Pregnancy Complications Flashcards
Defn SGA
< 10%ile (can be symmetric or asymmetric)
Defn LGA
> 90%ile
Defn macrosomia
> 4500 g
Defn LBW
< 2500 g
2 types of SGA
IUGR = maternal systemic disease that causes decreased placental perfusion
low groth potential = congenital abnorlaities, teratogens, cigarettes
How is SGA managed
- confirm accuracy of dating
2. serial US + umbilical artery doppler (checks underlying dz)
Serial US reults that differentiated IUGR vs low growth potential
IUGR = progressively falls off curve
low GP = stays small
What does revered diastolic flow on dopplar suggest
IUGR
What does low or absent diastolic flow on dopplar suggest
dec placental resitance
What are RF for having macrosomia baby
DM, maternal obesity, postterm preg, multiparity, advanced maternal age
Complications of macrosomia
birth trauma hypoglycemia jaundice low apgars childhood tumors shoulder dystocia
How is LGA managed?
- confirm accuracy of dating
2. consider IOL prior to macrosommia state
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
Causes of oligiohydraminos
ROM (MCC)
dec placental perfusion
dec fetal fluid prodiction
renal malformations (Potters seq)
Complications seen with oligiohydraminos
pulm hypoplasia
limb contractures
cord compression –> fetal asphyxiation –> death
oligiohydraminos + meconium in amniotic fluid, next step
anmioinfusion
Causes of polyhydraminos
congenital abn, diabets, Twin-Twin Transfusion Syndrome (TTTS), hydrops fetalis (edema, ascities, heart failure)
Complcations of polyhydraminos
cord prolapse
How is polyhydraminos managed
careful verification of presentation, obs for cord prolapse
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)
What is the prevelance of Rh-?
15% in caucasions and lower in other races
When is rhogam administered
28 wks and postpartum if baby is Rh+
What is biggest risk with retained IUFD
DIC if fetus is left > 3 wks
What is the management of IUFD
deliver fetus and do autopsy to search for cause if unknonwn
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
