Flashcards in Nichols Last Minute 2: Pre Ecclampsia, and more Labor Deck (29):
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.
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.
What do placental cytokines block?
NO and Prostacyclin
What from the ischemic placenta makes a pro inflammatory, procoagulant state?
What is blocked that makes pre eclampsia a procoagulant state?
What in general happens to maternal circulation due to angry placenta?
Endothelial cell injury and HTN
What are the most concerning effects of PRECC on fetus?
What do placental arteries look like in PRECC?
atherosclerosis: fibrinoid necrosis
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
How does HELLP happen?
Activation of clotting cascade
Thrombi in liver sinusoids
Enzyme release from damage
What is a dire consequence of HELLP?
Liver rupture, hemorrhage
What percentage of HELLP becomes DIC?
What percent of HELLP die of it?
What are the main causes of placental ischemia and infarct?
How much infarct can the fetus stand to lose?
What impairs brain plasticity?
Alchohol in pregnancy
What is mole most likely to do? less?
Less likely: choriocarcinoma
What are the most common spots of choriocarcinoma spread?
End organ heme: kidney, spleen, liver, lungs
What is the potter sequence?
Oligohydramnios: renal agenesis
What are amniotic bands?
Mechanical fibrotic lesions
Cause limb stricture or amputations
What type of cord knots were mentioned?
Fake knot-clamp like
When are cord knots exacerbated?
What is the cause of placental abruption?
Rupture of deciduall blood vessels: retroplacental clot
What causes pulmonary embolism in delivery?
DVT due to IVC compression on leg
1 in 500
Amniotic fluid embolism sequellae?
Peripartum cardiomyopathy can do what 2 things?
1/3: resolve spontaneously
2/3: dilated cardiomyopathy
Peripartum cardiomyopathy most common in who?
DDx for breathing problems in labor?
Pulmonary edema: if PRECC
Amniotic fluid embolism
Magnesium sulfate toxicity if Tx for eclampsia