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)
