Complications of the Prenatal Period Flashcards

1
Q

What are the classifications of HTN?

A

Chronic
Chronic with superimposed pre-eclampsia
Pre-eclampsia

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2
Q

Chronic HTN

A

BP> 140/90 mm Hg prior to 20 weeks gestation

Elevated BP persists after pregnancy

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3
Q

What are causes of chronic HTN?

A
Essential
Hyperthyroidism
Coarctation of the aorta
Hyperaldosteroinism
Cushings dz
Connective tissue dz
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4
Q

What are maternal complications of chronic HTN?

A
CVA
Renal disease
Retinopathy
Abruption
Superimposed pre-eclampsia
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5
Q

What are fetal complications of chronic HTN?

A

IUGR- infrauterine growth restriction

Fetal death

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6
Q

What are the goals in therapy for chronic HTN?

A
maintain BP < 140/90 mm Hg
-alpha-methyldopa
-labetolol
-nifedipine
monitor fetal growth-US
monitor for evidence of utero-placental insuff.
-NST
-biophysical profile

**NO ACE INHIB. OR ARBS

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7
Q

Pre-eclampsia

A

BP >140/90 after 20 weeks gestation
Proteinuria > 300 mg/24hr
Edema

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8
Q

What is the incidence of pre-eclampsia?

A

mild: 5-8%
severe: 0.6-1.2%

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9
Q

What are the maternal complications of pre-eclampsia?

A
CVA
Eclampsia
Acute renal failure
Pulmonary edema
Death
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10
Q

What are the fetal and neonatal complications of pre-eclampsia?

A

IUGR
Fetal death
Anemia, neutropenia and thrombocytopenia

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11
Q

What are the diagnostic criteria for severe pre-eclampsia?

A
BP> 160 or 110 mm Hg
Proteinuria > 5g
Oliguria <30ml/hr
Increased DTRs
Headache
Visual changes
Pulmonary edema
RUQ pain
Abnormal LFTs
Thrombocytopenia
IUGR
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12
Q

What do you do if a mother is experiencing characteristics of severe pre-eclampsia?

A

deliver that baby

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13
Q

What is the longest you wait to deliver a baby with severe or mild preclampsia at term?

A

48 hrs so you can give corticosteroids for fetal lumbar support

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14
Q

Do you deliver the baby if the mother has mild pre-clampsia and the baby is pre-term?

A

No, observe

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15
Q

Abruptio Placentae

A

premature separation of a normally implanted placenta

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16
Q

What is the frequency of abruptio placentae?

A

1%

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17
Q

What are the risk factors for abruptio placentae?

A
Age> 35 years
High parity
HTN
Smoking
Cocaine abuse
Multiple gestation
Uterine anomalies
Prior history of abruption
18
Q

What are the clinical manifestations of abruptio placentae?

A
Abdominal pain
Tetanic uterine contraction
Dark red vaginal bleeding
Coagulopathy
Abnormal fetal heart rate pattern
19
Q

How do you make a diagnosis of a abruptio placentae?

A

US

Clinical examination

20
Q

What is the management for abruptio placentae?

A

Delivery- usually by cesarean
Replacement of blood loss
Correction of coagulopathy

21
Q

How do we replace the blood lost?

A
isotonic crystalloid (3:1 rule)
Packed red cells
22
Q

Placenta Previa

A

Placenta is implanted over the internal cervical os

Frequency - 1%

23
Q

What are the risk factors for Placenta Previa?

A
Age > 35
Higher parity
Smoking
Uterine anomalies
Prior uterine scar
Multiple gestation
Prior history of previa
24
Q

What are the clinical manifestations of Placenta Previa?

A

painless, bright red vaginal bleeding
abnormal fetal heart rate tracing is less likely than with abruption
coagulopathy is also less likely

25
Q

What is the diagnostic technique for Placenta Previa?

A

US

26
Q

How do you manage Placenta Previa?

A

preterm with reassuring maternal-fetal status: observation and corticosteroids

preterm with non-reassuring maternal-fetal status: cesarean delivery

term with non-reassuring maternal-fetal status: cesarean delivery

27
Q

Preterm delivery

A

<37 weeks

28
Q

What is the frequency of preterm deliveries?

A

10-12%

29
Q

What is the impact of preterm deliveries?

A

responsible for 75% of neonatal deaths, excluding anomalies incompatable with life

30
Q

What is the number one obstetrics problem?

A

preterm deliveries

31
Q

What is the number one factor that increases the risk of preterm deliveries?

A

preterm POM

32
Q

What are other factors that increase the risk of preterm deliveries?

A
multiple gestations
polyhydramnios- excessive amniotic fluid
uterine anomaly
abruption
previa
fetal anomaly
incompetent cervix
smoking
cocaine abuse
trauma
non-genital infection (pnumonia/pyeloneph)
genital infection (upper/lower tract)
33
Q

What are the four things that kill premature babies?

A

hyaline membrane disease
IVH- intraventricular hemorrhage (less common after 32 weeks)
NEC- necrotizing entero colitis
Infection

34
Q

What is the number one killer of preterm babies?

A

hayline membrane disease

35
Q

What are additional complications of prematurity?

A
thermal instability
poor feeding
apnea and bradycardia
PDA-patent ductus arteriosis
hyperbilirubinemia
hypoglycemia
seizures
36
Q

How do we evaluate preterm labor?

A
physical exam
CBC- left shift for lymphocytes
Urine culture to rule out UTI
Screen for lower genital tract infection
Amniocentesis- assess for chorioamnionitis and fetal lung maturity
US
Fetal fibronectin
37
Q

What is the management for preterm labor?

A

Tocolytics- forestall delivery
Corticosteroids- reduce frequency of RDS, IVH, NEC
Abx- prevent maternal and neonatal infection

38
Q

What is a tocolytic that is a drug of choice and acts as a Ca+ blocker, given by mouth and has an adverse effect of hypotension?

A

nifedipine

39
Q

What is the most common cause of neonatal mortality?

A

preterm delivery

40
Q

What are two key criteria that determine the management of preeclampsia?

A

severity of Dz and the gestational age