Preconception & Fetal Mortality Flashcards
This is defined as 28 days gestation up until the first 7 days after birth?
Perinatal period
This time period is described as starting at birth and ending at year one?
Infant
Birth to 28 days old describes what period?
Neonatal
This is an infection of the placenta and amniotic fluid and can cause fetal death?
chorioamnionitis
Placental development begins ____ days after conception?
7
What is Baker Hypothesis?
That poor placental development is linked to:
-preeclampsia
-low birth weight
-preterm birth
-growth restriction in utero
This causes the fetus to have future chronic medical conditions
Why is the optimal time of birth (or removal from uterus) at a max of 42 weeks?
Because at 42 weeks the placental support of the fetus decreases and the fetus is better off outside the uterus
What are the three causes of fetal or perinatal mortality?
- Fetal issues like low birth weight or congenital abnormalities
- Placental issue like infection or cord damage
- Maternal cause like DM, CVD, or extreme age
Neonatal mortality is defined as death before the ___ day of life?
28th
Neonatal death is usually caused by what 2 major etiologies?
- Preterm birth issues
- congenital malformations
Most post neonatal deaths are caused by _____?
SIDS
What fraction of infant deaths occur in the neonatal period?
2/3
What is the most important way to prevent perinatal mortality?
Get pregnant person to stop smoking or reduce drastically for better outcome
What are the two categories that describe causes for maternal deaths?
- Direct: hemorrhage in birth or preeclampsia
- Indirect: exacerbation of current condition like DM ,CVD
Black, Alaskan native, and American Indian patients are _______ times more likely to die from pregnancy than a white person?
2-3
If a patient with asthma is pregnant what drugs should they avoid for this condition and what can they take?
Avoid oral corticosteroids
Use inhaled corticosteroids
In what case could a pregnant person take oral corticosteroids for asthma?
If there asthma is severe and uncontrolled because this poses a bigger risk to mom and fetus than the effects of the drug
What drugs are contraindicated in pregnancy when treating hypertension and what is their impact on the fetus?
ACE inhibitors, ARB’s
- cause renal abnormalities and death to fetus
What anticoagulant is a teratogenic drug?
Warfarin
Can seizure medications be taken safely in pregnancy?
NO
This substance found in the blood has a teratogenic effect on the fetus if too high, and is the most dangerous in the first trimester?
Glucose
Pregnant people should have an A1C of ____% or lower?
7%
If the pregnant person has this condition the fetus is at increased risk for higher rates of preterm birth, placental abruption, intrauterine growth restriction, preeclampsia, and fetal death?
hypertension
If a pregnant person has this condition, its severity is directly related to worse fetal outcomes (worse case of disease =worse fetal outcome)?
Hypertension
BMI between ____ & ____ is recommended during pregnancy?
18-24
Low risk pregnant patients should take how many milligrams of folic acid daily?
0.4mg
Low risk PT should take folic acid starting ____ up until the ______?
from 4 weeks gestation to the 3rd trimester
High risk pregnant patients should take _____mg of folic acid daily?
4.0mg
When should high risk pregnant PT begin folic acid regimine?
3 months prior to conception
If infertility is suspected to be male related, what is the first evaluation?
Semen analysis
What is the first step is assessing female driven infertility and what tests are indicated in this step?
Check ovarian function
-TSH
-Prolactin
-Mid-luteal progesterone
-Urinary LH surge
What is the second step in assessing female driven infertility and how is this accessed?
Check the ovarian reserve
- if over 35y/o check egg quantity and quality
-use vaginal ultrasound or hysterosalpingogram to count follicles
What is the pharmacological treatment for anovulation (2 drugs + a bonus drug)?
- Clomid - ovulatory stimulant
- Letrozole - ovulatory stimulant
Bonus: metformin
If a patient is over 35 years of age, when are they considered infertile?
After trying for 6 months - do work up then
History of LEEP or CONE procedure, congenital abnormalities, recurrent cervicitis, and hypoestrogenic states can cause what type of infertility?
Cervical cause
An abnormal shaped uterus, polyps, fibroids, and Asherman’s can cause what type of infertility?
Uterine
Chlamydia infection scarring, toxic fluid filled cysts, or scaring from surgery cause what type of infertility?
Tubal
This is the most common type of infertility and is caused by PCOS, hormone dysfunction, and anovulation?
Ovarian
The ______ vaccination should be giver between 27-36 weeks gestation to avoid risk of neonatal infection of _______?
TDAP; pertussis
