OBGYN: Hypercoagulablity, Rh, Multiple Gestations Flashcards
leading cause of maternal death
hemorrhage
what kind of state is being pregnant
Hypercoaguable state
hypercoaguable state also called
thrombophillia
list ways pregnancy cause hypercoaguable state (4)
- pregnancy causes decreased venous outflow bc of growing uterus, 2. hormonal changes,
- decreased mobility and
- incr in concentration of factors VII, VIII, X and fibrinogen in clotting cascade
incr in what clotting factors during pregnancy
VII
VIII
X
Fibrinogen
define thombus and thomboembolic event
thombus=clot
thromboembolic= obstruction of BV by a thrombus that lodged from another site in body
what state is higher risk of clot—pregnancy or PP?
PP
FIRST SIX WEEKS**
what do we NEVER give a PP woman for contraception
estrogen only
bc first six weeks is the highest risk of a clot and estrogen increases clots tooo
two main causes of pregnancy-associated venous thromboembolism (VTE)
DVTs and PE
most imp RF for VTE in pregnancy is?
history of thrombosis
do women require anti-coagulation during pregnancy
no—– the risk outweight its benefits
what woman would benefit from anti-coagulation during pregnancy
hx of thrombosis or hx of inherited thrombophillia
what is disseminated intravascular coagulation
- characteried by?
- what can cause obstetric DIC (6)
DIC
- life-threatening
- arise from obstetrical or nonobstetrical causes
Characterized by:
*systemic activation of blood coagulation–>results in generation and deposition of fibrin–>microvascular thrombi in various orans form
*all these clots use up the clotting factors and platelets–>results in a life-threatening hemorrhage because there are NO CLOTTING FACTORS AND PLATELETS LEFT TO STOP BLEEDING
CAUSES
- amniotic fluid embolism
- abrupto placentae
- acute peripartum hemorrhage
- retrained stillbirth
- septic abortion
- acute fatty liver of pregnancy
two important blood group systems
ABO blood group
Rh blood group
Rh system contains?
- proteins—-antigens— on the surface of RBCs
* *proteins are referred to as Rh Factor
what is the Rh factor
antigens or proteins on the surface of RBCs
describe a Rh+
when Rh factor is present on the surface of RBC
describe Rh-
when Rh factor is NOT on the surface of RBCs
what happens when you are RH- and blood mixes with Rh+
immune system will react to the Rh factor by making ANTIBODIES to destroy it
——Rh Sensitization
Rh sensitization?
when a RH- person’s blood mixes with RH+ blood—- the RH- immune system will create antibodies against the RH+ and destroy it
what is dangerous:
1. Rh- mom and Rh+ fetus
or
2. Rh+ mom and Rh- fetus
*when does mixing occur
Rh- MOM and Rh+ fetus
Mixing occurs RARELY in uterus and will mix at delivery
when does mom start making anti-Rh antibodies when she is RH- and baby is Rh+
is the first baby affected?
when the bloods mix—- so DELIVERY is when her body starts–>post delivery mom is considered sensitized and stay in her blood
***this means that the first baby is not affected
second child of a sensitized mom and Rh+ fetus— what happens to fetus
antibodies made during first delivery will attack the Rh+ baby–>it attacks the fetus’s RBCs –>anemia, jaundice or other serious problems
if mom is Rh-, what two things are always checked
- father’s Rh type—— bc if he also has Rh-, then the fetus will be Rh- and no issue
- presence of anti-Rh antibodies in the mother—- meaning she is sensitized
if mom is Rh- and fetus is determiend to be Rh+, the baby is evaluated for?
fetal hydrops
fetal hydrops
- define
- outcome
serious condition that is caused by the Rh isoimmunization of the fetus—-aka when the mom’s Rh antibodies attack baby’s RBCs
outcome=is poor with high mortality and morbidity
what is the goal if the mom never been sensitized?
to keep her from ever becoming sensitized
how do we get mom to never become sensitized
give her—RhoGAM aka Rh immune globulin
unsensitized moms get prophylaxis RhoGAM at what periods during pregnancy (5)
- 28 weeks gestation
- within 72 hours of delivery of a rh- baby
- after a miscarriage
- after abortion
- after ectopic pregnancy
during what scenarios do we give RhoGAM in the first trimester (1-12 weeks)
ectopic pregnancy abortion or miscarriage
define multiple gestation
two or more embryos or fetuses occupy the uterus simultaneously
multiple gestation is considered? frequently ends in?
a complication of pregnancy
*frequently ends in pre-term deliveries
monozygotic
- define
- how does it occur
ID twins (one egg, one sperm)
OCCURS
*when a single fertilized egg (embryo) splits
- same placenta
- different amniotic sacs
dizygotic
-define
-
fraternal twins (two eggs, two sperm)
- each twin has its own–
1. placenta
2. chorion
3. amnion
in monozygotic twins, the fetal membranes and placentas present depends on?
when the embryo splits—- earlier the split—the more separate the membranes and placentas
chorion
placenta
amnion
sac/membranes
dichorionic
two placentas for monozygotic
Diamniotic
two sacs
Monochorionic
one placenta
monoamniotic
one sac
twin to twin transfusion syndrome occurs with
monochorionic (one placenta) twins
define twin to twin transfuion syndrome
imbalance in circulations of the fetuses
causes significant transfer of blood from one twin (donor) to the other (recipient)–resulting in TTTS
Donor twin complications and recipient twin complications
DONOR: the most imp organs (brain and heart) get the blood and the rest of the body is shuntted—-cannot produce urine—leaves amniotic sac with less fluid—>OLIGOHYDRAMINOS
RECIPIENT: this twin will be overloaded with blood and urinating excessively—leaving the amniotic sac with more fluid—>POLYHYDRAMINOS
how to diagnose TTTS
measuring amniotic fluid
donor twin is at risk for developing?
organ failure due to inadequate blood flow
what hapens to the other twin if one dies during monochorionic situation
the other twin faces significant risk of dying…. because they are sharing the placenta
70-80% of TTTS twins will die
one tx for TTTS
laser surgery
list the risk to mom with multiple gestations (3)
- gestational diabetes
- Placenta and bleeding problems
- Preterm labor***
risks to the fetus during mutliple gestations (3)
- stillbirth
- premature birth
- low birth weight
number one risk of multiple gestation?
preterm delivery
