High risk pregnancies Flashcards Preview

HRR 3 > High risk pregnancies > Flashcards

Flashcards in High risk pregnancies Deck (37):
1

RhD isoimmunization- def

- Mother Rh negative with Rh positive fetus
- Presence of maternal IgG antibodies leads to increased risk fetomaternal hemorrhage

2

HELLP Syndrome- Definition

- Severe form of preeclampsia
- Hemolysis
- Elevated Liver enzymes
- Low Platelets

3

Preeclampsia-Sx

- Proteinuria
- HTN
- Hyperreflexia
- Edema in hands and face
- Blurred vision
- Scotomata
- Epigastric/ RUQ pain

4

Mild preeclampsia- Eti & dx

>140 or 90 on two occasions 6 hrs apart
- And >300 mg in 24 hr urine
- 2+ urine on dip

5

Severe preeclampsia- Dx

>160 or >110 on 2 occasions 6 hrs apar
> 5 gm protein over 24 hrs

6

Intrauterine growth restriction- Definition

- 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)

7

Intrauterine growth restriction- Management

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

8

Gestational DM- Def

- Insulin resistance
- Unexplained stillbirth
- Higher risk for all complications
- Screen all women 24-28 wks

9

Gestational DM- Mgmt

- 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)

10

Placenta previa- Def

- Abnormal location of cervix
- Leading cause of 3rd trimester bleed
- Advanced maternal age
- Moderate to severe painless vaginal bleeding

11

Placenta previa- Mgmt

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

12

Abruptio placentae- Def

- 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

13

Abruptio placentae- Mgmt

- Treat shock, stabilize hemodynamic
- C-sectaion

14

Premature rupture of membranes- Def

- spontaneous rupture of membranes before labor
-

15

Premature rupture of membranes- Mgmt

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

16

Postterm pregnancy- def

> 42 weeks
- Increased risk of stillbirth
- Meconium aspiration

17

Postterm pregnancy- Mgmt

- Review dating of pregnancy
- Induction of labor at 41 wks

18

RhD isoimmunization- Assessment

- 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

RhD isoimmunization- Tx

- Anti-D immunoglobulin prophylaxis

20

RhD isoimmunization- Risks

- Hemolytic disease of newborn
- Kernicterus due to jaundice

21

Pregnancy induced HTN- Eti

AKA: gestational HTN
- HTN detected for 1st time after 20 wks pregnancy
- Absence of proteinuria

22

Pregnancy induced HTN- Dx

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

23

Pregnancy induced HTN- Tx

- Surveillance for progression to preeclampsia
- Monitor fetal growth

24

Pregnancy induced HTN- Risks

- Transition to preeclampsia
- Recurrence in future pregnancies

25

Preeclampsia- Tx

- Deliver as soon as possible
- Corticosteroids 48 hrs prior
- Severe: Initial delivery at 34 weeks

26

Preeclampsia- Risks

- Preterm birth
- Placental abruption
- Growth restriction

27

Eclampsia- Sx

Onset of seizures in preeclampsia

28

Eclampsia- Tx

- Seizures self limiting, don't medicate
- Prevent injury & aspiration
- Deliver once patient has stabilized
- Magnesium sulfate

29

Preterm labor- Eti

Age >20 wks, <37 wks
- Regular uterine contractions at freq intervals
- Cervical change or dilatation & effacement

30

Preterm labor- Sx

- More than 2 contractions in 1/2 hr
- Dilation & effacement of cervix
- Bloody show

31

Preterm labor- Tx

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

32

Preterm labor- Risks

- Wide variety, good survival with good preterm care
- Lower weight = lower survival

33

Large for gestation age- Eti

- Maternal diabetes, obesity, large stature

34

Large for gestation age- Sx

- Increased fundal height- >3cm
- Abdominal size

35

Large for gestation age- Dx

EFW > 90th percentile on US
- Macrosomia = 4500 g regardless of age

36

Large for gestation age- Risks

- Shoulder dystocia
- Prolonged labor
- postpartum hemorrhage
- Stillbirth

37

Large for gestation age- Tx

- C-section for > 5000 g
- Normal delivery if possible