Medical Complications in Pregnancy Flashcards
Bleeding in pg
Causes in each trimester
First trimester
- abortion (+/- pelvic pain)
- ectopic pg (+ pelvic pain)
Second and Third Trimester
- Placenta previa (painless)
- Placental abruption (painful)
- Vasa previa
- cervical trauma
- vaginal infxs
- bloody show (in labor and cervix dilating rapidly)
Placenta previa
Definition
Etiology
RFs
Abnl location of placental over or close to os
Can be total, parital or marginal
Etiology - usually none is found
RFs
- prior c/s or h/o uterine curettage
- cocaine
- AMA
- tobacco
- increasing parity
- h/o previous previa (high risk of recurrence)
Placenta Previa
S/S
Dx
Management
S/S:
- most are asymptomatic
- painless vaginal bleeding
- with each bleeding episode gets more severe and unpredictable
- MCly presents around 29-30weeks
- uterus is soft, nontender, with no contractions
Dx
- can use US to detect placental location, but 90% of the time placenta moves out of the way before delivery
- f/u in 3rd trimester to confirm movement
Labs: CBC, Rh, type and screen, coags (DIC)
Management:
- can do expectant management with nothing PV, but more commonly do c/s
- try to get to 36weeks (optimal age because any past this will put at risk for more bleeding)
- double set up if wanting to try vaginal delivery
Placental Abruption
Definition
Complication
RF’s
Separation of the placenta from implantation site
Most serious complication is hypovolemia –> acute renal failure
Extremely high risk of recurrence
RF’s
- HTN disorders, preeclampsia
- Maternal trauma (MVA, etc)
- substance abuse: tobacco 90% inc’d risk, cocaine, alcohol
- ROM with rapid decompression of uterus
- uterine anomalies (PMH c/s, fibroids)
- extremes of maternal age
Placental Abruption S/S Classification Dx Tx
S/S
- vaginal bleeding
- painful and tender to paplation
- uterus tetanic
Classification
- Class 0: asymptomatic and dx’d retrospectively
- Class 3: severe bleeding with maternal shock/coagulopathy (DIC) and fetal death
Mangement:
- CBC, T&C, coags
- closely monitor vital
- assess fetal viability (>50% detachment usually –> fetal demise)
- Deliver if any maternal instability or if >34weeks
- expectant management if <34weeks, class 1, and stable
Vasa previa
Fetal vessels crossing or in close proximity to cervical os; risk of rupture when ROM
Classic triad:
- ROM
- painless vaginal bleeding
- fetal bradycardia
Rarely dx’d antenatally, but can be picked up with color doppler US
Emergent c/s
HTN in pg
MC medical disorder in pg
Second leading cause of maternal
Dx: >140/90 on at least 2 occasions
Nomenclature:
- preeclampsia, eclampsia
- chronic HTN
- preeclampsia superimposed on chronic HTN
- gestational HTN
Preeclampsia-Eclampsia RFs
Pregnancy-associated
- chromosomal abnlties
- hydrops fetalis
- multifetal pg
- structural congenital abnlties
- UTI
- donor sperm/egg
Paternal factors
- first time father
- previously fathered preeclamptic pg with another woman
- his mother was preeclamptic with him
Maternal factors
- extreme ages
- AA
- FHx
- nulliparity
- personal h/o preeclampsia
- DM, obesity, chronic HTN, renal dz, thrombophilias
Preeclampsia - Eclampsia
DX
Gestational BP elevation after 20weeks AND
Proteinuria >300mg in a 24 hr urine specimen OR
sxs of HA, blurred vision, abd pain; abnl lab tests (plt count, abnl AST/ALT)
Pts who are preeclamptic have inc’d risk of HTN, ischemic HD, stroke, and VE later in life
Chronic HTN
Gestational BP elevation before 20weeks
HTN that is dx’d for the first time during pg and does resolve postpartum
Risk for:
- abruption
- IUGR
- Preterm birth
- 15-25% develop preeclampsia or eclampsia
MC CAUSE OF IUGR
Gestational HTN
BP elevation without proteinuria that is detected for the first time after 20 weeks
Can be transient or become chronic
Management of preeclampsia
Prevention
- in high risk women, ASA and calcium supplementation are helpful
Acute HTN (DP >105-110 persistently)
- hydralazine, labetalol
Chronic HTN
- methyldopa (central alpha agonist), labetalol
Anticonvulsive
- MgSO4
Eclampsia
Preeclampsia + seizures
Signs:
- HAs, szs, hyperreflexia, increased peripheral resistance (RUQ pain, CVS stress, pulmonary edema, decreased GFR)
Treatment is delivery
- CAB
- Given MgSO4, avoid other AEDs
- prevent falls
Outcomes
- IUGR, abruption, death (maternal or fetal), coagulopathies (DIC, HELLP, hemolysis)
HELLP
Hemolysis, Elevated Liver enzymes, Low Platelet count
(variant of preeclampsia, may not meet criteria)
Hemolytic anemia; thrombocytopenia; high serum LDH; elevated AST
Sxs
- RUQ pain, nausea, emesis, HA
- BP may be nl, proteinuria may be absent
