Pregnancy Pathophysiology Flashcards
Why should Prenatal Care be started before pregnancy?
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.)
Folic acid is also known as Vitamin…
B9 (water soluble)
Importance of folate in fetal development
- For DNA
- Important for Neural Tube
When and how much do you need to take B9 in order to avoid neural tube defects?
- before conception!
- 600-800 mcg
- neural tube closure is completed by 30 days post-conception (6 weeks gestation)
Fetal malformations due to Maternal Preexisting Diabetes
- caudal regression syndrome (small legs)
- Neural Tube Defects (spina bifida, anencephaly)
- cardiac defects
How can Chronic HTN affect pregnancy?
Maternal:
- Preeclampsia
- CVA/MI
Fetal:
- growth restriction
- Preterm birth
Management of preexisting chronic hypertension
- preconception lifestyle modification
- dicontinue ACE inhibitors/ARB (teratogenic)
- Replace with Beta-blocker, Calcium channel blocker or other Diuretic
Examples of Prenatal Labs
Blood type
CBC
Screening (Hep B, HIV, Syphilis, Varicella, etc.)
Hep B Herpes HIV Chlamydia Syphilis Strep. agalactiae Rubella Varicella... are infections typically screened
prenatally
How do you manage a HIV+ pregnant patient?
- Antiretroviral prophylaxis
- Early immunoprophylaxis of infant
- Cesarean (if high viral load)
a group of congenital infections that are passed from mother to child at some time during pregnancy and cause teratogenesis (deformed organs).
TORCHeS
Toxoplasmosis ParvOvirus Rubella CMV Herpes Syphilis
Common but nonspecific symptoms of TORCH
hepatosplenomegaly
jaundice
thrombocytopenia
growth retardation
Recommended immunizations for Pregnant women
- Deactivated vaccines only!
- Hep A/B
- Tdap
- Influenza
- COVID 19
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
Omphalocele
Abdominal wall fails to close after intestines return to abdomen; usually isolated; protrusion NEAR midline; NOT covered by skin or peritoneum
Gastroschisis
birth defects of the brain, spine, or spinal cord
Neural tube defect
most common neural tube defects
- anencephaly (most of all)
2. spina bifida
What is used to diagnose neural tube defects?
U/S
elevated AFP
How can you help prevent Hemolytic Disease of the Fetus/Newborn (Rh negative mother, Rh positive fetus)
RhoGAM @28 weeks
What blood test is performed to asess for preexisting Rh sensitization?
direct Coombs test
Major pregnancy complications such as congenital anomalies, anemia, gestational diabetes, and hemolytic disease of newborn occur in ____ trimester
second
Distance from the superior aspect of the Symphysis Pubis to the Uterine Fundus; should equal gestational weeks; screens for fetal growth
Fundal Height
- most accurate 20-36 wks
Examples of tests for Fetal Well-being in third Trimester
- Non-Stress Test (NST) (heart rate and contraction period)
2. Biophysical Profile (BPP) (breaths, movement, amniotic fluid)
When do you suspect Intrauterine Fetal Growth Restriction?
EFW <10th percentile for gestation age
