W11_03 Pre-eclampsia, IUGR, stillbirth Flashcards
what are some hypertension disorders of pregnancies?
chronic hypertension;
gestational hypertension;
pre-eclampsia;
HELLP syndrome;
eclampsia
how does gestational hypertension differ from pre-clampsia?
GH is asymptomatic and no proteinuria. Pre-eclampsia has one of these
what’s HELLP syndrome?
Hemolysis, Elevated Liver enzymes, Low Platelets
what’s pre-clampsia?
new-onset HTN >20 pregnancy that includes;
proteinuria, or;
thrombocytopenia;
abnormal liver enzymes;
renal impairment;
can cause ischemia-reperfusion injury
what are some factors increasing risk of pre-eclampsia? (SCOPE study)
advanced mat age;
high BMI;
elevated BP
PV bleedine >5 days in 1st trimester;
pre-conception relationship <6 months;
FHx pre-eclampsia or CVD;
low maternal birth weight
what are some factors that reduce risk of pre-clampsia?
smoking in 1st trimester;
miscarriage with same partner, 12 months
PAPP-A, hCG, NT, AFP, uE3, DIA are markers of what?
placental function. Can test for down syndrome association with these values
what’s IPS?
intraplacental screening
what’s chorion regression?
when the placental cord is at the edge, rather than in the centre, and the placenta is smaller as a result, and has insufficiency
how does s-FLT1 contribute to pre-eclampsia?
released from syncytial knots and contributes to maternal EC dysfunction and vasoconstriction in pre-eclampsia
what does PLGF allow us to measure in pre-eclampsia?
time to delivery, by PLGF levels (high levels = longer)
what’s the treatment for pre-eclampsia?
if at term (>37 weeks), induce labour or CS;
what’s the medical treatment for antepartum pre-eclampsia?
education
steroids for lung maturation;
oral anti-hypertensives (labetalol, nifedipine, methyl dopa)
what’s the medical treatment for intra-partum pre-eclampsia?
1:1 nursing care;
IV fluid restriction (prevent increased ICP and cardiac load);
IV magnesium sulfate (for seizures);
oral/IV antihypertensives;
high-dependency care;
OB/anesthesia/RN collab;
protocol
what’s the post-partum care for pre-eclampsia?
DVT prophylaxis;
supportive pt/fam care;
birth control;
investigations for placental patho and thrombophilia screen, workup if persistently hypertensive, address maternal factors
define small for gestational age
estimated fetal weight, or birth weight below 10, 5, 3, percentiles
how to diagnose IUGR?
antepartum ultrasound;
intrapartum fetal distress in labour;
post-partum neonatal features (e.g. skinny, cracked skin, meconium staining);
70% stillborns exhibit IUGR
which measurements can help us date the fetus?
LMP (14),
cycle-adjusted LMP (7),
CRL (4),
BPD (7),
IVF (1),
20-week anatomy exam (7)
note: serial symphysis-pubic height is a poor method of screening for IUGR
50% sensitivity
is late-onset or early-onset more common in IUGR?
late-onest
note: the DIGITAT trial showed that if you have IUGR and/or pre-eclampsia at, or near term, the best thing to do is cesarian section
ok
define stillbirth
WHO: fetal death in late pregnancy (>20 week GA or <500g)
what’s the most important cause of stillbirth, according to dr Kingdom?
placental dysfunction (including IUGR)
what are some medical diseases related to stillbirth?
hypertension;
diabetes mellitus;
SLE;
chronic renal disease;
thyroid disorders
what are major risk factors for stillbirth in high income countries?
overweight;
age >35;
smoking;
primiparity;
diabetes;
hypertension
what blood tests of the mother can be used to check for stillbirth risk?
betke-kleihuer, ToRCH, group and screen, Ro/La (Ab that cause congenital heart block)
