OB- Maternal disorders complicating pregnancy Flashcards
Hyperemesis gravidarum exists when?
pregnant woman vomits so much she develops dehydration and electrolyte imbalance
what is Spine Hypotensive Syndrome?
A temporary, acute disorder due to compression of the IVC by the weight of the pregnant uterus
How is spint hypoensive syndrome indicated?
when a pregnant woman feels faint while lying on her back (mostly in the 3rd trimester)
How to relieve Spine Hypotensive Syndrome?
the patient must be positioned in a lateral decubitus position (preferably left lateral) in order to remove the weight of enlarged uterus on IVC and restore normal venous return
Hypertensive Disorders risk factors? (4)
- Chronic hypertension
- Diabetes mellitus
- Multiple pregnancy
- Chronic renal disease
What is chronic hypertension?
It refers to blood pressure 140/90mmHg or greater prior to pregnancy, before the 20 weeks gestation in the absence of a hydatiform mole or hypertension that persists for more than 42 days postpartum
significant fetal complications associated with hypertensive disorders (4)?
- IUGR
- Hypoxia (fetal distress)
- Fetal death
- Placenta in severe hypertensive disease may be small or prematurely calcified
clinical classification hypertensive disorders?(5)
- chronic hypertension
- pregnancy-induced hypertension
- preeclampsia
- eclampsia
- HELLP syndrome
hypertensive disorders: doppler waveform (uterine artery doppler) abnormal?
- The presence of an early diastolic notch
- Reduced end diastolic flow resulting in a high pulsality index (>1.5)
- High resistive index (>0.58)
- RI above the 95th percentile for GA.
Ultrasound Doppler spectrum of uterine artery blood velocity?
Upper panel: Normal blood velocity.
Lower panel: Decreased blood velocity with a characteristic notch in early diastole as a sign of increased placental vascular impedance.
3 common types of gestational hypertension?
- chronic hypertension
- gestational hypertension
- preeclampsia
What is chronic Hypertension?
Women who have high blood pressure (over 140/90) before pregnancy, early in pregnancy (before 20 weeks), or carry it on after delivery
what is Gestational Hypertension?
High blood pressure that develops after week 20 in pregnancy and goes away after delivery
what is preeclampsia? what are symptoms?
- Both chronic hypertension and gestational hypertension can lead to this severe condition after week 20 of pregnancy.
- Symptoms include: High BP and protein in the urine and can lead to serious complications for both mom and baby if not treated quickly.
When does Pregnancy-Induced Hypertension develop?
during pregnancy or immediate postpartum period
hypertension is defined as?
Systolic ≥ 140 mmHg
Diastolic ≥ 90 mmHg
- Usually develops after 20 weeks gestation but may develop before 20 weeks gestation in patients with gestational trophoblastic disease
what may increase the risk of developing gestational hypertension?
- A first-time mom
- Women whose sisters and mothers had pregnancy induced hypertension
- Women carrying multiple babies
- Women younger than age 20 or older than age 40
- Women who had high blood pressure or kidney disease prior to pregnancy
Signs and Symptoms of Pregnancy Induced Hypertension? (6)
- Blood Pressure > 140/90 mmHg
- Proteinurea > 5 gm/24 hours
- Oliguria < 400 ml in 24 hours
- Edema (Positive)
- Weight gain > 3.6 kg/week after 20th week of pregnancy
- Headaches, visual disturbance
Gestational hypertension can lead to a serious condition called?
preeclampsia (AKA toxemia)
Preeclampsia is a term describing?
hypertension with proteinuria, generalized edema or both
Preeclampsia S/S?
The onset is gradual, other symptoms are oliguria, cerebral or visual disturbances (headache, blurred vision)
Mild preeclampsia S/S? (3)
High blood pressure
Water retention
Protein in the urine
Severe preeclampsia S/S (9)
Headaches Blurred vision Inability to tolerate bright light Fatigue Nausea/vomiting Urinating small amounts RUQ pain Shortness of breath Tendency to bruise easily
what is eclampsia?
- It is the development of seizure or coma without an underlying neurologic or febrile origin (epilepsy or systemic infection) in a patient with preeclampsia.
