Pregnancy Complications Flashcards
How GDM is screened?
1-hr (50g) oral glucose tolerance test (OGTT)
- If Negative (<130-140 mg/dL) → Routine prenatal care
- If Positive (≥ 130-140 mg/dL) → 3-hr (100 g) OGTT
How is GDM diagnosed?
3-hr (100 g) OGTT
- Negative
- Positive for GDM
- Two or more values are met or exceeded:
- Fasting – 95 mg/dL
- 1-hr – 180 mg/dL
- 2-hr – 155 mg/dL
- 3-hr – 140 mg/dL
- Two or more values are met or exceeded:
What is the Non-stress test?
- Non-invasive, patient goes to provider’s office, often biweekly)
- External fetal monitor placed on abdomen, expect to see two 15x15 accelerations in 20 minutes if greater than 32 weeks EGA; predictive of fetal well-being for 3-4 days
What does a reactive non-stress test indicate?
A reactive non-stress test result indicates that the fetus’s heart rate increased normally in response to movement or contractions.
What does a non-reactive non-stress test indicate?
A non-reactive result means the heart rate didn’t increase enough.
What is a Biophysical profile (BPP)?
- evaluates the well-being of a fetus, particularly in high-risk pregnancies
- non-invasive
What are the five components assessed during a Biophysical profile?
Scored from 0-10, with lower score being more indicative of issues/need to deliver:
Fetal breathing
Fetal tone (extension/flexion of limb, opening/closing fist)
Fetal movement
AFI (amniotic fluid index)
Reactive non-stress test
What is the etiology of gestational diabetes (GDM)?
- Glucose crosses placenta, insulin does not
- Placental hormones increase
insulin resistance - insulin requirements increase between 26-34 weeks gestation
What is GDM associated with?
- Polyhydramnios
- Increased rate of fetal death
- Macrosomic infant (>4000gms)
- Prematurity, RDS, hypoglycemia, polycythemia in the newborn
- Congenital heart defects
How is GDM managed?
- Universal screening between 24-28 weeks
- Early screening if pt has risk factors:
- history of GDM with prior pregnancy
- strong family history of diabetes
-obese
How is chronic hypertension characterized in pregnancy?
- The presence of hypertension prior to pregnancy
- Diagnosis of development of hypertension before 20 weeks
How is GDM managed?
- Universal screening between 24-28 weeks
- Early screening if pt has risk factors:
- history of GDM with prior pregnancy
- strong family history of diabetes
- obese
How is gestational hypertension characterized in pregnancy?
- Development of hypertension after 20 weeks gestation
- Absent criteria for preeclampsia
What is the diagnostic criteria for gestational hypertension?
- SBP ≥ 140 or DBP ≥ 90, or both measured on 2 different occasions at least 4 hours apart after 20 weeks gestation
How is preeclampsia characterized in pregnancy?
- New onset hypertension which occurs most often after 20 weeks
- Often accompanied by new onset of
proteinuria
What is the diagnostic criteria for preeclampsia?
BP > 140 systolic or > 90 diastolic on 2 different occasions 4 hours apart
PLUS
Proteinuria
- >300mg in a 24-hour urine collection
- >0.3 value on a protein/creatinine (P/C) ratio
OR
BP >140 systolic or >90 diastolic
PLUS
ONE severe symptom
- Severe headache (unrelieved with tylenol, rest, etc.) with or without
vision changes
- Epigastric (abdominal pain)
- Chest pain
- Pulmonary edema
- Abnormal LFTs (liver function tests)
How is eclampsia characterized in pregnancy?
- New onset of tonic-clonic or focal seizures in the absence of other causative conditions
- Significant cause of maternal death
How is chronic hypertension with superimposed preeclampsia characterized in pregnancy?
- Preeclampsia is diagnosed in a pregnant person with known hypertension
- New onset of proteinuria
- Elevated liver function/enzymes
- Thrombocytopenia
- Neurologic symptoms
- Highest rate of maternal and fetal/neonatal complications
How is HELLP syndrome characterized?
Hemolysis (H)
- Rapid breakdown of RBCs
Eevated Liver Enzymes (EL)
- Liver transaminases are at least 2x
normal levels
- RUQ pain
- LDH >660
Low Platelets (LP)
- Platelets <100,000
(remember 150k is still the lower end of normal)
What can HELLP syndrome lead to?
- End organ damage and DIC
(disseminated intravascular coagulation) - Rupture of liver capsule
How to ensure thorough assessment for hypertension in pregnancy?
- Accurate blood pressure (manual cuff preferred)
- Reflexes and clonus (preeclampsia disrupts communication between
cerebral cortex and spinal cord) - Edema
- Neurological assessment
- Intake/output
How to get proper fetal surveillance?
- Kick counts
- NSTs
- BPPs
What labs are important for hypertension in pregnancy?
- CBC
- AST/ALT
- creatinine
- coagulation
- uric acid
- LDH
- urine
- protein/creatinine ratio
What medications are used for hypertension in pregnancy?
- Severe HTN: labetalol, hydralazine IV
- Magnesium sulfate for seizure prevention (not effective at lowering BP)
Describe magnesium toxicity values.
- Therapeutic range : 5-8mg/dL
- Loss of DTRs: 9-12mg/dL
- Respiratory depression: 12-15mg/dl
- Cardiac arrest : >15mg/dl
What is the antidote for magnesium toxicity?
calcium gluconate
What is Vasa previa?
cord vessels implanted in fetal membranes and cross or are near the cervix
What is placenta previa and how is it diagnosed?
- Placenta covers cervix and results in bleeding
- painless, bright red vaginal bleeding
- Diagnosed via ultrasound
What are risk factors of placenta previa?
- previous cesarean delivery or uterine surgery
- advanced maternal age
- tobacco use
- multiple gestation
- multiparity
How to manage placenta previa?
- bed rest
- fetal surveillance
- pelvic rest
- patient education
- no cervical exams
- hospitalization (multiple bleeding episodes)
- c/s if doesn’t resolve
What are different types of Invasive Placenta?
- accreta
- increta
- percreta
What is Placenta accreta?
chorionic villi invade beyond uterine lining and decidua basilis
What is Placenta increta?
chorionic villi invade into the myometrium
What is Placenta percreta?
chorionic villi go past the myometrium, can attach to other
organs such as bowel or bladder
What can invasive placenta lead to?
Significant risk of hemorrhage and need for hysterectomy
What is placenta abruption?
Placenta separates from uterine lining prior to delivery of fetus
What are signs and symptoms of placenta abruption?
- dark red vaginal bleeding
- abdominal pain
- rigid abdomen
- uterine contractions and tenderness
- elevated uterine resting tone
- non-reassuring fetal heart rate pattern
What are risk factors for placenta abruption?
- multiparity
- history of abruption,
- hypertension
- advanced maternal age
- premature rupture of membranes (PROM)
- cocaine use
- tobacco use
- polydramnios
