Preg 2 Flashcards
AMA has inc risk of __ in di/di twins
reserve __ only if abnormal results or US findings
Anatomy survey performed at __
Survey for __ and soft signs of ____
also examine ___
aneuploidy
amniocentesis
20 wks GA
structural malformations, fetal aneuploidy
cervical length
Placenta previa
placenta covers ___ of the cervix or extends close enough to ___ of cervix
causes __ when cervix dilates or ___ effaces
this occurs w advanced ___ or ___
usually seen around __ wks gestation, usually __
bleeding is ___
__ and extremes of ___ inc risk for ___
Majority have ___ around 28-30 wks
internal os, internal os
bleeding, lower uterine segment
GA, labor
10-20, resolves
painless
intercourse, activity, vaginal bleed
sentinel bleed
RF for placenta previa Previous \_\_\_ Multiple \_\_\_ Previous \_\_\_ M Advanced \_\_ tx for \_\_\_ Previous \_\_\_
placenta previa gestation C section multiparity maternal age infertility IU surgery
Placental abruption
Bleeding at the __ and ___ interface
leads to partial/complete ___ of placenta from ___ prior to delivery of fetus
occurs after ___ GA
if > __% of placenta separates, this leads to
Sx include ___ and ___
__ and/or ___ uterine tone
fetal heart status is ___
Assc w __ and ___ morbidity/mortality
Bleeding is ___ in origin
Fetal distress from loss of ___ and development of __
decidua/placental
separation, uterine wall
20wks
50%, fetal distress
vaginal bleeding, ab pain
contractions, excessive
non-reassuring
maternal/fetal
maternal
placental interface/hypoxia
RF for placental abruption Previous \_\_ T P C/S P Premature \_\_\_
placental abruption trauma preeclampsia cocaine/smoking polyhydramnios rupture of membranes
Patho Placentation (aka ___)
caused be defetive ___
thin, poorly formed, absent___
usually secondary to ___
scarring/damage of decidua enables ___ to attach directly to ___
RF
Prior __/ ____/ ____
placental accreta
decidualization
decidua
prev uterine surgery
placenta/myometrium
Csection/D&C/Myomectomy
Majority are __, attaching to the ___
some are ___, invading into the ___
less are ___, invading through __/__
Risk of accreta inc w ___ and prior ___
even more w ___
Sonographic markers
loss of __ of placenta
Inc ___, __ appearance
Thinning/loss of ___ layer bw uterine wall and ___ (decidua)
Loss of continuous ___ of bladder wall interface
H
accreta, myometrium
increta, myometrium
percreta, perimetrium/serosa
placenta previa, C section
2+ prior C section
homogeneity
lacuna, swiss cheese
hypoechoic, placenta
white line
hypervasc
Complications of placentation
Second trimester ___
Preterm ___/___
__ at time of delivery
Need for ___
need for ____
inc risk of D, A, S, R, D
vaginal bleeding
labor/delivery
hemorrhage
cesarean hysterectomy
blood transfusion
DIC, ARDS, Shock, RF, death
Vasa Previa
Unsupported __ overlying cervix
Assc w __
RF \_\_ lobe of placenta \_\_\_ cord insertion Low lying \_\_ Multiple \_\_ I
Bleeding is ___, ___ of normal
Fetal __ and ___
Mx admit at ___ wks
need ___
fetal vessels
fetal mortality
succenturiate velamentous placenta gestation IVF
fetal blood
distress/demise
30-32 wks
preterm Csection
Succenturiate placenta
Results from focal areas of __ of chorion laeve
Lobes of __ connected by ___ of fetal origin
Bridging vessels w/out protection of ___
more prone to __/__/_
Bleeding is ___
non-involution
placenta, vasc bridges
Whartons jelly
