Pregnancy Complications Flashcards
1
Q
Abruption of Placenta
A
- Premature separation of placenta from uterus
- Inc risk pre-term delivery
- Present w/ vaginal bleeding and uterine irritation
- Grade 1 - slight bleeding but BP okay, no coagulopathy
- Grade 2 - mod bleeding and contractions, maternal hypotension, inc HR, dec fibrinogen and distressed fetal HR
- Grade 3- severe hemorrhage and uterine pain, maternal hypotension, coagulopathy, fetal distress and often fetal death
- Risks - elevated BP, abdominal trauma, substance/smoking, small amniotic fluid vol, adv maternal age
2
Q
Placenta Previa
A
- Placenta implanted over cervical os (opening)
- Can be total or partial
- Present w/ painless vaginal bleeding BUT 90% of those diagnosed in 2nd trimester correct self by term (more lower growth than upper uterine growth)
- Risk - smoking, substance, adv maternal age, previous c sections, previous preg (scars or alterations may cause placenta to implant somewhere else)
3
Q
Invasive Placenta
A
- (accreta –> increta –> percreta)
- Normal - placenta in endometrium but NOT myometrium
- Accreta - superficial myometrium
- Increta - deeper myometrium
- Percreta - can even go to nearby structures like bladder - May also be associated w/ placenta previa
- Often requires hysterectomy
4
Q
Chorioamnioitis
A
- Intra-amniotic infections
- Fever, inc HR
- Commonly Group B strep (ascends fro vagina) or E coli
- Tx - abx
- Complications - pre-term birth, endometritis, septic shock, pulm hypotension, resp failure, inc risk fetal cerebral palsy
5
Q
Twin-Twin Transfusion Syndrome
A
- In MZ twins that share same placenta (monochorionic)
- Anastomoses b/n umbilical cord –> transfusion b/n twins
- 1 becomes donor (oligohydramnios)
- 1 becomes recipient (polyhydramnios)
- Tx - ablate anastomoses (70-80% mortality if not treated)
6
Q
Gestational Trophoblast Disease
A
- Extra trophoblast tissue w/ no obvious fetal tissue (Hydatidiform moles)
- Complete = no fetal tissue
- Partial = some non-viable fetal tissue
- Symptoms - vaginal bleeding in first trimester, abnormal growth of uterus or abnormal elevated hCG (can see on US)
- 10-15% become invasive and can cause uterine wall hemorrhage
- Tx - removal in benign cases (80%)
7
Q
Ectopic Pregnancy
A
- Implantation in fallopian tubes or abdomen or ovary
- Risk- chronic fallopian tube inflammation, previous tubal surgery
- Dx - elevated hCG and US
- Tx - surgery or stop growth of embryo w/ methotrexate
8
Q
Pre-Eclampsia (dx, risks, tx)
A
- Dx - BP > 140/90 (meas 2X 6 hrs apart) AND proteinuria > 300mg/24hr
- Risk - first preg, young or adv maternal age, hx HTN, obesity, mult gestation, family or personal hx, DM, renal disease, lupus, RA, thrombophilia, NOT SMOKING
- Tx - delivery of baby and placenta (CURE); responsible for 15% preterm births (indicated)
- Delivery is always best for mom but may not be best for fetus
9
Q
Pre-Eclampsia Pathophysiology
A
-reduced placental perfusion and abnormal vascular remodeling in placenta/uterus (more shallow invasion of placenta) –> hypoxia/ischemia –> release of mediators –> syndrome in mom of vasospasm, act of coagulation cascade, capillary leak
10
Q
Severe Pre-Eclampsia
Eclampsia
HELPP
A
- Considered severe if … HTN (BP > 160/100), eclampsia, CNS problems, pulmonary edema, renal dysfunction or thrombocytopenia (b/c coagulopathy), impaired liver function
- Severe more likely to have rapid progression to end organ damage and eclampsia
- Eclampsia - tonic clonic sz in context of pre-eclampsia w/o underlying neuro problem
- HELLP - hemolysis, elevated liver enzymes, low platelets (considered a variant of severe pre-eclampsia but do not always see HTN or proteinuria)
11
Q
Seizure Prophylaxis in Pre-eclampsia
A
Mg sulfate
12
Q
Pathogenesis of Gestational DM
A
- Hormones (human placental lactogen, human placental GH) + subclinical inflammation + dec adiponectin + excess lipolysis (for energy) –> dec insulin sensitivity as preg cont
- Causes gestational DM if mom cannot compensate by making enough insulin or if these effects are exaggerated
13
Q
Pederson Hypo
A
- maternal hyperglycemia –> fetal hyperglycemia –> fetal hyper-insulinemia –> inc nutrient storage and growth
- Inc energy to convert glucose to fat –> hypoxia for fetus –> catecholamines –> HTN, cardiac remodeling/hypertrophy, EPO, inc hematocrit
- Babies born w/ polycythemia, vascular sludging, poor circulation, hyperbilirubin and jaundice
- Maybe inc childhood obesity for fetus later
14
Q
Risk Factors of Gestational DM
A
Risks - PCOS (insulin resistance as part of PCOS), hx DM, adv maternal age, blacks/hispanics, prior large newborn, obesity, obstetric hx
SCREEN ALL PREG WOMEN
15
Q
Tx of Gestational DM
A
- dietary modification (more spaced out and less carbs)
- **80% can control w/ dietary modification alone
- insulin (does not cross placenta)
- glyburide (does cross placenta and may cause pancreatic hyperplasia in fetus so moving away from this)
- metformin (crosses placenta so not first line in US)
