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OBGYN Clerkship > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

Defn SGA

A

< 10%ile (can be symmetric or asymmetric)

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2
Q

Defn LGA

A

> 90%ile

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3
Q

Defn macrosomia

A

> 4500 g

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4
Q

Defn LBW

A

< 2500 g

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5
Q

2 types of SGA

A

IUGR = maternal systemic disease that causes decreased placental perfusion

low groth potential = congenital abnorlaities, teratogens, cigarettes

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6
Q

How is SGA managed

A
  1. confirm accuracy of dating

2. serial US + umbilical artery doppler (checks underlying dz)

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7
Q

Serial US reults that differentiated IUGR vs low growth potential

A

IUGR = progressively falls off curve

low GP = stays small

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8
Q

What does revered diastolic flow on dopplar suggest

A

IUGR

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9
Q

What does low or absent diastolic flow on dopplar suggest

A

dec placental resitance

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10
Q

What are RF for having macrosomia baby

A

DM, maternal obesity, postterm preg, multiparity, advanced maternal age

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11
Q

Complications of macrosomia

A 
birth trauma
hypoglycemia
jaundice
low apgars
childhood tumors
shoulder dystocia
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12
Q

How is LGA managed?

A
  1. confirm accuracy of dating

2. consider IOL prior to macrosommia state

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13
Q

How is AFI calculated? Defn of oligiohydraminos and polyhydraminos

A

deepest pocket of amniotic fluid is found in each quadrant and added together to get AFI
AFI < 5 = oligio
AFI > 20 is poly

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14
Q

Causes of oligiohydraminos

A

ROM (MCC)
dec placental perfusion
dec fetal fluid prodiction
renal malformations (Potters seq)

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15
Q

Complications seen with oligiohydraminos

A

pulm hypoplasia
limb contractures
cord compression –> fetal asphyxiation –> death

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16
Q

oligiohydraminos + meconium in amniotic fluid, next step

A

anmioinfusion

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17
Q

Causes of polyhydraminos

A

congenital abn, diabets, Twin-Twin Transfusion Syndrome (TTTS), hydrops fetalis (edema, ascities, heart failure)

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18
Q

Complcations of polyhydraminos

A

cord prolapse

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19
Q

How is polyhydraminos managed

A

careful verification of presentation, obs for cord prolapse

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20
Q

What is erythroblastosis fetalis?

A

Rh- woman with Rh+ fetus, mom mans Abs to Rh factor,these cross the placenta –> hemolytic anemia in fetus –> hydrops fetalis (edema, ascities, heart failure)

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21
Q

What is the prevelance of Rh-?

A

15% in caucasions and lower in other races

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22
Q

When is rhogam administered

A

28 wks and postpartum if baby is Rh+

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23
Q

What is biggest risk with retained IUFD

A

DIC if fetus is left > 3 wks

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24
Q

What is the management of IUFD

A

deliver fetus and do autopsy to search for cause if unknonwn

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25
Q

What is defn of post term delivery

A

> 42 wks

26
Q

What are complications of postterm delivery

A

macosomia, oligiohydraminoa, mecomium aspiration, IUFD, dysmaturity syndrome (see next card)

27
Q

What is dysmaturity syndrome?

A

chronic IUGR from uteroplacental insufficiency

28
Q

MCC post term delivery/pregnancy

A

inaccurate dating

29
Q

When embryo undergoes cleavage, when does the chorion seperate and the amnion seperate?

A

chorion seperates day 4

amnion seperates day 8

30
Q 
When does cleavage happen to result in 
Di di twins?
Mono-di-
Mono-Mono
Siamese twins?
A

Di di twins day 1-3
Mono-di day 4-8
Mono-Mono day 8-13
Siamese/conjoined twins day 13-15

31
Q

mono vs di zygotic twins

A

mono = 1 sperm and 1 egg –> idential DNA (no predisposing factors)

dizygotic = 2 sperm an 2 ova

32
Q

dizygotic twins have increased prevelance in

A

africans, IVF, clomiphene citrate

33
Q

What are complications of multiple gestations

A

PTL, placental previa, postpartum hemorrhage, preE, cord prolapse, malpresentation, GDM, incompetent cervix

34
Q 
Management for.... 
Siamese/conjoined twins 
mono-mono- twins
vertex/vertex twins
vertex, non-vertex twins
non-vertex/non-vertex twins
triplets and above
A 
Siamese/conjoined twins  = C/S
mono-mono- twins = C/S
vertex/vertex twins = vaginal
vertex, non-vertex twins = vag or C/S
non-vertex/non-vertex twins = C/S
triplets and above = C/S +/- selective reduction
35
Q

What is TTTS? what kind of twins are at risk for this?

