Maternal Fetal Medicine

Question 1

what defines gestational HTN?

Answer 1

BP >140/90 after 20 wga, no proteinuria, nml bp w/in 12 wks postpartum

Question 2

what % of F w/ gest. HTN devlp preE?

Answer 2

25%

Question 3

what is a elevated BP before 20 wga defined as?

Answer 3

this is us. considered simply chronic HTN that the person already had.

Question 4

Criteria for ddx of preE

Answer 4

bp>140/90, proteinuria > 0.3 g/24 hrs,

may be assoc. w/ other problesm such as visual dist, HA, epigastric pain, edema, or HELLP syndrome

Question 5

HELLP Syndrome

Answer 5

Hemolysis, Elevated Liver enz., Low Platelets, found in 20% of F w/ sev. preE, incr risk for mother and fetus - deliver the baby

Question 6

criteria for Sev. PreE

Answer 6

• bp > 160/ 110 on 2 occas. 6 hrs apart while pt is on bed rest
• proteinuria > 5g/24 hr
• oliguria, Cr > 1.2/mg/dL, visual dist, edema, liver pain, elev. LEs, thrombocytopenia, etc.

Question 7

superimposed PreE

Answer 7

woman w/ HTN prev. to 20 wks but w/ new onset proteinuria, sudden incr. in HTN, or dvlpmt of HELLP syndrome

Question 8

criteria for Eclampsia

Answer 8

new onset grand mal sz in a woman w/ preE

Question 9

risk factors for Pre E

Answer 9

primigravida, multiples, hx of preE, HTN, lupus APA etc, nephropathy, BMI > 35 or 35 or v. young, AA, thrombophilia

Question 10

etiology of preE

Answer 10

may be due to incomplete remodeling of the spiral arteries by the trophoblastic cells. severity may be related to degree of remodeling.

Question 11

prostacyclin, NO

Answer 11

vasodilators

Question 12

TXA2, endothelins

Answer 12

vasoconstrictors

Question 13

Eclampsia, mortality, tx

Answer 13

causes intracranial hemorrhage w/ the grand mal sz

- mag sulfate to prevent sz

Question 14

PreE causes what problems w/ fetus?

Answer 14

IUGR, Oligohydraminos, placental abruption, distress, monitor closely and deliver baby when risks to fetus outweigh those of early delivery or maternal morbidity

Question 15

criteria for IUGR

Answer 15

fetus who fails to reach its growth potential, us. at less than the 10th percentile (the lower the perc. the worse the outcomes are likely to be)

Question 16

risk factors for IUGR - maternal

Answer 16

HTN, Renal dz, Lung dz, DM, Heart Dz, Collagen-vasc dz, Hemoglobinopathies, severe malnutrion, smoking/substance abuse, infections (TORCH),
- maternal vasc dzs are the most comm cause

Question 17

risk factors for IUGR - fetal

Answer 17

genitic/congenital problems (esp. early IUGR <26 wks), placental dz, multiples

Question 18

TORCH - infections that can cross the placenta

Answer 18

Toxoplasmosis
Other (syph, VZV, parvo)
Rubella
CMV
Herpes Simplex

Question 19

what can doppler tell you about the fetus/placenta?

Answer 19

blood flow in the umbilical arteries, middle cerebral art, venous circulation, and uterine arteries - nml bloodflow is always forward, if you see rev. flow this reflects poorer oxygenation of the baby

Question 20

things used to assess fetal wellbeing

Answer 20

tone of mvmts, movement, breathing, fluid vol

Question 21

risks assoc w/ bariatric surgery and pregnancy

Answer 21

nutritional/vit deficiencies, surgical complications, medication differences (absorption, transit, etc), more c-sections and complications

Question 22

define peripartum cardiomyopathy

Answer 22

dvlpmt of cardiac failure in last month of pregnancy or w/in 5 mo after delivery W/O identifiable cause of heart failure, or previous heart dz.
- shown by decr. ejection fraction on echo

Question 23

causes of peripartum cardiomyopathy

Answer 23

unknown, may be the same as other idiopathic cardiomyopathy not in pregnancy, may be viral myocarditis.
risk factors: HTN, Obesity, superimposed PreE, Hx/o same, AMA, AA, multiples - note these are basically the same risk factors as for PreE

Question 24

S+S of perip. Cardiom.

Answer 24

Dyspnea, orthopnea, cough, palpiations, chest pain
Cardiomegaly, EF < 45% or fractional shorteningrec
- pts tend to put off symptoms b/c they attribute them to the pregnancy itself

Question 25

long-term prognosis for perip. cardiom.

Answer 25

28% recovered an EF of >50%, 75% took more than 12 months to recover that level. Be very cautious w/ another pregnancy. those that didn’t recover w/in 6 months have high morbidity and mortality rates