- Eclampsia may occur within hours of delivery
HELLP syndrome affects how many women with eclampsia or severe preeclamsia?
15%
what does HELLP syndrome refer to?
It refers to a subgroup of patients with a severe form of Pregnancy Induced Hypertension, who develop multiple organ damage
what is HELLP an acrynom for?
Hemolysis, Elevated Liver enzymes, Low Platelet count
Maternal complications associated with HELLP? (4)
Acute renal failure
Hepatic rupture
Adult respiratory distress syndrome
Disseminated intravascular coagulation
What is diabetes mellitus?
medical disease that leads to hyperglycemia and glycosuria as the hyperglycemia increases
classification of diabetes? (5)
Insulin-dependent diabetes (IDDM) Non-insulin-dependent diabetes (NIDDM) Gestational diabetes (GDM) Impaired glucose tolerance (IGT) Diabetes associated with certain known conditions and symptoms
Insulin-dependent diabetes (IDDM) or Type I diabetes? When does it develop?
- sudden onset and characterized by an absolute deficiency of insulin (possibly caused by the autoimmune destruction of beta cells)
- It develops before age 20 and it persists the whole life
- The deficiency of insulin accelerates the break down of the body’s reserve of fat resulting in the production of organic acids called ketones
diabetes complications?
Loss of vision due to cataracts
Severe kidney disorders
What is Non-insulin-dependent diabetes (NIDDM)?
- 90% of all diabetes
- It is associated with obesity and most often occurs over 40 years of age
- It occurs later in life
Non-insulin-dependent diabetes (NIDDM) clinical symptoms?
Mild, and the high glucose levels in the blood can usually be
controlled by diet alone or with anti-diabetic drugs
what is Gestational Diabetes Mellitus?
A woman who develops or discovers having diabetes during pregnancy
Risk factors of Gestational Diabetes Mellitus? (5)
- Strong family history of diabetes
- Fasting glycosuria
- Previous unexplained prenatal loss
- Previous large for dates infant
- Previous gestational diabetes and maternal obesity
Diabetes mellitus maternal risks?
- preeclampsia and eclampsia in patients with vascular disease
- infection: acture pyelonephritis
- fetal macrosomia
- caesarean section
- risk of preterm labour
- postpartum hemorrhage
Diabetes fetal risk?
- intrauterine demise
- Perinatal morbidity from birth injury due to macrosomia with accompanying shoulder dystocia and brachial plexus injury
- IUGR in patient with vascular disease
- Fetal congenital anomalies
diabetes mellitus most common anomalies fetal risk?
- Caudal regression syndrome (sacral agenesis, sirenomelia)
- Situs inversus
- Holoprosencephaly
- Renal anomalies
- Duplex kidney
- Renal agenesis
fetal risk cardiac anomalies Diabetes Mellitus Effects?
- VSD, ASD (most common)
- Transposition of the great vessels
fetal risk neural tube defects Diabetes Mellitus Effects?
Ancephalocele
Meningomyelocele
Role of U/S in diabetic pregnancy may be helpful for accurate determination of GA to accurately assess:?
accurate determination of GA to accurately assess:
- Macrosomia
- Polyhydramnios
- IUGR (diabetic with vascular disease), for planning of elective delivery and amniocentesis if necessary.
Role of U/S in diabetic pregnancy used for diagnosis of?
- Placental abruption
- Polyhydramnios
- Major congenital anomalies, detailed fetal echocardiography
- Non-immune fetal hydrops (edema, ascites, placental thickening)
- Umbilical cord anomalies (single umbilical artery, velamentous insertion)
what is Hydronephrosis?
During the pregnancy the renal collecting system (calyces and renal pelvis) and ureter typically exhibit mild dilation referred to as physiologic hydronephrosis of pregnancy
main cause of hydronephrosis and hydro ureter?
ureteral compression by the enlarging uterus
Other pathologic causes of hydronephrosis? (3)
- pelvic mass
- stone
- ureterocele
What are Urinary tract infections?
- The generalized dilation and decreased peristalsis associated with hydronephrosis of pregnancy combine to increase the capacity of the urinary tract during pregnancy
- ureteral reflux is also common
- U/S has a low sensitivity and specificity for the diagnosis of acute pyelonephritis
Ultrasound findings associated with acute pyelonephritis?
