TBI Complications of Pregnancy Flashcards
threatened abortion
vaginal bleed before 20 wk gestation
spontaneous abortion
loss of pregnancy before 20 wk gestation
misoprostol
PGE1 analog
induces smc contraction in uterus
missed abortion
non-viable early pregnancy
prod of conception remain in uterus
lil/no bleed
empty sac, no cardiac sounds
inevitable abortion
significant volume of bleeding
cervical os is OPEN
septic abortion
more assoc w/ induced abortion
fever, chills, malaise, abd pain, vaginal bleed/discharge
most common location of ectopic pregnancy is
ampulla of fallopian tube
hCG rises until
10 wk gestation
hCG levels indicating intrauterine pregnancy
1500-2000 mIU/ml
discriminatory zone
medical therapy for ectopic pregnancy
methotrexate
(folic acid antagonist)
inhibits growth of rapidly dividing cells (growing embryo)
contraindications of methotrexate for ectopic preg
- embryo bigger than 4cm
- ruptured ectopic
- abd bleed signs
- hepatic/renal/pulm/peptic ulcer/immunosuppressed
risk fx of ectopic preg
adhesions (PID, endometriosis, prev abd surg)
past ectopic
Placentia previa
placental tissue overlying or proximate to internal cervical os
beyond 24 wk gestation
PAINLESS BLEEDING in 3rd trimester
ABSENCE of abd pain/uterine contractions
how to distinguish Placentia previa from placental abruption
placenta abruption –> abd pain, uterine contractions
hCG levels higher than 2000 are more reliable in
ruling out a viable pregnancy
dx of Placentia previa
US
echogenic placental tissue overlying the internal cervical os
*BEFORE digital vaginal exam (may cause hemorrhage)
probs assoc w/ placenta previa
- placenta accreta
- malpresentation of fetus
- preterm premature rupture of the membranes
- intrauterine growth restriction
- vasaprevia and velamentous umbilical cord
- congenital anomalies
Placenta accreta
abnormal adherence to uterine wall
placenta increta
abnormal adherence of placenta through myometrium
placenta percreta
abnormal adherence in which placenta invades through myometrium to uterine serosa and even to adjacent organs
vasa previa
velamentous cord insertion causes fetal vessels to cross over os
velamentous placenta
umbilical vessels course through amnionic sac before reaching placenta, which leaves vessels unprotected/vulnerable to rupture or compression
succenturiate lobe
extra placental lobe that implants at some distance from the rest of the placenta
- vaginal bleeding
- uterine tenderness/abd or back pain
- uterine contractions
- fetal distress/demise
placental abruption
risk fx for placental abruption
HTN/preeclampsia Previous placental abruption Premature rupture of membranes Multiple gestations/overdistension Polyhydramnios Cigarette smoking Trauma Cocaine abuse Advanced maternal age Abnormalities of placentation and cord Intrauterine infection
uterine rupture tx
IMMEDIATE laparotomy with delivery of fetus and repair of uterus or hysterectomy
vasa previa
rupture of fetal vessel –> perinatal mortality exceeds 50%
present. ..
- vag bleed
- non-reassuring fetal HR pattern (sinusoidal)
- need to deliver immediately by C. section
pathogenesis of preeclampsia
- faulty trophoblastic vascular remodeling of uterine a.s –> placental hypoxia –> release of placental fx into maternal circulation –> dysfunction of vascular endothelium –> vasospasm, coagulation
- vasoconstriction –> inc resistance and HTN
- damage to endothelium –> edema and microangiopathic hemolysis from platelet adherence and fibrin deposition (thrombocytopenia)
- diminished blood flow –> end-organ damage (proteinuria, hepatocellular necrosis)
gestational HTN dx criteria
systolic BP greater or equal to 140 mmHg
or
diastolic BP greater or equal to 90 mmHg
developing AFTER wk 20 in previously normotensive pt
and NO proteinuria
preeclampsia dx criteria
systolic BP greater or equal to 140 mmHg
or
diastolic BP greater or equal to 90
^on 2 occasions at least 4 hr apart
AFTER wk 20 in a previously normotensive pt
AND
proteinuria or inc protein/creatinine ratio
pt with new onset HTN without proteinuria, new onset of which findings is dx of preeclampsia?
thrombocytopenia inc serum creatinine 2x normal liver transaminases pulm edema cerebral visual sx
severe preeclampsia dx criteria
systolic greater or equal to 160 mmHg
or diastolic greater or equal to 110 mmHg on 2 occasions at rest
also CNS dysfunction (HA) hepatic abnormality thrombocytopenia renal abnormality pulm edema
hemolysis
elevated LFTs
low platelets
HELLP syndrome
risk fx for preeclampsia
PHx of preeclampsia first preg black race Fix of preeclampsia DM chronic HTN obesity chronic kidney disease antiphospholipid Abs twin preg advanced maternal age (>40)
sx of preeclampsia become apparent in most women after how many weeks gestation?
34
eclampsia
one or more generalized convulsions and/or coma in a woman with preeclampsia in absence of other neuro conditions
before, during delivery, or postpartum
anti seizure meds for eclampsia
Mg sulfate
tx of preeclampsia/eclampsia
DELIVERY
HTN medical tx used dur preg
- methyldopa
- labetalol
- nifedipine (CCB)
- oral hydralazine
HTN medical tx CONTRAINDICATED dur preg
nitroprusside
ACEi/ARBs
Rh antigen
AD inheritance
most commonly D antigen
Ig_ readily crosses placenta
IgG
anti-D Ig
RhoGam
Kleihauer-Betke
estimate of amount of fetal cells crossed into mother
smear of mothers blood, stain for fetal red cells
Does prior spontaneous abortion put woman at inc risk of ectopic?
No
painless bleeding during preg is ____ UPO
placenta previa
Is advanced maternal age a risk fx of placental abruption?
No
Is HTN a risk fx of placental abruption?
Yes
Is advanced maternal age a risk fx of placental previa?
Yes
Is HTN a risk fx of placental previa?
No
