1. confirm accuracy of dating 2. serial US + umbilical artery doppler (checks underlying dz)

1. confirm accuracy of dating 2. consider IOL prior to macrosommia state

Pregnancy Complications Flashcards by Alex Maxted

Defn SGA

< 10%ile (can be symmetric or asymmetric)

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Defn LGA

> 90%ile

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Defn macrosomia

> 4500 g

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Defn LBW

< 2500 g

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2 types of SGA

IUGR = maternal systemic disease that causes decreased placental perfusion

low groth potential = congenital abnorlaities, teratogens, cigarettes

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How is SGA managed

confirm accuracy of dating

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

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Serial US reults that differentiated IUGR vs low growth potential

IUGR = progressively falls off curve

low GP = stays small

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What does revered diastolic flow on dopplar suggest

IUGR

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What does low or absent diastolic flow on dopplar suggest

dec placental resitance

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What are RF for having macrosomia baby

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

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Complications of macrosomia

birth trauma
hypoglycemia
jaundice
low apgars
childhood tumors
shoulder dystocia

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How is LGA managed?

confirm accuracy of dating

2. consider IOL prior to macrosommia state

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How is AFI calculated? Defn of oligiohydraminos and polyhydraminos

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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Causes of oligiohydraminos

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

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Complications seen with oligiohydraminos

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

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oligiohydraminos + meconium in amniotic fluid, next step

anmioinfusion

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Causes of polyhydraminos

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

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Complcations of polyhydraminos

cord prolapse

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How is polyhydraminos managed

careful verification of presentation, obs for cord prolapse

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What is erythroblastosis fetalis?

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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What is the prevelance of Rh-?

15% in caucasions and lower in other races

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When is rhogam administered

28 wks and postpartum if baby is Rh+

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What is biggest risk with retained IUFD

DIC if fetus is left > 3 wks

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What is the management of IUFD

deliver fetus and do autopsy to search for cause if unknonwn

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What is defn of post term delivery

> 42 wks

What are complications of postterm delivery

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

What is dysmaturity syndrome?

chronic IUGR from uteroplacental insufficiency

MCC post term delivery/pregnancy

inaccurate dating

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

chorion seperates day 4 | amnion seperates day 8

``` When does cleavage happen to result in Di di twins? Mono-di- Mono-Mono Siamese twins? ```

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

mono vs di zygotic twins

mono = 1 sperm and 1 egg --> idential DNA (no predisposing factors) dizygotic = 2 sperm an 2 ova

dizygotic twins have increased prevelance in

africans, IVF, clomiphene citrate

What are complications of multiple gestations

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

``` Management for.... Siamese/conjoined twins mono-mono- twins vertex/vertex twins vertex, non-vertex twins non-vertex/non-vertex twins triplets and above ```

``` 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 ```

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

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

What is the management of TTTS

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

What is severe n/v + intolerance of PO diet

hyperemesis gravidarum

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

molar pregnancy (get b-hCG)

When does morning sickness typically resolve

week 16

seizure threshold lowered or inc when pregnant

lowered

What is the etiology of most seizures in pregnancy

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

what is the teratogenicty of anti-epileptic drugs

folate antagonism --> neural tube defects | epoxide generation --> fetal hydantoin syndrome (IUGR, craniofacial malformations, etc)

How is a seizure d/o mananged in pregancy

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

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

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

how is preg managed in pts with high risk heart dz

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)

Peripartum cardiomyopathy management

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

Pts with mild renal Dz are at risk for

preEclampsia and IUGR

Management of preg women with renal transplant

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

``` GFR for stage 1 CKD stg 2 3 4 5 (ESRD) ```

``` stage 1 CKD = 90-100 stg 2 = 60-89 3 = 30-59 4 = 14-29 5 (ESRD) = < 15 ```

Management of DVT in preg

heparin or lovenox (enoxapain) | **warfarin is CI

management of PE in preg

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

How is hyperthyroidism in pregnancy managed

screen for tyroid stimulating immunoglobulins (TSIs) | if elevated, give PTU and monitor fetus for goiter and IUGR

Treatment for thyroid storm in preg

Beta blockers

what is infanthyperthyroism/cause?.

maternal TSIs cross placenta and attack fetal thyroid gland

What are common pregnancy complications in women with lupus

inc risk preeclampsia IUGR spontaneous abortion

How is SLE managed in pregnancy

low dose aspirin, heparin, or corticosteroids for ppx

how to differentiate between lupus flare and pre eclampsia?

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

What is the management for a lupus flare in preg

high dose corticosteroids, cyclophosphamide is unresponsive

What is neonatal lupus syndrome

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

Fetal alcohol syndrome characteristics

abn facies, IUGR, MR, bad heart

effect of caffine on preg

inc risk Spontaneous Ab with > 150mg/day

Effect of nicotine on preg

IUGR, placental abruption, PTD