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Flashcards in Nichols OB 2 Deck (36):
1

Pre-eclampsia is

a complication of pregnancy involving a systemic syndrome of maternal endothelial dysfunction causing:
- HTN
- Proteinuria
- Edema

2

What are some risk factors for pre-eclampsia

First pregnancy
Obesity
Age less than 20 or over 40
DM
Multiple pregnancies
HTN
long intervals between pregnancy

3

BOOM...SO, normally, spiral artery remodelling occurs when the Extra-villous trophoblast cells invade the myometrial spiral arteries going to the placenta and destroy the smooth muscle in their walls thus changing them from small caliber low flow arteries to Low resistance high flow arteries.

Pre-eclamptic trophoblasts fail to convert spiral arteries

4

How does pre-eclampsia form?

The ischemic placenta releases anti-angiogenic substances:
1) sFlt-1, a truncated form of VEGF receptor that acts as a decoy
2) soluble endoglin, a for of TGF-beta receptor that acts as a decoy

This blocks TGF and VEGF mediated production of nitric oxide and prostacyclin, causing maternal hypertension, proteinuria, and edema

5

Ischemic placenta also releases pro-inflammatory cytokines like tumor necrosis factor.

ok

6

What is the truncated VEGF receptor?

sFlt-1....acts as a decoy so VEGF binds it and doesn't work

7

What is the truncated form of TGF-beta receptor?

endoglin...acts as a decoy so that TGF-Beta doesnt bind

BOTH OF these decoys block the VEGF and TGF mediated production of prostacyclin and nitric oxide which would normally result in vasodilation. Instead you get hypertension, proteinuria and edema due to the HTN

8

Blockage of prostacyclin production makes Pre-eclampsia what kind of state?

Pro-coagulant

9

Pre-eclampsia leads to what in the fetus?

IUGR

10

Pre-eclampsia leads to what in the mother

Hypertension, DIC (disseminated intravascular coagulation (due to low prostacyclin levels), HELLP, and eclampsia

11

What is HELLP

Hemolysis, liver enzymes high, low platelets
HeLLp

12

Visible changes in placental arteries during pre-eclampsia resemble what non-pregnancy related condition

atherosclerosis

13

Dx of pre-eclampsia is warranted when?

New onset of HTN and proteinuria after 20 weeks gestation...KNOW

14

What question do you ask first when managing pre-eclampsia

Need to know how severe it is

15

If it is mild, tx includes

administration of corticosteroids to accelerate fetal lung development

16

If severe?

DELIVER THE KID

17

HeLLp

Hemolysis, Liver enzymes high, Low platelets

18

What the fuck is HeLLp

Well, we know that pre-eclampsia is a pro-coagulant state... In this state, clotting factors and plateletts are activated into fibrin clots which shred red cells causing hemolysis. The widespread clotting causes low platelett count, and thrombi in the liver injure hepatocytes (liver cells) which then release their enzymes

19

Most common causes of Placental ischemia and necrosis?

1) Pre-eclampsia is the overwhelming favorite
2) Hypercoagulable states
3) Autoimmune vasculitis
4) Smoking

20

Fetus can tolerate what level of placental infarction?

50%

21

Heavy drinking during pregnancy disrupts proper brain development in children and adolescents

Children with heavy alcohol exposure have reduced brain plasticity

22

Hydatidiform mole on pathology?

edematous grape-like chorionic villi

23

Choriocarcinoma spreads how

hematogenously

24

If choriocarcinoma spreads hematogenously, where does it go first?

LUNGS

25

First symptoms of choriocarcinoma?

Uterine bleeding

26

Treatment of choriocarcinoma

hysterectomy and chemo

27

What the hell does oligohydraminoas mean?

deficiency of amniotic fluid

28

What happens when there is too little amniotic fluid?

Basically there is no padding between the fetus and pressure coming from outside the placenta. Causes compressive injuries to the fetus BUT also causes pulmonary hypoplasia because the fetus needs to "breathe" for fetal lung development and absence of fetal urine in amniotic fluid due to fetal renal disease causes lack of lung development

29

Potter facies

flat face due to oligohydraminos

30

clubfeet and contractures of hands and feet due to

oligohydramnios

31

umbillical cord knots occur in what percent of pregnancies?

1%

32

What is placental abruption?

Bleeding at the decidual-placental interface which causes detachment before delivery of the fetus

33

Risk of Pulmonary thromboembolism is increased up to 50 fold during pregnancy

Risk is greatest during delivery and after

34

Amniotic fluid embolism

life threatening obstetric emergency due to acute cardiopulmonary failure from pulmonary vasospasm, hypertension, and right heart failure triggering pulmonary diffuse alvolar damage

35

What causes amniotic fluid embolism

Thought to be due to fetal and amniotic elements entering maternal veins as decidua detaches. Embolizes to the lungs where they react with vasospasm

36

Five leading causes of maternal death

thromboembolism, hemorrhage, pre-eclampsia, infection, cardiomyopathy