preg complications Flashcards
risk factors for cervical insufficency
- prior cervical trauma
- collagen disorders - Ehlers-Danlos syndrome
- congenital abnormalities - mullerian duct defects
how is the diagnosis of cervical insufficiency made?
obstetrics history in women with at least two consecutive second-trimester pregnancy losses or early premature births (< 28 weeks gestation) that are associated with relatively painless early cervical dilation or at least three preterm births prior to 34 weeks gestation in which other causes have been excluded
identifying cervical dilation or effacement on exam between 14 and 27 weeks gestation in the absence of uterine contractions adequate to explain the cervical changes
Cervical length ≤ 25 mm before 24 weeks gestation on transvaginal ultrasound supports the diagnosis
tx for cervical insufficency
progesterone supplementation
cervical cerclage
tx pt for preeclampsia sz ppx, what would you be looking for as a sign of mag toxicity? other signs?
loss of patellar reflexes (lvls >10)
respiratory paralysis (lvls >15)
cardiac arrest (lvls >25)
tx with calcium gluconate
GDM risk factors
- family hx
- age >25
- prepreg BMI > 30
- multiple gestations
- prev big baby (> 4,000 g)
complications of GDM
- preeclampsia
- gHTN
- polyhydramnios
- LGA infant
- birth trauma
- neonatal complications (hypoglycemia, jaundice, RDS, shoulder dystocia)
what is considered a normal 1hr GTT
BG < 135
What is considered a normal 3 hr GTT
Fasting: < 95
1 hr: < 180
2 hr: < 155
3 hr: < 140
diagnostic of 2 or more values are abnormal
empiric tx for cystitis in pregnancy
Fosfomycin
amoxi-clauve
cefpodoxime
other options:
Nitrofurantoin - avoid during first tri or near term
cephalexin
bactrim - avoid during first tri or near term
s/sx of molar pregnancy
- larger than expected uterine size with date discrepancies
- exaggerated signs/sx of preg - severe N/V, marked gHTN, proteinuria, bHCG excessively high (>100,000)
- painless second tri bleeding
how early can a molar pregnancy be detected
8 weeks
complications fo alloimmunization
- fetal anemia
- hydrops fetalis
- pre-term labor
- fetal demise
more rapid and aggressive antibody response with each subsequent pregnancy
primary prevention of alloimmunization
anti-D immunoglobin at 28 weeks (rhogam) at FIRST and subsequent pregnancies
in subsequent preg when prevention is not an option, how do you manage RhD incompatability
maternal anti-D titers, measure serially until a critical titer level is reached (1:16 or 1:32)
when these levels are reached –> get doppler velocimetry of the middle cerebral artery of the fetus
increased velocity = decreased hgb, if critical fetal anemia then need for transfusion with further testing should be determined
diagnostic criteria for preeclampsia and w/ and w/ out severe features
both:
* BP > 140/90 on two seperate occasions at least 4 hours apart
* OR BP > 160/110
w/ out severe features:
* proteinuria > 300 over 24hrs
* UPC ratio >0.3
w/ severe sx:
*sx or lab findings of end-organ damage *
* pulm edema
* new cerebral or visual disturbances
* severe and persistent RUQ pain
* plts < 100,000
* Cr > 1.1
* elev. AST/ALT
when should patients with preeclampsia deliver?
without severe features: 37 weeks
with severe features: 34 weeks AND sz ppx with mag sulfate
risk factors for preeclampsia
- nulliparity
- previous preeclampsia
- age > 40 years or < 18 years
- diabetes mellitus
- obesity
- systemic lupus erythematosus
- chronic hypertension
- chronic kidney disease
risk factors for placental abruption
- hypertension
- mechanical trauma
- drug use (e.g., tobacco and cocaine)
* previous placental abruption = BIGGEST RF - thrombophilia
placenta abruption managment
- < 34 weeks antenatal steroids and magnesium sulfate for fetal neuroprotection
- 34–36 weeks: consider antenatal steroids
- > 36 weeks: delivery
what is a contraindication for labetalol for gHTN/prx tx
uncontrolled asthma
