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CNIH > OB- Maternal disorders complicating pregnancy > Flashcards

OB- Maternal disorders complicating pregnancy Flashcards

1
Q

Hyperemesis gravidarum exists when?

A

pregnant woman vomits so much she develops dehydration and electrolyte imbalance

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2
Q

what is Spine Hypotensive Syndrome?

A

A temporary, acute disorder due to compression of the IVC by the weight of the pregnant uterus

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3
Q

How is spint hypoensive syndrome indicated?

A

when a pregnant woman feels faint while lying on her back (mostly in the 3rd trimester)

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4
Q

How to relieve Spine Hypotensive Syndrome?

A

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

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5
Q

Hypertensive Disorders risk factors? (4)

A
  1. Chronic hypertension
  2. Diabetes mellitus
  3. Multiple pregnancy
  4. Chronic renal disease
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6
Q

What is chronic hypertension?

A

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

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7
Q

significant fetal complications associated with hypertensive disorders (4)?

A
  • IUGR
  • Hypoxia (fetal distress)
  • Fetal death
  • Placenta in severe hypertensive disease may be small or prematurely calcified
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8
Q

clinical classification hypertensive disorders?(5)

A
  1. chronic hypertension
  2. pregnancy-induced hypertension
  3. preeclampsia
  4. eclampsia
  5. HELLP syndrome
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9
Q

hypertensive disorders: doppler waveform (uterine artery doppler) abnormal?

A
  • 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.
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10
Q

Ultrasound Doppler spectrum of uterine artery blood velocity?

A

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.

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11
Q

3 common types of gestational hypertension?

A
  1. chronic hypertension
  2. gestational hypertension
  3. preeclampsia
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12
Q

What is chronic Hypertension?

A

Women who have high blood pressure (over 140/90) before pregnancy, early in pregnancy (before 20 weeks), or carry it on after delivery

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13
Q

what is Gestational Hypertension?

A

High blood pressure that develops after week 20 in pregnancy and goes away after delivery

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14
Q

what is preeclampsia? what are symptoms?

A
  • 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.
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15
Q

When does Pregnancy-Induced Hypertension develop?

A

during pregnancy or immediate postpartum period

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16
Q

hypertension is defined as?

A

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
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17
Q

what may increase the risk of developing gestational hypertension?

A
  • 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
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18
Q

Signs and Symptoms of Pregnancy Induced Hypertension? (6)

A
  1. Blood Pressure > 140/90 mmHg
  2. Proteinurea > 5 gm/24 hours
  3. Oliguria < 400 ml in 24 hours
  4. Edema (Positive)
  5. Weight gain > 3.6 kg/week after 20th week of pregnancy
  6. Headaches, visual disturbance
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19
Q

Gestational hypertension can lead to a serious condition called?

A

preeclampsia (AKA toxemia)

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20
Q

Preeclampsia is a term describing?

A

hypertension with proteinuria, generalized edema or both

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21
Q

Preeclampsia S/S?

A

The onset is gradual, other symptoms are oliguria, cerebral or visual disturbances (headache, blurred vision)

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22
Q

Mild preeclampsia S/S? (3)

A

High blood pressure
Water retention
Protein in the urine

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23
Q

Severe preeclampsia S/S (9)

A 
Headaches
Blurred vision
Inability to tolerate bright light
Fatigue
Nausea/vomiting
Urinating small amounts
RUQ pain
Shortness of breath
Tendency to bruise easily
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24
Q

what is eclampsia?

A
  • 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
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25
Q

HELLP syndrome affects how many women with eclampsia or severe preeclamsia?

A

15%

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26
Q

what does HELLP syndrome refer to?

A

It refers to a subgroup of patients with a severe form of Pregnancy Induced Hypertension, who develop multiple organ damage

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27
Q

what is HELLP an acrynom for?

A

Hemolysis, Elevated Liver enzymes, Low Platelet count

28
Q

Maternal complications associated with HELLP? (4)

A

Acute renal failure
Hepatic rupture
Adult respiratory distress syndrome
Disseminated intravascular coagulation

29
Q

What is diabetes mellitus?

A

medical disease that leads to hyperglycemia and glycosuria as the hyperglycemia increases

30
Q

classification of diabetes? (5)

A 
Insulin-dependent diabetes (IDDM)
Non-insulin-dependent diabetes (NIDDM)
Gestational diabetes (GDM)
Impaired glucose tolerance (IGT)
Diabetes associated with certain known conditions and symptoms
31
Q

Insulin-dependent diabetes (IDDM) or Type I diabetes? When does it develop?

A
  • 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
32
Q

diabetes complications?

A

Loss of vision due to cataracts

Severe kidney disorders

33
Q

What is Non-insulin-dependent diabetes (NIDDM)?

