Maternity Flashcards
What is consider chronic HTN in pregnancy?
Hypertension before 20 weeks gestation
What is the criteria for gestational HTN?
140/90 after 20 weeks gestation
What is the criteria for preeclampsia?
Elevated blood pressure (140/90) after 20 weeks gestations WITH proteinuria OR end organ damage
What is the criteria for preeclampsia with severe features?
BP 160/110, thrombocytopenia, liver enzymes 2x normal, persistent RUQ pain, creatinine ≥ 1.1, pulmonary edema, persistent headache, or visual changes
What is the criteria for eclampsia?
New onset seizures in a woman with preeclampsia
What is superimposed preeclampsia?
Preeclampsia in a woman with chronic hypertension
What is HELLP?
Hemolysis, Elevated Liver enzymes, and Low Platelets syndrome: Scariest complication of preeclampsia
What lab findings would you see with preeclampsia?
Proteinuria or end organ damage (thrombocytopenia, renal insufficiency, or impaired liver function)
Pharmacologic treatment for preeclampsia
Antihypertensives (not many are considered safe in pregnancy):
* Beta blockers
* Calcium channel blockers
* Central alpha-adrenergic inhibitors
* Loop diuretic
* Peripheral arteriolar vasodilator: typically inpatient, often during labor, for precipitously increasing BP
Anticonvulsant: Magnesium sulfate
* Used for preeclamptic women to prevent eclampsia
Normal magnesium level and therapeutic magnesium level in preeclampsia
Normal 1.5-25 mg/dL
Therapeutic 4.8-9.6 mg/dL
Nonpharmacologic treatment for preeclampsia
- Depends on gestational age
- Bedrest with bathroom privileges
- Fetal surveillance
- Serial BP measurement
- Serial lab work (CBC, AST/ALT, BUN/Creatinine, urinalysis)
- Usually inpatient, but may be outpatient if preeclampsia is mild
How to assess edema? Grading?
Press the index finger over the bony prominence of the tibia or medial malleolus.
+1 Slight pitting with about 2 mm depression that disappears rapidly. No visible distortion of extremity.
+2 Deeper pitting with about 4 mm depression that disappears in 10 to 15 seconds. No visible distortion of extremity.
+3 Depression of about 6 mm that lasts more than a minute. Dependent extremity looks swollen.
+4 Very deep pitting with about 8 mm depression that lasts 2 to 3 minutes. Dependent extremity is grossly distorted
What are the risk factors of preeclampsia?
- Primigravida or new father
- Multifetal gestation
- Hx of preeclampsia
- Chronic HTN
- Diabetes (pre-gestational or gestational)
- Thrombophilia
- Obesity
- Age > 35
- Renal disease
However, the majority of individuals with pre-eclampsia are young and healthy and have no risk factors.
How is HELLP diagnosed? What are the symptoms?
HELLP syndrome symptoms include hemolysis of red blood cells, elevated liver enzymes, low platelet count, right upper quadrant pain, hypertension, proteinuria, nausea, and vomiting.
Patho of gestational diabetes.
Hormonal milieu of 3rd trimester of pregnancy (estrogen, progesterone, human placental lactogen) causes insulin resistance
Maternal pancreas responds by increasing insulin production
Glucose easily crosses placenta
Insulin does not cross placenta
Fetal insulin production increases
When does screening for gestational diabetes occur?
Oral Glucose Tolerance Test (OGTT): routine screening between 24-28 weeks
* Nonfasting
* 50g oral glucose load
* ≥ 140 after 1 hour, f/u with 3 hr test
3 hour diagnostic GTT:
* Fasting
* 100 g oral glucose load
* Check blood glucose after 1, 2, 3 hours
* 2/4 abnormal values = gestational diabetes
What are the risk factors for gestation diabetes?
Non-modifiable
* Age ≥ 25 years
* History of insulin resistance
* History of pregnancy loss
* History of congenital anomalies
* History of macrosomia or gestational diabetes
* Pacific Islander, Hispanic, African American, Native American, or Asian
Modifiable
* Physical inactivity
* Overweight/obese
* Hypertension or cardiac disease
Patho of big babies with gestational diabetes.
Glucose cross placenta, but insulin does not
Baby produces more insulin which acts as growth hormone while also decreasing surfactant
What is gestational trophoblastic Dx?
Molar Pregnancy (trophoblastic Dx) early (1st trimester) complication in pregnancy- the abnormal development of the placenta in which fluid-filled clusters are produced instead of normal placental tissue. The abnormal tissue growth leads to the loss of pregnancy.
- Chromosomal abnormality
- Fetus never develops
- Uterus fills with grape-like clusters of vesicles
spotting, vesicles in underwear, severe nausea/vomiting, no fetal movement, no fetal heart tones
What factors contribute to high risk pregnancies?
- maternal age 35 or older,
- prior health conditions (obesity, diabetes, HTN, renal disease, autoimmune disease, thyroid disease),
- health conditions related to pregnancy
- pregnancy with multiples
- family history of conditions
- elevated blood pressure
- history of fetal complications
- lifestyle factors (alcohol misuse, tobacco use, illegal substance use, risky sexual behavior), including obesity.
What complications are common in teenage pregnancy?
development of anemia
pregnancy-related hypertension
preterm labor and birth.
Teens may also require cesarean section or experience failure to progress during labor.
What is an ectopic pregnancy?
pregnancy begins as usual, but zygote implants outside uterus
Ruptured ectopic: surgical abdomen (tenderness to palpation, fever, vomiting), vaginal bleeding
Treated with Surgical removal or chemical abortion methotrexate
What happens to the fetus with maternal alcohol consumption? What effects can be seen in these babies?
intellectual and developmental complications,
behavioral problems,
abnormal facial features, and
cardiac,
renal,
orthopedic,
attention span,
communication,
vision,
and hearing complications.
Alcohol also increases the risk for miscarriage and stillbirth.
SIDS
What is placenta previa?
Placenta attaches and cervical OS
Placenta previa occurs when the placenta partially or completely covers the cervix.
Painless, bright red bleeding from the vagina that may range from light to heavy, cramping that intensifies during contractions, and back pressure are all signs of placenta previa.
Treatment: Planned C-Section, Pelvis Rest, possible bedrest, prepare blood products
