Maternal Fetal Medicine Flashcards
what defines gestational HTN?
BP >140/90 after 20 wga, no proteinuria, nml bp w/in 12 wks postpartum
what % of F w/ gest. HTN devlp preE?
25%
what is a elevated BP before 20 wga defined as?
this is us. considered simply chronic HTN that the person already had.
Criteria for ddx of preE
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
HELLP Syndrome
Hemolysis, Elevated Liver enz., Low Platelets, found in 20% of F w/ sev. preE, incr risk for mother and fetus - deliver the baby
criteria for Sev. PreE
- 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.
superimposed PreE
woman w/ HTN prev. to 20 wks but w/ new onset proteinuria, sudden incr. in HTN, or dvlpmt of HELLP syndrome
criteria for Eclampsia
new onset grand mal sz in a woman w/ preE
risk factors for Pre E
primigravida, multiples, hx of preE, HTN, lupus APA etc, nephropathy, BMI > 35 or 35 or v. young, AA, thrombophilia
etiology of preE
may be due to incomplete remodeling of the spiral arteries by the trophoblastic cells. severity may be related to degree of remodeling.
prostacyclin, NO
vasodilators
TXA2, endothelins
vasoconstrictors
Eclampsia, mortality, tx
causes intracranial hemorrhage w/ the grand mal sz
- mag sulfate to prevent sz
PreE causes what problems w/ fetus?
IUGR, Oligohydraminos, placental abruption, distress, monitor closely and deliver baby when risks to fetus outweigh those of early delivery or maternal morbidity
criteria for IUGR
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)
risk factors for IUGR - maternal
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
risk factors for IUGR - fetal
genitic/congenital problems (esp. early IUGR <26 wks), placental dz, multiples
TORCH - infections that can cross the placenta
Toxoplasmosis Other (syph, VZV, parvo) Rubella CMV Herpes Simplex
what can doppler tell you about the fetus/placenta?
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
things used to assess fetal wellbeing
tone of mvmts, movement, breathing, fluid vol
risks assoc w/ bariatric surgery and pregnancy
nutritional/vit deficiencies, surgical complications, medication differences (absorption, transit, etc), more c-sections and complications
define peripartum cardiomyopathy
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
causes of peripartum cardiomyopathy
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
S+S of perip. Cardiom.
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
long-term prognosis for perip. cardiom.
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