A

unequal bloodflow in shared placenta of mono-di- twins thar results in one small/anemia twin and one large/polycythemic twin

36
Q

What is the management of TTTS

A

serial US q2wks in all mono-di twins –> tx with serial amnioreduction in larger twin

37
Q

What is severe n/v + intolerance of PO diet

A

hyperemesis gravidarum

38
Q

What should you r/o in all pts with hyperemesis gravidarum

A

molar pregnancy (get b-hCG)

39
Q

When does morning sickness typically resolve

A

week 16

40
Q

seizure threshold lowered or inc when pregnant

A

lowered

41
Q

What is the etiology of most seizures in pregnancy

A

inc epileptic medication metabolism, dec pt compliance, dec seizure threshold, hormonal changesz

42
Q

what is the teratogenicty of anti-epileptic drugs

A

folate antagonism –> neural tube defects

epoxide generation –> fetal hydantoin syndrome (IUGR, craniofacial malformations, etc)

43
Q

How is a seizure d/o mananged in pregancy

A

monotherapy with lowest dose of Rx
at 19-20 wks klook for congenital anomales w/ US
folate supplementation
vit K supp at 27 wks

44
Q

What pre-ext maternal heart dz is high risk in preg

A

pulm HTN
Eisenmenger syndrome
severe MS or AS (wait 1 yr after correction to get pregers)
marfan syndrome

45
Q

how is preg managed in pts with high risk heart dz

A

terminate preg = first line
basline EKG + medical stabilization
d/c teratogenic drugsa (ACEi/ARBs, diuretics, coumadin)
at delivery: early epidural, careful fluid monitorins, abx ppx for SBE (bac endocarditis)

46
Q

Peripartum cardiomyopathy management

A

Dx with ECHO ( dilated heart with ECHO 34wks and medical management if < 34 wks

47
Q

Pts with mild renal Dz are at risk for

A

preEclampsia and IUGR

48
Q

Management of preg women with renal transplant

A

increase immunosuppressants (prednisone) dosage bc there is an inc risk of acute rejection in preg

49
Q 
GFR for
stage 1 CKD
stg 2
3
4
5 (ESRD)
A 
stage 1 CKD = 90-100
stg 2 = 60-89
3 = 30-59
4 = 14-29 
5 (ESRD) = < 15
50
Q

Management of DVT in preg

A

heparin or lovenox (enoxapain)

**warfarin is CI

51
Q

management of PE in preg

A

heparin or lovenox (enoxapain); t-PA if <3hrs

52
Q

How is hyperthyroidism in pregnancy managed

A

screen for tyroid stimulating immunoglobulins (TSIs)

if elevated, give PTU and monitor fetus for goiter and IUGR

53
Q

Treatment for thyroid storm in preg

A

Beta blockers

54
Q

what is infanthyperthyroism/cause?.

A

maternal TSIs cross placenta and attack fetal thyroid gland

55
Q

What are common pregnancy complications in women with lupus

A

inc risk preeclampsia
IUGR
spontaneous abortion

56
Q

How is SLE managed in pregnancy

A

low dose aspirin, heparin, or corticosteroids for ppx

57
Q

how to differentiate between lupus flare and pre eclampsia?

A

check complement levels (SLE will have dec C3-C5)

58
Q

What is the management for a lupus flare in preg

A

high dose corticosteroids, cyclophosphamide is unresponsive

59
Q

What is neonatal lupus syndrome

A

maternal Ag-Ab complex crosses placenta anf cause lupus in neonate
**baby can also have congenital heart block 2/2 anti-ro (SSA) cross placenta and attack fetal heart –> 3rd degree block

60
Q

Fetal alcohol syndrome characteristics

A

abn facies, IUGR, MR, bad heart

61
Q

effect of caffine on preg

A

inc risk Spontaneous Ab with > 150mg/day

62
Q

Effect of nicotine on preg

A

IUGR, placental abruption, PTD

OBGYN Clerkship (31 decks)

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