Nichols Last Minute 2: Pre Ecclampsia, and more Labor

Question 1

How does pre eclampsia begin?

Answer 1

Spiral arteries stay narrowed, placenta makes HTN inducing cytokines.

Trophoblast cells fail to convert spiral arteries from small caliber to large caliber, resulting in high pressure and placental ischemia.

Question 2

Ischemic placenta releases what to cause pre eclampsia?

Answer 2

Decoy VEGF receptor (fms-like tyrosine kinase 1)
Decoy TGF-beta receptor (endoglin)

These block VEGF ad TGF mediated product of NO and Prostacycling, causing HTN, proteinuria, edema.

Question 3

What do placental cytokines block?

Answer 3

VEGF
TGF
NO and Prostacyclin

Question 4

What from the ischemic placenta makes a pro inflammatory, procoagulant state?

Answer 4

TNFalpha

Question 5

What is blocked that makes pre eclampsia a procoagulant state?

Answer 5

Prostacyclin

Question 6

What in general happens to maternal circulation due to angry placenta?

Answer 6

Endothelial cell injury and HTN

Question 7

What are the most concerning effects of PRECC on fetus?

Answer 7

IUGR
HELLP
Eclampsia

Question 8

What do placental arteries look like in PRECC?

Answer 8

atherosclerosis: fibrinoid necrosis

Question 9

What happens in late stage ishemia of villi? early stage?

Answer 9

Early: accelerated maturation leads to more efficient gas exchange

Late: villous hypoplasia.. they die off

Question 10

How does HELLP happen?

Answer 10

Activation of clotting cascade
Shearing hemolysis
Thrombi in liver sinusoids
Enzyme release from damage

Question 11

What is a dire consequence of HELLP?

Answer 11

Liver rupture, hemorrhage

Question 12

What percentage of HELLP becomes DIC?

Answer 12

20%!!! 1/5

Question 13

What percent of HELLP die of it?

Answer 13

1%

Question 14

What are the main causes of placental ischemia and infarct?

Answer 14

PRECC
hypercoagulatble states
autoimmune vasculitis
smoking

Question 15

How much infarct can the fetus stand to lose?

Answer 15

50%

Question 16

What impairs brain plasticity?

Answer 16

Alchohol in pregnancy

Question 17

What is mole most likely to do? less?

Answer 17

Persistant mole

Less likely: choriocarcinoma

Question 18

What are the most common spots of choriocarcinoma spread?

Answer 18

End organ heme: kidney, spleen, liver, lungs

Brain

Question 19

What is the potter sequence?

Answer 19

Oligohydramnios: renal agenesis
Smush face
Contracted hands

Question 20

What are amniotic bands?

Answer 20

Mechanical fibrotic lesions

Cause limb stricture or amputations

Question 21

What type of cord knots were mentioned?

Answer 21

Full knot

Fake knot-clamp like

Question 22

When are cord knots exacerbated?

Answer 22

2nd trimester

Question 23

What is the cause of placental abruption?

Answer 23

Rupture of deciduall blood vessels: retroplacental clot

Question 24

What causes pulmonary embolism in delivery?

Answer 24

DVT due to IVC compression on leg

1 in 500

Question 25

Amniotic fluid embolism sequellae?

Answer 25

Cardio failure
Lung failure
DIC

Question 26

Peripartum cardiomyopathy can do what 2 things?

Answer 26

1/3: resolve spontaneously

2/3: dilated cardiomyopathy

Question 27

Peripartum cardiomyopathy most common in who?

Answer 27

Black women

Several children

Question 28

DDx for breathing problems in labor?

Answer 28

PE
Pulmonary edema: if PRECC
Peripartum cardiomyopathy
Amniotic fluid embolism
Anxiety
Magnesium sulfate toxicity if Tx for eclampsia

Question 29

What are the five leading causes of maternal death in US?

Answer 29

1. thrombus
2. hemorrhage
3. PRECC
4. infection
5. cardiomyopathy