Lecture 41 - Complications of Pregnancy

Question 1

Postpartum hemorrhage is defined as greater than or equal to _____mL blood loss with signs and symptoms of hypovolemia.

Answer 1

1000mL

Question 2

There are two types of postpartum hemorrhage, early and late. Early occurs within _____hrs and Late occurs after that time period. Which type is most common?

Answer 2

24hrs

Early is most common

Question 3

____ _____ is the most common cause of postpartum hemorrhage. This should make sense, knowing the contraction of the myometrium to close off the villus sinuses normally prevents blood loss.

Answer 3

Uterine Atony

Question 4

The most common cause of Late postpartum hemorrhage is retained products of conception –> often from implantation of the ______ somewhere it shouldn’t normally, and the uterus tries to expel it after birth. What is this called?

Answer 4

Placenta

Placental accreta

Question 5

What are risk factors for Uterine Atony?

Answer 5

Basically anything that makes the uterus Tired, Overstretched, or Abnormal.

Question 6

What is the relationship between hx of postpartum hemorrhage and risk for subsequent postpartum hemorrhage?

Answer 6

The risk for subsequent postpartum hemorrhages is directly correlated with the number and severity of previous postpartum hemorrhage.

Question 7

Amniotic fluid ______ is a risk factor for uterine atony. All of the cytokines released as a result decrease uterus contractility.

Answer 7

Embolism

Question 8

_______ placental lobe refers to an extra placental lobe, and this increases the risk for retained placenta (placenta accreta –> risk for Late postpartum hemorrhage). Also, anything that may cause damage to the ______ layer of the uterus can increase risk of retained placenta.

Answer 8

Succenturiate placental lobe

Myometrial

Question 9

Gestational HTN is defined as SUSTAINED Systolic BP greater than or equal to _____mmHg OR Diastolic BP greater than or equal to ____mmHg.

The severity of the HTN has a direct correlation with risk of Perinatal death –> There is increased risk for every _____mmHg increase in MAP.

Answer 9

140mmHg

90mmHg

5mmHg

Question 10

Preeclampsia is defined as GHTN with _______. Preeclampsia is considered severe if Systolic BP is > or = _____mmHg OR Diastolic BP is > or = ______mmHg.

Answer 10

Protenuria

160mmHg

110mmHg

Question 11

Eclampsia is defined as Preeclampsia with ______ (these are most likely to happen ____partum).

Answer 11

Seizures

Intrapartum

Question 12

One of the main pathophysiological issues with Preeclampsia and Eclampsia is ______ _____, which leads to ischemia/end-organ damage.

Answer 12

Arteriolar vasospasm

Question 13

HELP syndrome is common among patients with preeclampsia. What does HELP stand for?

Answer 13

Hemolysis
Elevated Liver enzymes
Low Platelets

Question 14

Human Placental Lactogen (HPL) is a hormone secreted by the placenta that can cause _______ resistance. This may result in gestational ______.

Answer 14

Insulin

Diabetes

Question 15

Evaluation of diabetes in pregnancy starts with a screening test. This involves administration of a 50g glucose load and measurement of blood glucose level ____ hr later –> > or = _____mg/dL will mean the patient requires a diagnostic test.

The diagnostic test must be done ______ (fasted or fed?). It involves administration of 300g of glucose and 4 measurements across 3hrs. ____ measurements > or = _____mg/dL is required for definitive diagnosis.

Answer 15

1hr later

140mg/dL

Fasted

2 measurements

140mg/dL

Question 16

White classification of Gestational diabetes is as follows:

Class A1 –> ______

Class A2 –> ______

Answer 16

A1 –> non-insulin dependent

A2 –> insulin dependent

Question 17

Preeclampsia is typically diagnosed in the _____ trimester. How does this change with gestational or pre-gestational diabetes?

Answer 17

3rd

More likely to be diagnosed earlier

Question 18

All forms of diabetes during pregnancy put the Fetus at risk for _______ (due to storage of the excess glucose as fat) and delayed organ maturity, especially the lungs. Which cells specifically in the fetal lungs are affected, and what do they do normally?

Answer 18

Macrosomia

Type II pneumocytes, which are responsible for producing surfactant.

Question 19

Preexisting diabetes is a risk factor for Fetal congenital anomalies. The most common Cardiovascular anomaly is a ______, however, _____ of the great vessels is more Characteristic of gestational diabetes.

_____ agenesis is typically pathognomonic for gestational diabetes, and the mother should be checked.

Answer 19

VSD (ventricular septal defect)

Transposition of the great vessels

Sacral agenesis

Question 20

Women who develop gestational diabetes are at risk of developing overt diabetes in a non-pregnant state. Thus, they need to be followed up with postpartum. This involves a glucose tolerance test with 70g oral glucose ____weeks postpartum.

Answer 20

6 weeks