Pre-eclampsia, fetal growth restriction, and stillbirth Flashcards Preview

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Flashcards in Pre-eclampsia, fetal growth restriction, and stillbirth Deck (36):
1

6 hypertensive disorders of preg

1. Gestational Hypertension – blood pressure elevation after 20 weeks of
gestation that is asymptomatic and not associated with proteinuria
2. Chronic hypertension – blood pressure elevation that predates
pregnancy (or may be first discovered in early pregnancy)
3. Pre‐eclampsia – new‐onset hypertension (generally) after 20 weeks of
gestation, accompanied by proteinuria, OR features of severe disease
4. Chronic Hypertension with super‐imposed pre‐eclampsia
5. HELLP Syndrome – Hemolysis, Elevated Liver enzymes, Low Platelets
6. Eclampsia – Encephalopathy associated with severe pre‐eclampsia
characterized by grand mal convulsions

2

features of pre-eclampsia

new onset HT+
protenuira OR
thrombopenia
liver enzymes
renal impariment

3

4 systems affected by pre-eclmpsia

1. fetus
2. renal
3. liver
4. brains

4

factors that increase preEC risk

– Advanced Maternal age
– High BMI
– Elevated BP
– PV bleeding >5days in 1st trimester
– Pre‐conception relationship

5

3 factors that reduce risk

1. smokingin T1
2. misscarriage same partner
3. attempt to conceive >12Mo

6

what is perfect placenta

disc with cord in middle and vessels all around

7

4 tests to consider

1. maternal characerisitics
2. IPS biochem
3. morphology
4. uterine artery doppler

8

what does multiply abnormal IPS indicate

75% PPV for preterm

9

what is bad morphology

small thick and with areas of poor development

10

what is placental insufficiency

chorion regression - doesn't grow around the cord

11

what does doppler help indicate

uteroplacental insufficiency

12

what is s-FLT1

- anti-angiogenic protein
- released from synsytio and contributes to maternal endothelial dysfunction - less angiogeneiese and more vasoconstiction

13

what does low PIGF indicate

low time to delivery

14

what to do in severe pre-eclmp or later in time

deliver

15

what is importance of eclampsia

#1 killer in low resource settings

16

treatment in antenatal perios

1. education and suveilace
2. steroids for lungs
3. oral HTs

17

what is treatment in intra-partum period

1. 1to1 nurse
2. fluid restriciton
3. MgSO4
4. antiHT
5. high dependency care
6. anasthesia

18

what can be helpful early on

aspirin

19

def. small for gestational age

Estimated Fetal Weight (EFW) or Birth Weight
below a specific centile

20

def. IUGR

Fetus failing to achieve it’s growth potential

21

3 general causes for IUGR

1. maternal/env.
2. placental
3. fetal - chromo, congential

22

what is key for screening IUGR

accurate dating

23

what is general screening

serial height and if

24

4 tests to screen in high risk women

same as preeclamp

25

what are 2 general presentations of IUGR

early and late (32weeks)

26

what is problem and prog in early and late

early: prob is MGMT - high MandM
late: prob is diagnosis - less mort

27

what is key to look at on doppler (3)

1. umbilical A
2. MCA
3. ductus venosus

28

def. stillbirth

delivery of dead fetus at >20wk or >500grm

29

2 types of still birth

1. antepartum (1/200)
2. intra-partum - rare in dev. world

30

what is most important preventable cause of stillbirth

failure to diagnose IUGR

31

what is modern most common epi associatiokn

BMI>30

32

ways to manage stillbirth

1. blood tests
2. induction of labor
3.supportive care
4. autopsy

33

how to measure fetal maternal hemmorage

measure HbF in maternal blood

34

interventions in low resource settings

1. diet
2. prevent malaria
3. detect syphylllis
4. detect IUGR
5. skilled birth attendants
6. OB services

35

most important way to prevent still birth in low resource

OB care

36

2 interventions to reduce still birth in canada

1. prevent preterm
2. ID loate onset IUGR

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