PT, Biomarkers, Maternal Morality WK1 Flashcards
1
Q
PT: Incidence
A
- Incidence - 11% preg
2
Q
PT: Types
A
- Spontaneous PT labor 45%
- PPROM - <37wk, before onset labor, 25%
- Medically indicated 30% PT birth
- C/s
- Induction labor
3
Q
Spontaneous PT: Patho
A
- Processes induce uterine contractions, cervical dilation, ROM
- Decrease progesterone →
- Inflammatory cytokines - TNF alpha, IL 10
- Inhibition natural killer cells
- Decrease maternal-fetal tolerance
4
Q
PT: Risk Factors Race
A
- AA
- PT 18% vs 11% (esp EPT)
5
Q
PT: Risk Factors SDOH
A
- Education
- Abnormal maternal age
- <6m between preg
- Single
6
Q
PT: Risk Factors Enviornmental
A
- Tobacco*
- Cocaine
- Air pollution - ozone, carbon monoxide, sulfur dioxide, lead
- Toxicants - pesticides, heavy metals
NOT alcohol
7
Q
PT: Risk Factors Nutrition
A
- BMI >30
*
8
Q
PT: Risk Factors Infection
A
- Intraamniotic infection
- Mycoplasma species
- Bacterial vaginosis (esp AA)
- STI (esp AA)
- Periodontal dx
- UTI
9
Q
PT: Risk Factors Genetic
A
- Family hx
- Hx PT
- Gene to gene interactions
NOT single nucleotide polymorphisms
10
Q
PT: Risk Factors OB
A
- Abnormal vascular development placenta
- Abnormal placentation
- Vaginal bleeding
- Overdistention uterus
- Abnormal amniotic fluid volume
- Anatomic abnormalities uterus
- Hx cervical surgical intervention
- Short cervix
- Cervical insufficiency
11
Q
Stillbirth: Defintion
A
- >20wk in utero demise
12
Q
Stillbirth: Incidence
A
- Incidence - 5-6:1000 US preg
- 80% stillbirths delivered <37wk
- 50% stillbirths IUGR
13
Q
Stillbirth: Association (3)
A
PT, Stillbirth, IUGR
14
Q
IUGR: Biomarkers (2)
A
- Decrease maternal serum PlGF placental growth factor predict severe IUGR
- mass spectrometry - App C11/C11i0
15
Q
Early Onset PE <34wk: Biomarkers (3)
A
- PlGF
- PAPP-A
- Upregulation miR-210
16
Q
PT before onset labor: Biomarkers (4)
A
- C reactive protein
- Corticotropin releasing hormone CRH
- Neutrophil to lymphocyte ratio
- HLA panel reactive antibodies
17
Q
Chorio: Biomarkers (2)
A
- Amniotic fluid IL 6
- IL 1beta (proinflammatory cytokine)
18
Q
PT: Biomarkers (2)
A
- IL1RLI transcripts increase
- Altered miRNA expression
19
Q
Autism: 2 Associations (4) (3)
A
- Autism, PT, chorio, VLBW
- Autism, maternal metabolic dx (obesity, DM), PE
20
Q
Metabolic Dx: Biomarkers (3)
A
- Altered placental morphology - high BP child/adults, chronic heart failure adult
- Placental CRH - decrease BMI but increase central adiposity child
- Altered expression 8 miRNA - maternal obesity, weight gain parameters offspring
21
Q
Maternal Death: Definition
A
- Maternal death - preg - <1yr end of preg
22
Q
Maternal Death: Types
A
- Preg associated - NOT rt preg
- Preg related - rt preg or aggravated by preg or its mgmt
23
Q
Maternal Mortality: GA Incidence
A
- Top 10 maternal mortality rate
- 60% preg related deaths preventable
24
Q
Maternal Mortality: Causes
A
- Cardiomyopathy
- Hemorrhage (very preventable)
- CV dx
- Embolism
- PE and eclampsia (esp AA)
- Amniotic fluid embolism
25
Q
Maternal Mortality: Risk Factors
A
- AA
- >35yr
- Rural (esp AA)
26
Q
Maternal Mortality: GA Committee Recommendations
A
- Extend medicaid coverage
- Postmortem exam any maternal death
- DPH develop model prenatal, postpartum, telehealth care for county health departments
- Fund MMRC, GaPQC, AIM bundles
- Statewide group prenatal care models
- Obesity epidemic
- RN home visit programs
- GA rural healthcare workers
- Medicaid streamline to enroll in WIC
- Reach SDOH, disparities, genetics
- CV and mental health telemedicine
- Long acting reversible contraceptives
- Public health awareness campaigns
- Hospital hemorrhage bundle cart
- Healthcare workforce racial sensitivity training
- EMS expansion
- Preg and postpartum data collection and analysis
- Triton technology
- Detailed death certificate reporting
