Maternal Complications Flashcards
The rate of ______ in a diabetic is 3-5%
fetal mortality
The risk of major fetal anomaly is _______.
6-12%
_________ plays a major role of monitoring in a pregnant diabetic.
Ultrasound
Diabetes is usually a ______ occurrence, __% of the time.
spontaneous, 90
The other 10% are caused by related _______,______, and _______.
pancreatic disease, hormone imbalance, drug reactions.
What are the two types of diabetes mellitus?
Type 1-juvenile onset, (insulin dependent)
Type 2-adult onset, (non-insulin dependent)
Serum marker for how well a diabetic is controlled in pregnancy, a poorly controlled diabetic is most frequently associated with fetal anatomic anomalies.
Hemoglobin A1C
Glucose intolerance of pregnancy
Gestational diabetes
Gestational diabetes usu. occurs in ____, and ____, trimesters. Is usu. associated with ______ ______.
2nd, 3rd, fetal macrosomia
What congenital anomalies arise due to the increased risk associated with diabetes mellitus?
Caudal regression neural tube defects Cardiovascular malformations Genitourinary anomalies Single umbilical artery Gastrointestinal anomalies skeletal anomalies IUGR
What are the fetal complications affected by DM?
Respiratory distress syndrome
Hypoglycemia.
What is associated with Gestational Diabetes
Fetal macrosomia hydrops Polyhydramnios still birth trauma dystocia
What is fetal macrosomia?
Fetal weight greater than 4000 g or greater than 90 percentile for gestational age.
Define dystocia
Difficult delivery
Fetuses of gestational diabetic mother can have which other two conditions
hypocalcemic, hypoglycemia
What is involved with Hypertension in mothers.
Systolic pressure gradient and 140 mmHg
Increase in systolic pressure greater than 130 mmHg over the pregnancy
Diastolic pressure greater than 90 mmHg
Increase in diastolic pressure greater than 15 mmHg over prepregnancy state
Describe essential hypertension
pre-existing hypertension not related to the pregnancy. ( Also called chronic hypertension)
Hypertension that occurs during pregnancy without signs of preeclampsia
Pregnancy induced hypertension/gestational hypertension PIH
A disorder of pregnancy which is characterized by proteinuria and neurologic symptoms.
GEPH–Gestational edema proteinuria hypertensive syndrome–otherwise called (Toxemia of pregnancy)
GEPH or toxemia of pregnancy is most common in ________, _______, and _______.
1st time mothers (most common)
multiple gestations
patients with a family history
What are the two classifications of toxemia of pregnancy
Preeclampsia
Eclampsia
Symptoms associated with Preeclampsia
hypertension
generalized edema
Proteinuria
Rapid weight gain which is secondary to Edema
Symtoms associated with Eclampsia
Same as seen in preeclampsia but with seizures
List what Pathology of GEPH leads to:
hypoxia, necrosis of tissue premature placental aging renal cellular damage disseminated intravascular coagulopathy DIC Portal hemorrhagic necrosis in the liver cerebral edema pulmonary edema
What are the Sono findings of GEPH
IUGR
Increase of abruptio placentae
Oligohydramnios
Fetal demise
______ is used to track fetal growth and monitor the pregnancy
Ultrasound
______ _____ is a complication of preeclampsia.
HELLP syndrome
What does HELLP stand for
hemolysis-H
Elevated liver enzymes-EL
Low platelets-LP
List 3 complications associated with severe maternal infection.
Spontaneous abortion
Fetal death
Premature labor and delivery
Name the most common significant utero infections.
TORCH infections
What does TORCH stand for.
Toxoplasmosis Other/syphilis and parvovirus Rubella Cytomegalovirus/CMV Herpes/genital type
This protozoan is found in cat feces and undercooked meat, name it.
Toxoplasmosis—**Maternal infection crossed the placental barrier and results in fetal infection.
Name 8 results of Toxoplasmosis
Intracranial calcifications Micro opthalmia IUGR Microcephaly Hydrocephalus Thick placenta Thromboctyopenia Jaundice
An extremely teratogenic infection for the fetus, name this.
Rubella or German Measles
Defects of Rubella are:
Cataracts
Congenital heart disease
Deafness
Mental retardation
The most common infection in pregnancy.
Cytomegalovirus/CMV
CMV may cause _____ _____ if exposure occurs in 1st trimester. Other findings are:(6)
embryonic demise Spontaneous abruption of placenta IUGR Fetal ascites Cranial anomalies Chest anomalies Fetal death
______ can be transmitted to the fetus during vaginal delivery.
Herpes
Herpes can cause a woman to have ___ _____.
Cesarean section
Women with Herpes may also cause (3)
CNS, eye, visceral involvement
Generalized multiple organ involvement
Death
Common respiratory viral infection
Parvovirus
Parvovirus can lead to the following (2)
Pancytopenia/anemia which can lead to fetal hydrops
Percutaneous umbilical cord sampling or fetal transfusion may become necessary
Refers to premature dilation and efacement of uterine cervix
Incompetent cervix
**May be congenital or acquired and is mc related to prior cx trauma i.e. cervical surgery for cervical carcinoma.
What happens with an incompetent cervix?
Cervix unable to prevent premature expulsion of pregnancy
How is imcompetent cervix prevented?
Cerclage– stitch to keep the cx closed.
Name the cerclage procedure.
McDonald or Shirodkar procedure
Features of incompetent Cx. (3)
shortened cervix, < 2.5 cm
Dilation of the cervix greater than 2cm in 2nd Trimester–(Most reliable sign)
Bulging membranes into the dilated cervix–hourglass sign.(Poor prognostic indicator)
The stages of incompetent cervix–TYVU- which stands for
Trust Your Vaginal Ultrasound T-Normal Y-internal os slightly dilated V-funneling U-extremely short, thin cx
Maternal anemias
The need for increased perfusion to a highly vascularized placenta results in a __% increase in blood volume.
40%
Because increased plasma volume accounts for much of the increase, _____ and ______ values are much lower during pregnancy than in the nonpregnant state.
hemoglobin, hematocrit
Clinical signs of anemia
Hemoglobin less than 10 g per 100 ML’s
Hematocrit less than 30%
Types of anemia
Iron deficiency (95%) Folic acied deficiency Aplastic anemia Drug-induced hemolytic anemia Thalassemia and Sickle Cell Anemia
This is a rare and catastrophic cause of maternal death
Uterine rupture
Name the clinical signs of Uterine rupture
Horrific pain
Sudden increase in fetal station
Define preterm labor
The onset of labor prior to 37 weeks gestation
What can cause preterm labor
Previous uterine surgery Uterine anomaly Maternal stress Multiple gestation Heavy cigarette smoking Polyhydramnios Percentile previous or abruption,source of bleeding Systemic infection Idiopathic Premature rupture of membranes Uterine masses
What is found on Ultrasound when membranes rupture prematurely?
Oligohydramnios
Most common mass of uterus
Myeloma or leiomyoma
______ and ______ types of masses will be prone to torsion
Submucosal and surserosal types
_______ may cause obstruction of vaginal delivery.
Leiomyomas
They are also known to cause _____ ______
Fetal malpresentation
What are the Ultrasound findings of Leiomyomas
solid, hypoechoic uterine mass which distorts with uterine contour
How to differentiate between focal myometrial contraction and leiomyoma?
Focal myometrial contraction will change with time, a leiomyoma will not.
What type cyst often found during pregnancy.
Ovarian
Name the most common cyst.
Corpus luteum
Name the cyst that occurs with gestational trophoblastic disease
Theca lutein which are lg and multi-septated
