Nichols Last Minute 2: Pre Ecclampsia, and more Labor Flashcards Preview

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Flashcards in Nichols Last Minute 2: Pre Ecclampsia, and more Labor Deck (29):
1

How does pre eclampsia begin?

Spiral arteries stay narrowed, placenta makes HTN inducing cytokines.

Trophoblast cells fail to convert spiral arteries from small caliber to large caliber, resulting in high pressure and placental ischemia.

2

Ischemic placenta releases what to cause pre eclampsia?

Decoy VEGF receptor (fms-like tyrosine kinase 1)
Decoy TGF-beta receptor (endoglin)

These block VEGF ad TGF mediated product of NO and Prostacycling, causing HTN, proteinuria, edema.

3

What do placental cytokines block?

VEGF
TGF
NO and Prostacyclin

4

What from the ischemic placenta makes a pro inflammatory, procoagulant state?

TNFalpha

5

What is blocked that makes pre eclampsia a procoagulant state?

Prostacyclin

6

What in general happens to maternal circulation due to angry placenta?

Endothelial cell injury and HTN

7

What are the most concerning effects of PRECC on fetus?

IUGR
HELLP
Eclampsia

8

What do placental arteries look like in PRECC?

atherosclerosis: fibrinoid necrosis

9

What happens in late stage ishemia of villi? early stage?

Early: accelerated maturation leads to more efficient gas exchange

Late: villous hypoplasia.. they die off

10

How does HELLP happen?

Activation of clotting cascade
Shearing hemolysis
Thrombi in liver sinusoids
Enzyme release from damage

11

What is a dire consequence of HELLP?

Liver rupture, hemorrhage

12

What percentage of HELLP becomes DIC?

20%!!! 1/5

13

What percent of HELLP die of it?

1%

14

What are the main causes of placental ischemia and infarct?

PRECC
hypercoagulatble states
autoimmune vasculitis
smoking

15

How much infarct can the fetus stand to lose?

50%

16

What impairs brain plasticity?

Alchohol in pregnancy

17

What is mole most likely to do? less?

Persistant mole
Less likely: choriocarcinoma

18

What are the most common spots of choriocarcinoma spread?

End organ heme: kidney, spleen, liver, lungs

Brain

19

What is the potter sequence?

Oligohydramnios: renal agenesis
Smush face
Contracted hands

20

What are amniotic bands?

Mechanical fibrotic lesions
Cause limb stricture or amputations

21

What type of cord knots were mentioned?

Full knot
Fake knot-clamp like

22

When are cord knots exacerbated?

2nd trimester

23

What is the cause of placental abruption?

Rupture of deciduall blood vessels: retroplacental clot

24

What causes pulmonary embolism in delivery?

DVT due to IVC compression on leg
1 in 500

25

Amniotic fluid embolism sequellae?

Cardio failure
Lung failure
DIC

26

Peripartum cardiomyopathy can do what 2 things?

1/3: resolve spontaneously
2/3: dilated cardiomyopathy

27

Peripartum cardiomyopathy most common in who?

Black women
Several children

28

DDx for breathing problems in labor?

PE
Pulmonary edema: if PRECC
Peripartum cardiomyopathy
Amniotic fluid embolism
Anxiety
Magnesium sulfate toxicity if Tx for eclampsia

29

What are the five leading causes of maternal death in US?

1. thrombus
2. hemorrhage
3. PRECC
4. infection
5. cardiomyopathy