W11_03 Pre-eclampsia, IUGR, stillbirth

Question 1

what are some hypertension disorders of pregnancies?

Answer 1

chronic hypertension;
gestational hypertension;
pre-eclampsia;
HELLP syndrome;
eclampsia

Question 2

how does gestational hypertension differ from pre-clampsia?

Answer 2

GH is asymptomatic and no proteinuria. Pre-eclampsia has one of these

Question 3

what’s HELLP syndrome?

Answer 3

Hemolysis, Elevated Liver enzymes, Low Platelets

Question 4

what’s pre-clampsia?

Answer 4

new-onset HTN >20 pregnancy that includes;
proteinuria, or;
thrombocytopenia;
abnormal liver enzymes;
renal impairment;
can cause ischemia-reperfusion injury

Question 5

what are some factors increasing risk of pre-eclampsia? (SCOPE study)

Answer 5

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

Question 6

what are some factors that reduce risk of pre-clampsia?

Answer 6

smoking in 1st trimester;
miscarriage with same partner, 12 months

Question 7

PAPP-A, hCG, NT, AFP, uE3, DIA are markers of what?

Answer 7

placental function. Can test for down syndrome association with these values

Question 8

what’s IPS?

Answer 8

intraplacental screening

Question 9

what’s chorion regression?

Answer 9

when the placental cord is at the edge, rather than in the centre, and the placenta is smaller as a result, and has insufficiency

Question 10

how does s-FLT1 contribute to pre-eclampsia?

Answer 10

released from syncytial knots and contributes to maternal EC dysfunction and vasoconstriction in pre-eclampsia

Question 11

what does PLGF allow us to measure in pre-eclampsia?

Answer 11

time to delivery, by PLGF levels (high levels = longer)

Question 12

what’s the treatment for pre-eclampsia?

Answer 12

if at term (>37 weeks), induce labour or CS;

Question 13

what’s the medical treatment for antepartum pre-eclampsia?

Answer 13

education
steroids for lung maturation;
oral anti-hypertensives (labetalol, nifedipine, methyl dopa)

Question 14

what’s the medical treatment for intra-partum pre-eclampsia?

Answer 14

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

Question 15

what’s the post-partum care for pre-eclampsia?

Answer 15

DVT prophylaxis;
supportive pt/fam care;
birth control;
investigations for placental patho and thrombophilia screen, workup if persistently hypertensive, address maternal factors

Question 16

define small for gestational age

Answer 16

estimated fetal weight, or birth weight below 10, 5, 3, percentiles

Question 17

how to diagnose IUGR?

Answer 17

antepartum ultrasound;
intrapartum fetal distress in labour;
post-partum neonatal features (e.g. skinny, cracked skin, meconium staining);
70% stillborns exhibit IUGR

Question 18

which measurements can help us date the fetus?

Answer 18

LMP (14),
cycle-adjusted LMP (7),
CRL (4),
BPD (7),
IVF (1),
20-week anatomy exam (7)

Question 19

note: serial symphysis-pubic height is a poor method of screening for IUGR

Answer 19

50% sensitivity

Question 20

is late-onset or early-onset more common in IUGR?

Answer 20

late-onest

Question 21

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

Answer 21

ok

Question 22

define stillbirth

Answer 22

WHO: fetal death in late pregnancy (>20 week GA or <500g)

Question 23

what’s the most important cause of stillbirth, according to dr Kingdom?

Answer 23

placental dysfunction (including IUGR)

Question 24

what are some medical diseases related to stillbirth?

Answer 24

hypertension;
diabetes mellitus;
SLE;
chronic renal disease;
thyroid disorders

Question 25

what are major risk factors for stillbirth in high income countries?

Answer 25

overweight;
age >35;
smoking;
primiparity;
diabetes;
hypertension

Question 26

what blood tests of the mother can be used to check for stillbirth risk?

Answer 26

betke-kleihuer, ToRCH, group and screen, Ro/La (Ab that cause congenital heart block)