- Renal enlargement
- Generalized decrease in the echogenicity of the cortex and medulla
- Decreased sound attenuation due to increased fluid content of the edematous inflamed kidney
Hepatobiliary Disorders?
- Ultrasound is useful to evaluate the patient who has right upper quadrant pain or jaundice during pregnancy.
- Ultrasound is most valuable to assess extrahepatic biliary tree for obstruction.
- Cholelithiasis/acute cholecystitis
- Pregnancy increases the risk of cholelithiasis and cholecystitis.
what is cholelethiasis?
- Patients with gallstones typically present with right upper quadrant pain and may also have nausea and vomiting, and intolerance to fatty foods
- Acute cholecystitis is inflammation of the GB and is usually due to gallstones, although it may occur in the absence of gallstone
jaundice during pregnancy may be due to?
any disease associated with jaundice including biliary obstruction due to gallstones in the extra hepatic bile duct, tumor obstructing the bile duct and cholangitis
non-obstructive hepatic disease due to?
acute fatty liver or intrahepatic cholestasis of pregnancy
Cholestasis refers to?
to any condition that impairs the flow of bile
Cholestasis of pregnancy occurs? what does it trigger?
in late pregnancy and triggers intense itching, usually on the hands and feet
Budd-Chiari Syndrome refers to?
- obstruction of the hepatic venous flow associated presenting as an acute illness with abdominal pain, ascites, hepatosplenomegaly and portal hypertension
what is associated with budd-chiari syndrome?
Pregnancy increases the risk of hypercoagulability, which is associated with Budd-Chiari Syndrome.
Congenital Infections ?
Exposure to infection during pregnancy has been recognized as a significant cause of congenital anomalies, IUGR and fetal Hydrops.
what are harmful infections known as?
TORCH
What does TORCH stand for?
Toxoplasmosis (parasite)
Others are:
- Syphilis (bacterium)
- Varicella or chicken pox (virus)
- Parovirus B19 infection
- Hepatitis B virus infection
Rubella (virus)
Cytomegalovirus (virus)
Herpes simplex (virus)
Perinatal infections account for what % of congenital anomalies?
2-3%
Most of the TORCH infections cause what?
- mild maternal morbidity
- but have serious fetal consequences, and treatment of maternal infection frequently has no impact on fetal outcome
what is Toxoplasmosis risk related to?
- The risk is related to the GA at which maternal infection occurs.
- There is greater risk of transmission to the fetus in the 3rd trimester but is usually without significant consequences.
- There is less frequent transmission in the 1st trimester, but the consequences are usually more severe including: spontaneous abortion, stillbirth and severe congenital infection in the fetus
The risk is related to the gestational age at which maternal infection occurs
toxoplasmosis- severse disease characteristic triad of anomalies include?
- Chorioretinitis (inflammation of the choroid (thin pigmented vascular coat of the eye and retina of the eye), hydrocephaly or microcephaly, and cerebral calcification.
- Hydrops may be associated with fetal infection.
what is Hepatitis B Virus (HBV)?
- Maternal infection occurring in the first trimester is not associated with fetal disease.
- Acute third trimester infections have been associated with an increased risk of prematurity and transmission of the hepatitis to the infant.
what is Rubella Virus (German Measles)?
- When Rubella infections occur in the first month of pregnancy, there is a 50% chance of congenital anomalies.
- This chance falls to 22% in the 2nd month, to 6%-10% in the 3rd to 4th month.
- The timing of infection is important.
rubella virus (german measles) timing of infection?
If infection occurs during:
Week 6: cataract
Week 7 to 8: deafness
- The fetus may have heart, lung and brain abnormalities. Having rubella infection in the first three months of pregnancy also increases your risk of having a miscarriage
What is Cytomegalovirus
?
- Gestation age at the time of exam does not appear to influence the rate of fetal infection
Abnormalities associated are:
- Hydrops, microcephaly, hydrocephaly, chorioretinitis, hepatosplenomegaly, cerebral calcification, mental retardation, heart block and petechia.
