SM_209b: Abnormal Pregnancy Flashcards
Abnormalities of pregnancy often result in ____ which is defined as ____
Abnormalities of pregnancy often result in preterm birth which is defined as delivery < 37 weeks gestation
Describe preterm birth
Preterm birth
- Birth < 37 weeks of gestation
- Accounts for 85% of perinatal morbidity and mortality
- Neonatal outcome primarily dependent upon gestational age
- Etiologies: spontaneous (70-80%), iatrogenic (20-30%)
Describe causes of spontaneous and iatrogenic preterm birth
Spontaneous and iatrogenic preterm birth
- Spontaneous preterm birth: preterm PROM, preterm contraction, cervical insufficiency
- Iatrogenic preterm birth: placental abnormalities (placenta previa, vasa previa, placental abruption), FGR, preeclampsia, isoimmunization
Preterm labor is ____
Preterm labor is uterine contractions associated with cervical dilation at < 37 weeks gestation
- Potential contributing mechanisms: uterine overdistention, decline in progesterone action, cervical disease, breakdown of maternal - fetal tolerance, stress, unknown, infection, vascular disorders, decidual senescence
Describe prevention of preterm birth
Prevention of preterm birth
- 17 OHP
- Contraception
- Smoking cessation
- Screening and treating asymptomatic bacteriuria
- Treat symptomatic BV
- Single embryo transfer
- Vaginal progesterone
Management of preterm labor involves ____, ____, and ____
Management of preterm labor involves administering steroids for fetal benefits (consideration of tocolysis), administering PCN for GBS chemoprophylaxis, and administering magnesium for fetal neuroprotection
- Goals of diagnosis: diagnose and treat underlying cause, transfer to facility with appropriate NICU, medically optimize fetus for potential delivery
Cervical insufficiency is an ____ defined as ____ usually occuring in ____
Cervical insufficiency is an incompetent cervix defined as painless cervical dilatation in the abscence of contractions usually occurring in the mid-trimester (16-24 weeks)
Risk factors for cervical insufficiency are ____, ____, and ____
Risk factors for cervical insufficiency are prior history of cervical insufficiency, multiple gestation, and connective tissue disorders
Describe stages of cervical distensibility
Stages of cervical distensibility
- Softening
- Ripening
- Dilation
- Repair
___ is used to treat cervical insufficiency
Cerclage is used to treat cervical insufficiency
Describe indications and contraindications for cerclage
Cerclage
Emergent: ultrasound or physical exam based
Prophylactic: done if history suggestive of diagnosis of cervical insufficiency
Contraindications: contractions / labor, PPROM, infection, fetal demise, and major fetal anomaly
Premature rupture of membranes (PROM) is ____
Premature rupture of membranes (PROM) is rupture of membranes prior to the onset of labor at any gestational age
Preterm premature rupture of membranes (PPROM) is ____
Preterm premature rupture of membranes (PPROM) is rupture of membranes prior to onset of labor and before 37 weeks gestational age
Preterm premature rupture of membranes (PPROM) possible contributing mechanisms are ____ and ____
Preterm premature rupture of membranes (PPROM) possible contributing mechanisms are alteration in cervical stromal composition and induction of amniotic membrane matrix metalloproteinases
Preterm premature rupture of membranes (PPROM) diagnosis involves ____
Preterm premature rupture of membranes (PPROM) diagnosis involves sterile speculum exam
- Vaginal pooling
- Basic pH of fluid
- Microscopic ferning pattern
Describe expectant management and delivery of preterm premature rupture of membrane (PPROM)
Expectant management and delivery of preterm premature rupture of membrane (PPROM)
- Expectant management: preterm labor (2/3 within 7 days, 1/2 of these within 2 days), infection, placental abruption, IUFZG
- Delivery: prematurity
Describe management of preterm premature rupture of membrane (PPROM)
Management of preterm premature rupture of membrane (PPROM)
- Confirm gestational age
- If < 34 weeks and no contraindications, expectant management w/ antibiotics ( 7 day course promotes gestational latency) and administration of steroids
- Initiate fetal surveillance
- Contraindications for expectant management: labor, significant vaginal bleeding, infection
Placenta previa is ____ that presents with ____
Placenta previa is implantation of placenta in a location where it covers the cervical os that presents with painless bright red vaginal bleeding
