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Reproductive Health & Pathology > Pregnancy & Labor > Flashcards

Pregnancy & Labor Flashcards

1
Q

Pregnancy Induced Hypertension

A 
Blood pressure increase of
- 30 mm Hg systolic or
- 15 mm Hg diastolic over prepregnancy
values
or
  • BP of 140/90 after 20 weeks if previous
    BP is unknown
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2
Q

Chronic HTN

A
  • BP > 140/90 before 20 wk gestation
    or
    • Known previous hypertension
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3
Q

Pre-Eclampsia

A
  • BP increase as with PIH, plus proteinuria
    and edema
  • Proteinuria = 0.1 gm/liter in a random
    specimen or 0.3 gm in a 24 hour specimen
  • Edema may manifest as clinical swelling
    or rapid weight gain
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4
Q

Severe Pre-Eclampsia

A 
• BP of 160 mm Hg systolic or 110 mm Hg
diastolic
• Proteinuria OF 5 gm or more in 24 hr
• Oliguria (500 ml or less in 24 hr)
• Cerebral or visual disturbances
• Epigastric pain
• Pulmonary edema or cyanosis
• Impaired liver function of unclear etiology
• Thrombocytopenia

HELLP Syndrome
• Hemolysis
• Elevated Liver enzymes
• Low Platelets

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5
Q

Eclampsia

A
  • Eclampsia is the presence of seizures
    not attributable to another cause
    • High fetal mortality
    • Significant maternal morbidity
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6
Q

Treatment of PIH/Pre-eclampsia

A 
- Delivery is the definitive treatment.
• Delivery is indicated for a woman
– at term with PIH
– preterm with severe disease
– Immediate if oliguria, renal failure, or HELLP syndrome, regardless of fetal gestation
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7
Q

Alpha Methyldopa

A 
- Acts as a false neurotransmitter
• Most extensively used antihypertensive
medication in pregnancy
• Fetal safety is well documented
• Watch for orthostatic hypotension
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8
Q

Hydralazine

A
  • Vasodilator

• Watch for reflex tachycardia

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9
Q

Musculoskeletal change during pregnancy

A

Lordosis: more curvature of the spine to accommodate the size and weight of the fetus

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10
Q

Heigh of Fundus at 20 weeks gestation

A

at the height of the belly button/umbilicus

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11
Q

Morning sickness (time of onset and cause)

A
  • usually beginning about 4-8 weeks until about 14-16 weeks
  • This may be related to sensitivity to human chorionic gonadotrophin levels (hCG)
  • High levels of progesterone cause smooth muscle relaxation which decreases the tone and motility of the gastrointestinal (GI) system (good for absorbing nutrients, but bad for nausea)
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12
Q

“physiologic anemia” of pregnancy

A
  • Aldosterone controls plasma volume increase
  • Erythropoetin controls increase of red blood cells
  • Plasma volume increase begins earlier than red blood cell volume increase
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13
Q

Uterine Phases of Parturition

A

Phase 0 - Relaxation phase - contractile unresponsiveness
- uses a lot of inhibitors, especially PROGESTERONE

Phase 1 - Preparation for labor
- ESTROGEN

Phase 2 - Processes of labor - three stages of labor
Stimulation: PROTSTGLANDINS AND OXYTOCIN

Phase 3 - Parturient recovery - uterine involution, breast feeding, restoration of fertility

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14
Q

Oxytocin

A
  • 9 amino acid peptide synthesized in the HYPOTHALAMUS and released from the POSTERIOR PITUITARY
  • Short ½ life, 3 to 6 minutes
    • Important in maintaining uterine contractions postpartum
  • Infusions of oxytocin cause contractions and can induce labor
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15
Q

Cervical Effacement

A
  • the progressive thinning of the cervix from about 2 cm in thickness to paper thin.
  • The cervical substance is drawn upward to become a part of the lower uterine segment.
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16
Q

Cervical Dilatation

A
  • The cervix must dilate to 10 centimeters to accommodate the diameter of a full-term fetus’s head
17
Q

3 Stages of Labor

A

First Stage of Labor

  • begins when uterine contractions are of sufficient frequency, intensity and duration to bring about effacement and progressive dilatation of the cervix
  • further divided into latent and active phases (acceleration, maximum slope, deceleration)

Second Stage of Labor
- begins when dilatation of the cervix is complete and ends with delivery of the fetus

Third Stage of Labor

  • Interval between delivery of fetus to delivery of placenta.
  • During this stage the placenta separates and is expelled
18
Q

Seven Cardinal Movements for Delivery

A
  1. Engagement: the BPD descends to the level below the plane of the pelvic inlet
  2. Descent: Fastest during Deceleration phase of stage 1
  3. Flexion: Flexion of the fetal chin onto the fetal chest occurs passively as the descending head meets resistance
  4. Internal Rotation: baby rotates so more “up and down”
  5. Extension
  6. External Rotation (Restitution)
  7. Expulsion

“Every Delivery Feels IckyEEE”

19
Q

Reasons for performing a cesarean delivery

A
  • fetal malpresentation
  • nonreassuring fetal heart rate tracing during labor
  • arrest of labor
20
Q

Pre-Term Birth & Risk Factors

A

– Infants delivered <259 days post conception

Major risk factors for preterm birth (but EVERY PREGNANCY IS AT RISK):
– Prior history of preterm birth
– Multifetal gestation
– Bleeding after the 1st trimester
– Low maternal body mass index (BMI)
Initiating Factors:
- Infection
• Vascular – ischemia/hemorrhage
• Stress-nutrition
• Uterine over distension
• Cervical disease
• Progesterone deficiency
• Abnormal allogenic recognition
• Allergy
• Unknown
21
Q

Low birth weight (LBW)

A

<2,500 gm at birth regardless of gestational age

22
Q

Very low birth weight (VLBW)

A

<1,500 gm at birth

23
Q

Premature rupture of membranes (PROM)
vs.
Preterm premature rupture of membranes
(PPROM)

A

PROM: rupture of membranes before the onset of labor

PPROM: rupture of membranes before 37 weeks
gestation, before the onset of labor

24
Q

How to Diagnose Pre-Term Labor

A
  • Fibronectin is a glycoprotein produced by a variety of cell types and is thought to have a role in intracellular adhesion in relation to maintenance of adhesion of the
    placenta to the decidua.
  • Fetal fibronectin detected in cervical secretions may signal impending preterm birth; however, there is a
    significant false positive rate.
  • The ABSENCE of fetal fibronectin in cervical secretions is more useful clinically because these patients can be potentially treated less agressively.
25
Q

Maternal Indications for Preterm

Delivery

A
  • Preeclampsia
    • Renal disease
    • Cardiac disease
26
Q

Fetal Indications for Preterm Delivery

A

Unfavorable intrauterine environment where
risks of in utero damage or stillbirth are
more significant than the risks of
prematurity, e.g.
– Intrauterine growth restriction
– Poorly controlled maternal diabetes mellitus
– Placenta previa
– Placental abruption

27
Q

Antenatal Corticosteroids reduce the risk of:

A
  • respiratory distress syndrome
    – intraventricular hemorrhage
    – necrotizing enterocolitis
    – patent ductus arteriosus

Reproductive Health & Pathology (4 decks)

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