tearing/shearing/compression
fetal
Velamentous cord insertion
Umbilical cord inserts into ___ instead of ___
Loss of __, lacks protecting/cushioning of __
more prone to __/__
bleeding is ___
amniotic membrane, placenta
wharton’s jelly, umbilical cord
compression/tearing
fetal
Marginal cord insertion
Insertion of ___ into __ of placenta
defined as ___ cm from edge
more common in ___
inc risk of __ and __ and __ and __
umbilical cord, margin
1-2cm
multiple gestations
IUGR, preterm delivery, preeclampsia, placenta previa
Placenta previa presents w
Mx modify ___, __ rest, __
Placenta accreta presentation: __ mid gestation
mx
Placental abruption presentation: __ vag bleeding and fetal ___
mx
Velamentous cord insertion present: growth ___, fetal __
mx: serial ___ and ___ testing
marginal cord insertion growth ___
mx w serial __
painless vag bleeding
activity, pelvic rest, Csection
spotting no warning
Preterm cesarean hysterectomy
painful, fetal distress emergent delivert (vag/C)
growth abnorm, fetal distress
growth US, antenatal testing
growth abnorm
growth US
Class D meds have risk to __
such as __ and __
Most sensitive time for majority of organs is ___ period bw __ and __ wks
Ovum period: from __ to ___
___ sensitivity to teratogens
___ connections w maternal blood
Even after cell loss, conceptus can ___ development
Development of mainly ___ structures
Insult results in ___
fetus
lisinopril, Paxil
embryonic, 3-8 wks
fert to implant
limited
no direct
regain normal development
extra embryonic structures
miscarriage
Embryonic period from __ to __ wks
__ to teratogens
critical time for ___
fetal period from \_\_ to \_\_ \_\_ time Morph effects on \_\_ and \_\_\_ and \_\_\_ \_\_\_ deficits minor \_\_\_ \_\_ effects
2-8 wks
highly susceptible
organ develop
9wks, term palate, teeth, external genitalia fxnal morph abnorm growth
Common teratogenic meds A A A B C C C D
aminopterin androgenic hormones ace inhibitors busulfan carbamazepine chlorbiphenyls cyclophosphamide DES
Common teratogenic meds I I L M P P T T V W
isotretinoin Iodide Li Misoprostol Phenobarbital Phenytoin Tetracycline Trimethadione Valproic acid Warfarin
Majority of ___ cause birth defects
worst w
inc risk for __, ___, ___
high risk w __ rather than ___
Each drug has __
anticonvulsants
valproic acid
IUGR, major malformations, cog defects
polytherapy, monotherapy
different effects
__ is worse than AED therapy
Can lead to __ and __/___ hypoxia, eventually __ and ___
do not take pt off ___ when preg
refer to
try to get ___
continually __ pt
Seizure
trauma, maternal/fetal, morbid/mortal
AED
neuro
monotherapy
educate
ACE inhibitors
First trimester exposure has small risk of ___
CV such as ___ adn __
CNS such as __ and __
Second trimester can impair fetal/neonate ___ fxn
Can lead to __ and __ and ___
Cord compression leads to ___ and ___
Other sx ___ and ___
congenital malformations
ASD/VSD
spina bifida/microcephaly
RF
oliguria/anuria/RF
fetal distress/demise
pulm hypoplasia, arthrogryposis
Warfarin effects \_\_ hypoplasia Shortened \_\_\_ Stippling of \_\_\_\_ \_\_ and \_\_ effects Vulnerable period is \_\_ and \_\_ wks gestation
Thalidomide bw 38-50 LMP
can cause bilateral __ and __ defects
__ more than ___
CHD such as ___
DES can cause abnorm of ___
uterine malform include __ or ___
Adenocarcinoma of __ or ___
nose distal phalanges epiphyses cog/growth 6-9th
