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Reproductive-Week 3/4 > Pregnancy Pathophysiology > Flashcards

Pregnancy Pathophysiology Flashcards

1
Q

Why should Prenatal Care be started before pregnancy?

A

Usually by the first signs of pregnancy (positive pregnancy test), most major milestones have been passed (organogenesis); thus any potential damage has already been done sadly (teratogens, folate deficiency, etc.)

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2
Q

Folic acid is also known as Vitamin…

A

B9 (water soluble)

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3
Q

Importance of folate in fetal development

A
  • For DNA

- Important for Neural Tube

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4
Q

When and how much do you need to take B9 in order to avoid neural tube defects?

A
  • before conception!
  • 600-800 mcg
  • neural tube closure is completed by 30 days post-conception (6 weeks gestation)
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5
Q

Fetal malformations due to Maternal Preexisting Diabetes

A
  • caudal regression syndrome (small legs)
  • Neural Tube Defects (spina bifida, anencephaly)
  • cardiac defects
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6
Q

How can Chronic HTN affect pregnancy?

A

Maternal:

  • Preeclampsia
  • CVA/MI

Fetal:

  • growth restriction
  • Preterm birth
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7
Q

Management of preexisting chronic hypertension

A
  • preconception lifestyle modification
  • dicontinue ACE inhibitors/ARB (teratogenic)
  • Replace with Beta-blocker, Calcium channel blocker or other Diuretic
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8
Q

Examples of Prenatal Labs

A

Blood type
CBC
Screening (Hep B, HIV, Syphilis, Varicella, etc.)

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9
Q 
Hep B
Herpes
HIV
Chlamydia
Syphilis
Strep. agalactiae
Rubella
Varicella... are infections  typically screened
A

prenatally

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10
Q

How do you manage a HIV+ pregnant patient?

A
  • Antiretroviral prophylaxis
  • Early immunoprophylaxis of infant
  • Cesarean (if high viral load)
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11
Q

a group of congenital infections that are passed from mother to child at some time during pregnancy and cause teratogenesis (deformed organs).

A

TORCHeS

Toxoplasmosis
ParvOvirus
Rubella
CMV
Herpes
Syphilis
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12
Q

Common but nonspecific symptoms of TORCH

A

hepatosplenomegaly
jaundice
thrombocytopenia
growth retardation

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13
Q

Recommended immunizations for Pregnant women

A
  • Deactivated vaccines only!
  • Hep A/B
  • Tdap
  • Influenza
  • COVID 19
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14
Q

persistence of herniated intestines that do not return to abdomen by week 10; midline protrusion at the navel containing intestines; covered by peritoneum-like transparent sac

A

Omphalocele

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15
Q

Abdominal wall fails to close after intestines return to abdomen; usually isolated; protrusion NEAR midline; NOT covered by skin or peritoneum

A

Gastroschisis

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16
Q

birth defects of the brain, spine, or spinal cord

A

Neural tube defect

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17
Q

most common neural tube defects

A
  1. anencephaly (most of all)

2. spina bifida

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18
Q

What is used to diagnose neural tube defects?

A

U/S

elevated AFP

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19
Q

How can you help prevent Hemolytic Disease of the Fetus/Newborn (Rh negative mother, Rh positive fetus)

A

RhoGAM @28 weeks

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20
Q

What blood test is performed to asess for preexisting Rh sensitization?

A

direct Coombs test

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21
Q

Major pregnancy complications such as congenital anomalies, anemia, gestational diabetes, and hemolytic disease of newborn occur in ____ trimester

A

second

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22
Q

Distance from the superior aspect of the Symphysis Pubis to the Uterine Fundus; should equal gestational weeks; screens for fetal growth

A

Fundal Height

  • most accurate 20-36 wks
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23
Q

Examples of tests for Fetal Well-being in third Trimester

A
  1. Non-Stress Test (NST) (heart rate and contraction period)

2. Biophysical Profile (BPP) (breaths, movement, amniotic fluid)

24
Q

When do you suspect Intrauterine Fetal Growth Restriction?

