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HRR 3 > High risk pregnancies > Flashcards

High risk pregnancies Flashcards

1
Q

RhD isoimmunization- def

A
  • Mother Rh negative with Rh positive fetus

- Presence of maternal IgG antibodies leads to increased risk fetomaternal hemorrhage

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2
Q

HELLP Syndrome- Definition

A
  • Severe form of preeclampsia
  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelets
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3
Q

Preeclampsia-Sx

A
  • Proteinuria
  • HTN
  • Hyperreflexia
  • Edema in hands and face
  • Blurred vision
  • Scotomata
  • Epigastric/ RUQ pain
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4
Q

Mild preeclampsia- Eti & dx

A

> 140 or 90 on two occasions 6 hrs apart

  • And >300 mg in 24 hr urine
  • 2+ urine on dip
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5
Q

Severe preeclampsia- Dx

A

> 160 or >110 on 2 occasions 6 hrs apar

> 5 gm protein over 24 hrs

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6
Q

Intrauterine growth restriction- Definition

A
  • At or below 10th percentile for gestational age
  • Includes healthy and constitutionally small babies (70%) of this group
  • Increased complication & death when <3rd percentile
  • Most common cause is HTN & smoking
  • Measured by fundal height & ultrasound (abd circumference)
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7
Q

Intrauterine growth restriction- Management

A
  • Monitor (non-stress test)
  • Non-reactive stress test = bad
  • Steroids if <34 weeks
  • No smoking
  • Delivery when fetal death risk exceeds neonatal death
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8
Q

Gestational DM- Def

A
  • Insulin resistance
  • Unexplained stillbirth
  • Higher risk for all complications
  • Screen all women 24-28 wks
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9
Q

Gestational DM- Mgmt

A
  • Check CBG 4x per day
  • Fasting (70-95)
  • 1 hr post prandial <120
  • ADA diet, 1800-2400 cals
  • Exercise
  • All pts with gestational DM must be checked 6 weeks postpartum (2 hr 75g glucose)
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10
Q

Placenta previa- Def

A
  • Abnormal location of cervix
  • Leading cause of 3rd trimester bleed
  • Advanced maternal age
  • Moderate to severe painless vaginal bleeding
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11
Q

Placenta previa- Mgmt

A
  • Do not do bimanual or cervix exam on known placenta previa
  • Observation
  • Steroids, RhoGAM
  • Schedule c-section
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12
Q

Abruptio placentae- Def

A
  • Premature separation of implanted placenta
  • 2nd or 3rd trimester bleeding
  • External or concealed hemorrhage
  • Abd trauma, stimulant use
  • Presentation: painful bleeding, abd pain, rigid abdomen
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13
Q

Abruptio placentae- Mgmt

A
  • Treat shock, stabilize hemodynamic

- C-sectaion

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14
Q

Premature rupture of membranes- Def

A
  • spontaneous rupture of membranes before labor

-

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15
Q

Premature rupture of membranes- Mgmt

A
  • Sign of infection = delivery
  • No sign- admit and hope labor occurs within 24 hrs
  • Preterm- manage with steroids, abx
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16
Q

Postterm pregnancy- def

A

> 42 weeks

  • Increased risk of stillbirth
  • Meconium aspiration
17
Q

Postterm pregnancy- Mgmt

A
  • Review dating of pregnancy

- Induction of labor at 41 wks

18
Q

RhD isoimmunization- Assessment

A
  • Screen all pregnant women for ABO blood group & RhD antigen
  • Antibody titer at 26-28 wks
  • Fetal middle cerebral artery flow
  • Indirect coombs test
19
Q

RhD isoimmunization- Tx

A
  • Anti-D immunoglobulin prophylaxis
20
Q

RhD isoimmunization- Risks

A
  • Hemolytic disease of newborn

- Kernicterus due to jaundice

21
Q

Pregnancy induced HTN- Eti

A

AKA: gestational HTN

  • HTN detected for 1st time after 20 wks pregnancy
  • Absence of proteinuria
22
Q

Pregnancy induced HTN- Dx

A

> 140 or > 90 on 2 occasions 6 hrs apart in absence of proteinuria
- Previously normotensive woman

23
Q

Pregnancy induced HTN- Tx

A
  • Surveillance for progression to preeclampsia

- Monitor fetal growth

24
Q

Pregnancy induced HTN- Risks

A
  • Transition to preeclampsia

- Recurrence in future pregnancies

25
Q

Preeclampsia- Tx

A
  • Deliver as soon as possible
  • Corticosteroids 48 hrs prior
  • Severe: Initial delivery at 34 weeks
26
Q

Preeclampsia- Risks

A
  • Preterm birth
  • Placental abruption
  • Growth restriction
27
Q

Eclampsia- Sx

A

Onset of seizures in preeclampsia

28
Q

Eclampsia- Tx

A
  • Seizures self limiting, don’t medicate
  • Prevent injury & aspiration
  • Deliver once patient has stabilized
  • Magnesium sulfate
29
Q

Preterm labor- Eti

A

Age >20 wks, <37 wks

  • Regular uterine contractions at freq intervals
  • Cervical change or dilatation & effacement
30
Q

Preterm labor- Sx

A
  • More than 2 contractions in 1/2 hr
  • Dilation & effacement of cervix
  • Bloody show
31
Q

Preterm labor- Tx

A
  • Corticosteroids
  • Attempt to delay delivery by 48 hrs
  • Tocolytic therapy- beta mimetics, CCBs, prostaglandin inhibitors
  • Mg sulfate
32
Q

Preterm labor- Risks

A
  • Wide variety, good survival with good preterm care

- Lower weight = lower survival

33
Q

Large for gestation age- Eti

A
  • Maternal diabetes, obesity, large stature
34
Q

Large for gestation age- Sx

A
  • Increased fundal height- >3cm

- Abdominal size

35
Q

Large for gestation age- Dx

A

EFW > 90th percentile on US

- Macrosomia = 4500 g regardless of age

36
Q

Large for gestation age- Risks

A
  • Shoulder dystocia
  • Prolonged labor
  • postpartum hemorrhage
  • Stillbirth
37
Q

Large for gestation age- Tx

A
  • C-section for > 5000 g

- Normal delivery if possible

HRR 3 (12 decks)

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