limb/limb girdle
UE, LE
conotruncal defect
cervix/vagina
T shaped/uterine hypoplasia
vagina/cervix
SSRIs inc __ admissions
can cause ___ of newborn
Paxil inc risk of __ and __ and ___ when used 1st trimester
Isotretinoin Risk of \_\_\_ Major malfomation of \_\_/\_\_\_/\_\_\_/\_\_ \_\_\_ palsies \_\_ dysfxn Vulnerable period \_\_\_
NICU
Persistent pHTN
omphalocele, craniosynostosis, CHD
preg loss brain/ear/heart/facial defects CN 7 cog 1st trimester
Gestational DM- begins/recog during __ and assc w inc __/__/__ risks
__ of DM in preg
many women w GDM develop ___
RF Previous preg w FH of \_\_ O M Age > P M Previous Previous unexplained
preg, maternal/fetal/neonatal
majority
T2DM
GDM DM obesity multiple gestation 25 PCOS metabolic syndrome macrosomic infant perinatal loss
Placenta secretes ___ hormones
such as __/__/__/__
Alters maternal ___ to ensure fetus has __ of nutrients
inc maternal ___
dec maternal ___
Maternal comps H, C, O, M
Fetal comps M. O, S
M/H, R, S, M, H, H, H, P
diabetogenic
hPL, CRH, GH, P
glucose metab, ample supply
insulin resistance
insulin sens
HTN disorder, Csection, operative delivery, maternal trauma
Macrosomia, operative deliv, shoulder dystocia/trauma, Met/Heme do, RDS, shock, Met syndrome, hypoGly, hyperBilirubin, hypoCa, Polycythemia
Manage GDM D/E Log \_\_ and \_\_ and \_\_ I \_\_ meds
Goal is ___
diet/exercise
food, BG, meds
insulin
oral hypoglycemics
euglycemia
HTN do of pregnancy characterized by BP >
chronic HTN- hx of __ prior to preg or manifesting < __ wks gestation
chronic HTN w superimposed ___- hx of __ prior to preg/<20 wks GA with new onset ___ or worsening ___/___
Gestational HTN- new onset elevated BP after ___ w/out __ or ___
Preeclampsia- new onset SBP > or DBP > __ on 2 occasions __ apart after 20 wks w
Proteinuria > ___ g in 24hr urine sample or __/__ ratio > __ g or dipstick >___
140/90
elevated BP, 20wks
preeclampsia, elevated BP, proteinuria, proteinuria/BP control
20wks GA, proteinuria/other features
140, 90, 4hrs
.3g, protein/creatinine, .3, 1
Preeclampsia w severe features
BP > ___ w/wout ___ but w __
BP > ___ w ___ or w severe features
Severe features include H or V A\_\_ or \_\_ pain P Platelets < \_\_\_ Elevated \_\_ usually 2x normal Elevated \_\_\_ to 1.1 or 2x \_\_
140/90, proteinuria, severe features
160/110, proteinuria
headache, vis sx ab, RUQ pulm edema 100,000 LFT serum creatinine, patient normal
Preeclampsia usually due to impaired ___, or abnormal ___
possibly ___ or ___ dysfxn
CM probably due to ___ of target organs, including B, L, K, P
Maternal Comps of preeclampsia S A T P C L R D
trophoblast invasion, troph differentiation
placental ischemia, systemic endothelial cell
microangiopathy
Brain, liver, kidney, placenta
seizure abruption thrombocytopenia pulm edema cerebral hemorrhage liver hemorrhage RF death
Fetal comps of preeclampsia
P
I
Fetal __/___
Tx is __
Timing of delivery is a balance bw __ at dx and risk of __ to infant and __ of mother
___ given for seizure proph
BP controlled w ___ safe in preg
premature
IUGR
distress/demise
delivery
GA, prematurity, worsening dz
Mg sulfate
antiHTN
Post partum hemorrhage
After ___ >500 ml
after ___ >1L
RF U including M, P, M Gestational \_\_\_/\_\_ Placental \_\_\_/\_\_ Prior \_\_\_
vaginal delivery
C section
uterine distension multiples, polyhydramnios, macrosomia HTN, Preeclampsia previa/accreta PP hemorrhage