A

EFW <10th percentile for gestation age

25
Q

Reservoir for nutrients, Cushions umbilical cord and fetus, and Antibacterial

A

Amniotic Fluid

26
Q

Causes of Oligohydramnios (reduced amniotic fluid)

A

Abnormal renal system
Abnormal lungs
Poor placental perfusion

27
Q

Consequences of Oligohydramnios

A
  • Umbilical cord compression
  • Fetal compression (limb and face deformation)
  • Potter’s sequence
28
Q

clubbed feet, pulmonary hypoplasia and cranial anomalies related to the oligohydramnios

A

Potter’s sequence

29
Q

Causes of Polyhydramnios (excess amniotic fluid)

A
  • Inc. fetal urine production (diabetes)

- Dec. fetal swallowing (GI issues)

30
Q

Warning signs of preterm labor

A

Uterine contractions
“Water breaking”
Vaginal bleeding
Lower region of Pelvic Pressure

31
Q

Idiopathic systolic dysfunction related to pregnancy; ejection fraction <45% with dilation of heart chambers; SOB, LE edema, tachy, elevated JVP, rales

A

Peripartum Cardiomyopathy

32
Q

blood clots that form in veins; 4-5 higher risk in pregnancy and postpartum

A

VTE (venous thromboembolism)

33
Q

Normal blood loss or discharge 24 hours to 12 weeks postpartum; can range from red-brown to yellow-white

34
Q

Regular uterine contractions with cervical changes prior to 37 weeks gestation; can be due to premature activation of H-P-A axis, infection, decidual hemorrhage or uterine distention

A

Preterm Labor

35
Q

What are 4 common causes of Preterm Labor

A

Premature activation of H-P-A axis
Infection
Decidual hemorrhage
Uterine distention

36
Q

How to evaluate/diagnose Preterm Labor

A
  • Regular uterine contractions
  • Cervical Dilatation
  • Cervicovaginal Fetal-Fibronectin
37
Q

Extracellular matrix protein at Decidual-Chorionic interface; disruption by infection or inflammation causes release in secretions; marker for Preterm Labor

A

Fetal-Fibronectin

38
Q

Drugs to help delay Preterm Labor (“Tocolytics”) to inhibit uterine contractions

A

Magnesium Sulfate
Terbutaline (B2 agonist)
Nifedipine (Ca channel blocker)
Indomethacin (NSAID)

39
Q

MOA of NSAIDs (such as Indomethacin)

A

Dec. conversion of AA to Prostaglandin (prevent contraction)

40
Q

MOA of B2 agonists (such as Terbutaline)

A

Inc. cAMP–> inhibit MLCK–> dec. intracellular calcium

41
Q

MOA of Magnesium sulfate

A

Competes with Calcium for entry into cells

42
Q

Rupture of fetal membranes prior to labor

A

Premature Rupture of Membranes

43
Q

Diagnostic tests for Premature Rupture of Membranes

A

Vaginal pooling of amniotic fluid

“Nitrazine” +

44
Q

Complications of Premature Rupture of Membranes

A 
Preterm Birth 
Infection
Abruption 
Umbilical Cord Compression
Fetal Death
45
Q

Treatment for Premature Rupture of Membranes

A
  • Corticosteroids <32 weeks

- Latency Antibiotics (Ampicillin + Erythromycin) –> prolong time of labor onset

46
Q

Painless cervical dilation leading to pregnancy losses; can be acquired or Congenital; bulging membranes at cervical os on physical exam

A

Cervical Insufficiency

47
Q

Development of HTN (>=140/90) WITH proteinuria (>=0.3g) after 20 weeks gestation

A

Preeclampsia

48
Q

Development of HTN after 20 weeks gestation WITHOUT proteinuria

A

Gestational HTN

49
Q

Signs/Symptoms of severed Preeclampsia

A 
BP >160/110
HELLP
dec. amniotic fluid
oliguria
fetal growth abnormalities
50
Q

Pathogenesis of Preeclampsia

A

Abnormal Placental implantation–> abnormal spiral arteries–> endothelial dysfunction, vasoconstriction and ischemia

51
Q

Treatment for Preeclampsia

A
  1. Antihypertensives if BP >170/105
  2. Seizure Prophylaxis
    - Magnesium Sulfate
  3. delivery if possible
52
Q

Severe Preeclampsia with Hemolysis, Elevated Liver Enzymes and Low Platelets; due to endothelial dysfunction causing thrombi formation and widely consuming coagulation factors & platelets; DELIVER patient whenever this happens regardless of gestational age

A

HELLP Syndrome

53
Q

In addition to Preeclampsia, what defines HELLP Syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelets

54
Q

Blood loss of >500 (after vaginal birth) or >1000 mL (after c-section); due to high Uterine Artery blood flow (receives 15% of Cardiac Output)

A

Postpartum Hemorrhage

55
Q

Most common cause of Postpartum Hemorrhage

A

uterine atony (lack of effective uterine contractions to cease blood flow)

56
Q

Tx for Postpartum Hemorrhage

A

fluid/blood replacement

uterotonic agents

Reproductive-Week 3/4 (13 decks)

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