Pre-eclampsia, fetal growth restriction, and stillbirth

Question 1

6 hypertensive disorders of preg

Answer 1

1. Gestational Hypertension – blood pressure elevation after 20 weeks of
   gestation that is asymptomatic and not associated with proteinuria
2. Chronic hypertension – blood pressure elevation that predates
   pregnancy (or may be first discovered in early pregnancy)
3. Pre‐eclampsia – new‐onset hypertension (generally) after 20 weeks of
   gestation, accompanied by proteinuria, OR features of severe disease
4. Chronic Hypertension with super‐imposed pre‐eclampsia
5. HELLP Syndrome – Hemolysis, Elevated Liver enzymes, Low Platelets
6. Eclampsia – Encephalopathy associated with severe pre‐eclampsia
   characterized by grand mal convulsions

Question 2

features of pre-eclampsia

Answer 2

new onset HT+
protenuira OR
thrombopenia
liver enzymes
renal impariment

Question 3

4 systems affected by pre-eclmpsia

Answer 3

1. fetus
2. renal
3. liver
4. brains

Question 4

factors that increase preEC risk

Answer 4

– Advanced Maternal age
– High BMI
– Elevated BP
– PV bleeding >5days in 1st trimester
– Pre‐conception relationship

Question 5

3 factors that reduce risk

Answer 5

1. smokingin T1
2. misscarriage same partner
3. attempt to conceive >12Mo

Question 6

what is perfect placenta

Answer 6

disc with cord in middle and vessels all around

Question 7

4 tests to consider

Answer 7

1. maternal characerisitics
2. IPS biochem
3. morphology
4. uterine artery doppler

Question 8

what does multiply abnormal IPS indicate

Answer 8

75% PPV for preterm

Question 9

what is bad morphology

Answer 9

small thick and with areas of poor development

Question 10

what is placental insufficiency

Answer 10

chorion regression - doesn’t grow around the cord

Question 11

what does doppler help indicate

Answer 11

uteroplacental insufficiency

Question 12

what is s-FLT1

Answer 12

• anti-angiogenic protein
• released from synsytio and contributes to maternal endothelial dysfunction - less angiogeneiese and more vasoconstiction

Question 13

what does low PIGF indicate

Answer 13

low time to delivery

Question 14

what to do in severe pre-eclmp or later in time

Answer 14

deliver

Question 15

what is importance of eclampsia

Answer 15

1 killer in low resource settings

Question 16

treatment in antenatal perios

Answer 16

1. education and suveilace
2. steroids for lungs
3. oral HTs

Question 17

what is treatment in intra-partum period

Answer 17

1. 1to1 nurse
2. fluid restriciton
3. MgSO4
4. antiHT
5. high dependency care
6. anasthesia

Question 18

what can be helpful early on

Answer 18

aspirin

Question 19

def. small for gestational age

Answer 19

Estimated Fetal Weight (EFW) or Birth Weight

below a specific centile

Question 20

def. IUGR

Answer 20

Fetus failing to achieve it’s growth potential

Question 21

3 general causes for IUGR

Answer 21

1. maternal/env.
2. placental
3. fetal - chromo, congential

Question 22

what is key for screening IUGR

Answer 22

accurate dating

Question 23

what is general screening

Answer 23

serial height and if

Question 24

4 tests to screen in high risk women

Answer 24

same as preeclamp

Question 25

what are 2 general presentations of IUGR

Answer 25

early and late (32weeks)

Question 26

what is problem and prog in early and late

Answer 26

early: prob is MGMT - high MandM late: prob is diagnosis - less mort

Question 27

what is key to look at on doppler (3)

Answer 27

1. umbilical A 2. MCA 3. ductus venosus

Question 28

def. stillbirth

Answer 28

delivery of dead fetus at >20wk or >500grm

Question 29

2 types of still birth

Answer 29

1. antepartum (1/200) | 2. intra-partum - rare in dev. world

Question 30

what is most important preventable cause of stillbirth

Answer 30

failure to diagnose IUGR

Question 31

what is modern most common epi associatiokn

Answer 31

BMI>30

Question 32

ways to manage stillbirth

Answer 32

1. blood tests 2. induction of labor 3. supportive care 4. autopsy

Question 33

how to measure fetal maternal hemmorage

Answer 33

measure HbF in maternal blood

Question 34

interventions in low resource settings

Answer 34

1. diet 2. prevent malaria 3. detect syphylllis 4. detect IUGR 5. skilled birth attendants 6. OB services

Question 35

most important way to prevent still birth in low resource

Answer 35

OB care

Question 36

2 interventions to reduce still birth in canada

Answer 36

1. prevent preterm | 2. ID loate onset IUGR