- Accounts for 20% of third trimester bleeding
Describe risk factors for placenta previa
Placenta previa risk factors
- Prior cesarean section
- Multiparity
- Advanced maternal age
- Prior placenta previa
- Smoking
- Multiple gestation
Describe goals of diagnosis and possible complications of placenta previa
Diagnosis and possible complications of placenta previa
- Awareness: pelvic rest
- Expectant management: administration of antenatal corticosteroids if appropriate
- Planned c-section at 37 weeks gestation
- Possible complications: maternal hemorrhage, placenta accreta
Placenta accreta is ____ that commonly results from ____
Placenta accreta is when the placenta grows too deeply into the uterine wall that commonly results from placenta previa
- May cause severe blood loss after delivery
Vasa previa is ____ that presents with ____
Vasa previa is a fetal vessel transversing the cervical os that presents with vaginal bleeding that is arising from fetal vessels (i.e. fetal blood)
- Fetal blood volume: ~ 100 cc/kg
Describe diagnosis of vasa previa
Vasa previa
- Apt test shows fetal Hb resistant to lysis by alkaline solution
- Crash c-section
- Improved prenatal diagnosis with ultrasound
Apt test demonstrating fetal Hb resistant to lysis by alkaline solution is ____
Apt test demonstrating fetal Hb resistant to lysis by alkaline solution is vasa previa
Placental abruption is ____ characterized by ____
Placental abruption is premature separation of placenta from uterine characterized by vaginal bleeding in the presence of uterine contraction
Describe risk factors for placental abruption
Risk factors for placental abruption
- HTN
- Prior placental abruption
- Abdominal trauma
- Smoking
- Cocaine
- Submucosal fibrois
- PPROM
Placental abruption management involves ____ and ____
Placental abruption management involves administration of antenatal steroids if appropriate and delivery based upon maternal and fetal status
Fetal growth restriction is ____
Fetal growth restriction is fetus < 10% percentile for given gestational age
Describe causes of fetal growth restriction
Fetal growth restriction causes
- Fetal: aneuploidy, anomalies, infection (TORCH), multiple gestation
- Placental: uteroplacental insufficiency
- Maternal: malnutrition, illicit drug use, smoking, maternal medical conditions
Describe diagnosis of fetal growth restriction
Fetal growth restriction diagnosis
- Suspected size < dates on fundal height measurement
- Ultrasound
- Goals of diagnosis: counseling patients regarding prognosis and if applicable options regarding pregnancy management, institution of appropriate antenatal surveillance, administration of steroids if appropriate
Preeclampsia is ____
Preeclampsia is new-onset HTN accompanied by proteinuria
Describe severe preeclampsia
Severe preeclampsia
- BP > 160/110 on two occassions at least 4 hours apart
- Maternal symptoms: headache, visual changes, RUQ pain
- Hepatic injury / failure
- Renal dysfunction / failure
- Pulmonary edema
Coagulopathy - HELPP syndrome
- Eclampsia
Definitive therapy for preeclampsia is ____
Definitive therapy for preeclampsia is delivery
- Need to balance risks of prematurity with risks to maternal and fetal health with expectant management
- Control BPs
- Prevent eclampsia -> MgSO4
Rh alloimmunization is ____
Rh alloimmunization is exposure of Rh negative mother to Rh positive fetal blood resulting in maternal production of antibodies against the D antigen
Rh alloimmunization is prevented by ____
Rh alloimmunization is prevented by administration of Rh immune globulin to all pregnant women who are Rh negative (unless certain that father is Rh negative)
- 28 weeks
- After delivery
- Concerns for breakage in feto-maternal barrier
Describe Rh alloimmunization management strategies
Rh alloimmunization management strategies
- Paternal phenotype / genotype
- Fetal antigen status (amniocentesis, cell free DNA)
- Serial antibody titers
- Fetal MCA doppler peak systolic velocity indices
- Periumbilical cord blood sampling with intrauterine transfusion
Spontaneous abortion is ____ that presents as ____, ____, and ____
Spontaneous abortion is pregnancy loss < 20 weeks gestation that presents as vaginal bleeding, pelvic pain, or as an incidental finding on ultrasound
Stillbirth is ____, which is when ____
Stillbirth is intrauterine fetal demise, which is when pregnancy loss is at ≥ 20 weeks gestation
