Pre-eclampsia, fetal growth restriction, and stillbirth Flashcards
6 hypertensive disorders of preg
- Gestational Hypertension – blood pressure elevation after 20 weeks of
gestation that is asymptomatic and not associated with proteinuria - Chronic hypertension – blood pressure elevation that predates
pregnancy (or may be first discovered in early pregnancy) - Pre‐eclampsia – new‐onset hypertension (generally) after 20 weeks of
gestation, accompanied by proteinuria, OR features of severe disease - Chronic Hypertension with super‐imposed pre‐eclampsia
- HELLP Syndrome – Hemolysis, Elevated Liver enzymes, Low Platelets
- Eclampsia – Encephalopathy associated with severe pre‐eclampsia
characterized by grand mal convulsions
features of pre-eclampsia
new onset HT+ protenuira OR thrombopenia liver enzymes renal impariment
4 systems affected by pre-eclmpsia
- fetus
- renal
- liver
- brains
factors that increase preEC risk
– Advanced Maternal age – High BMI – Elevated BP – PV bleeding >5days in 1st trimester – Pre‐conception relationship
3 factors that reduce risk
- smokingin T1
- misscarriage same partner
- attempt to conceive >12Mo
what is perfect placenta
disc with cord in middle and vessels all around
4 tests to consider
- maternal characerisitics
- IPS biochem
- morphology
- uterine artery doppler
what does multiply abnormal IPS indicate
75% PPV for preterm
what is bad morphology
small thick and with areas of poor development
what is placental insufficiency
chorion regression - doesn’t grow around the cord
what does doppler help indicate
uteroplacental insufficiency
what is s-FLT1
- anti-angiogenic protein
- released from synsytio and contributes to maternal endothelial dysfunction - less angiogeneiese and more vasoconstiction
what does low PIGF indicate
low time to delivery
what to do in severe pre-eclmp or later in time
deliver
what is importance of eclampsia
1 killer in low resource settings
treatment in antenatal perios
- education and suveilace
- steroids for lungs
- oral HTs
what is treatment in intra-partum period
- 1to1 nurse
- fluid restriciton
- MgSO4
- antiHT
- high dependency care
- anasthesia
what can be helpful early on
aspirin
def. small for gestational age
Estimated Fetal Weight (EFW) or Birth Weight
below a specific centile
def. IUGR
Fetus failing to achieve it’s growth potential
3 general causes for IUGR
- maternal/env.
- placental
- fetal - chromo, congential
what is key for screening IUGR
accurate dating
what is general screening
serial height and if
4 tests to screen in high risk women
same as preeclamp
what are 2 general presentations of IUGR
early and late (32weeks)
what is problem and prog in early and late
early: prob is MGMT - high MandM
late: prob is diagnosis - less mort
what is key to look at on doppler (3)
- umbilical A
- MCA
- ductus venosus
def. stillbirth
delivery of dead fetus at >20wk or >500grm
2 types of still birth
- antepartum (1/200)
2. intra-partum - rare in dev. world
what is most important preventable cause of stillbirth
failure to diagnose IUGR
what is modern most common epi associatiokn
BMI>30
ways to manage stillbirth
- blood tests
- induction of labor
- supportive care
- autopsy
how to measure fetal maternal hemmorage
measure HbF in maternal blood
interventions in low resource settings
- diet
- prevent malaria
- detect syphylllis
- detect IUGR
- skilled birth attendants
- OB services
most important way to prevent still birth in low resource
OB care
2 interventions to reduce still birth in canada
- prevent preterm
2. ID loate onset IUGR
