeclampsia only affects the mom
F! affects baby as well = slow fetal growth, low birth weight, preterm labour, stillbirth
how is preeclampsia resolved?
by delivering baby as soon as possible
renal tests pre-eclampsia
- increase in serum creatinine
- increase in serum uric acid
kidneys not filtering properly
hepatic tests in pre-eclampsia
- nausea or vomiting
- right upper quadrant pain
- increase in AST, ALT, LDH, or bilirubin
eclampsia
preecclampsia probs + seizures
- terminal for mom
- observed in <1% of women with pre-eclampsia
- investigation similar to pre-eclampsia
- immediate delivery!!!
another possible treatment for preeclampsia but not a certainty
MgSO4
HELLP syndrome
severe presentation of pre-eclampsia (deliver now or eclampsia)
- hemolysis, elevated liver enzyme, low PLT count
- right upper abdominal pain (liver), nausea, vomiting
- death o critical illness up to 25% of the case
preterm labour
- <37 wks gestation
- major cause of neonatal morbidity
- risk factors
> previous preterm birth
> short cervix
> less than 6 mos since last pregnancy, etc.
clinical utility of hCG testing
- early pregnancy
- ectopic pregnancy
- miscarriages
- GTD
- germ cell tumours (AFP)
- maternal prenatal screen for fetal chromosomal abnormalities
- pituitary adenomas
