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