A
  • 90% of all diabetes
  • It is associated with obesity and most often occurs over 40 years of age
  • It occurs later in life
34
Q

Non-insulin-dependent diabetes (NIDDM) clinical symptoms?

A

Mild, and the high glucose levels in the blood can usually be
controlled by diet alone or with anti-diabetic drugs

35
Q

what is Gestational Diabetes Mellitus?

A

A woman who develops or discovers having diabetes during pregnancy

36
Q

Risk factors of Gestational Diabetes Mellitus? (5)

A
  • Strong family history of diabetes
  • Fasting glycosuria
  • Previous unexplained prenatal loss
  • Previous large for dates infant
  • Previous gestational diabetes and maternal obesity
37
Q

Diabetes mellitus maternal risks?

A
  • preeclampsia and eclampsia in patients with vascular disease
  • infection: acture pyelonephritis
  • fetal macrosomia
  • caesarean section
  • risk of preterm labour
  • postpartum hemorrhage
38
Q

Diabetes fetal risk?

A
  • 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
39
Q

diabetes mellitus most common anomalies fetal risk?

A
  • Caudal regression syndrome (sacral agenesis, sirenomelia)
  • Situs inversus
  • Holoprosencephaly
  • Renal anomalies
  • Duplex kidney
  • Renal agenesis
40
Q

fetal risk cardiac anomalies Diabetes Mellitus Effects?

A
  • VSD, ASD (most common)

- Transposition of the great vessels

41
Q

fetal risk neural tube defects Diabetes Mellitus Effects?

A

Ancephalocele

Meningomyelocele

42
Q

Role of U/S in diabetic pregnancy may be helpful for accurate determination of GA to accurately assess:?

A

accurate determination of GA to accurately assess:

  • Macrosomia
  • Polyhydramnios
  • IUGR (diabetic with vascular disease), for planning of elective delivery and amniocentesis if necessary.
43
Q

Role of U/S in diabetic pregnancy used for diagnosis of?

A
  1. Placental abruption
  2. Polyhydramnios
  3. Major congenital anomalies, detailed fetal echocardiography
  4. Non-immune fetal hydrops (edema, ascites, placental thickening)
  5. Umbilical cord anomalies (single umbilical artery, velamentous insertion)
44
Q

what is Hydronephrosis?

A

During the pregnancy the renal collecting system (calyces and renal pelvis) and ureter typically exhibit mild dilation referred to as physiologic hydronephrosis of pregnancy

45
Q

main cause of hydronephrosis and hydro ureter?

A

ureteral compression by the enlarging uterus

46
Q

Other pathologic causes of hydronephrosis? (3)

A
  • pelvic mass
  • stone
  • ureterocele
47
Q

What are Urinary tract infections?

A
  • 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
48
Q

Ultrasound findings associated with acute pyelonephritis?

A
  • 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
49
Q

Hepatobiliary Disorders?

A
  • 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.
50
Q

what is cholelethiasis?

A
  • 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
51
Q

jaundice during pregnancy may be due to?

A

any disease associated with jaundice including biliary obstruction due to gallstones in the extra hepatic bile duct, tumor obstructing the bile duct and cholangitis

52
Q

non-obstructive hepatic disease due to?

A

acute fatty liver or intrahepatic cholestasis of pregnancy

53
Q

Cholestasis refers to?

A

to any condition that impairs the flow of bile

54
Q

Cholestasis of pregnancy occurs? what does it trigger?

A

in late pregnancy and triggers intense itching, usually on the hands and feet

55
Q

Budd-Chiari Syndrome refers to?

A
  • obstruction of the hepatic venous flow associated presenting as an acute illness with abdominal pain, ascites, hepatosplenomegaly and portal hypertension
56
Q

what is associated with budd-chiari syndrome?

A

Pregnancy increases the risk of hypercoagulability, which is associated with Budd-Chiari Syndrome.

57
Q

Congenital Infections ?

A

Exposure to infection during pregnancy has been recognized as a significant cause of congenital anomalies, IUGR and fetal Hydrops.

58
Q

what are harmful infections known as?

A

TORCH

59
Q

What does TORCH stand for?

A

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)

60
Q

Perinatal infections account for what % of congenital anomalies?

A

2-3%

61
Q

Most of the TORCH infections cause what?

A
  • mild maternal morbidity

- but have serious fetal consequences, and treatment of maternal infection frequently has no impact on fetal outcome

62
Q

what is Toxoplasmosis risk related to?

A
  • 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
63
Q

toxoplasmosis- severse disease characteristic triad of anomalies include?

A
  • 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.
64
Q

what is Hepatitis B Virus (HBV)?

A
  • 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.
65
Q

what is Rubella Virus (German Measles)?

A
  • 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.
66
Q

rubella virus (german measles) timing of infection?

A

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
67
Q

What is Cytomegalovirus

?

A
  • 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.

CNIH (69 decks)

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