what does a BMI >35 indicate?
most likely to give stillborn birth after 28 wks
is warfarin safe during pregnancy?
no it is teratogenic
intrapartum risks for obese pts
induce labour, instrument delivery, C section, PPH
post partum risks for obese pts
difficulty breastfeeding, delayed wound healing, infection, PPD, PPH, big baby w/ large placental implantation site
anemia
- leads to maternal fatigue
- iron pills or iron transfusion
- SE of iron pills = n/v, constipation; encourage increase in fibre and fluids
- low blood flow and O2 to placenta = IUGR risk
causes of hemorrhagic disorders
- spontaneous abortion
- ectopic pregnancy
- placenta previa
- placenta abruptio
when is betamethasone given?
under 34 weeks gestation
when is magnesium sulphate given?
under 32 weeks gestation
what is antepartum hemorrhage?
- vaginal bleeding after 20 weeks
- causes: spontaneous abortion, placenta previa, placenta abruptio
s&s of ectopic pregnancy
sharp stabbing pain in lower abdominal quadrants
early birth loss
before 12 weeks
late birth loss
12-20 weeks
what can lead to profuse bleeding and maybe be life-threatening?
any bleeding or miscarriage after 12 weeks
causes of spontaneous abortion
- chromosomal issues
- teratogen exposure
- poor implantation
- endocrine imbalances
- GDM w/ uncontrolled blood sugars
- anti-phospholipid syndrome
- TORCH
TORCH
toxoplasmosis infections, STIs, rubella, cytomegalovirus, herpes simplex
what can late losses be due to?
maternal age, chronic infections, premature dilation of cervix, recreational drug use, poor diet
s&s of late loss
lower abdo ache, bleeding, passing of conception, cramps, lower back ache
later symptoms = cramping, heavy bleeding
types of abortion
threatened: woman put on bedrest and monitoring; spotting
incomplete: body expelled part of tissue and products of pregnancy
complete: all tissue opened, fetus lost
placenta previa
where placenta is implanted in lower segment of uterus; can be completely or partially over cervix
risk factors for placenta previa
previous previa advanced maternal age multipara multiple gestation pregnancy by in vito previous uterine surgery
manifestations of placenta previa
painless (unless in labour)
nontender, soft uterus
bright red vaginal bleeding
fetal HR normal/abnormal depending on O2 flow
key points with previa
- no vaginal birth or internal exam
- if under 34 wks, give betamethasone
- greatest risk to baby is being IUGR, sitting low in uterus, being preterm, or in malpresentation
- risk to mom: infection, endometriosis
placenta abruptio
when placenta is in right place but starts to detach itself, and maybe seals over; if active, will see bleeding
MOST COMMON CAUSE OF PERINATAL DEATH
s&s of placenta abruptio
sharp abdominal pain uterine tenderness increased tone abnormal FHR dark red vaginal bleeding
