Pregnancy Complications Flashcards
(261 cards)
1
Q
What is the normal fetal heart rate range?
A
110-160 bpm
Normal fetal heart rate is critical for assessing fetal well-being.
2
Q
What is bradycardia in fetal heart rate monitoring?
A
FHR <110 bpm for >10 min
Bradycardia can indicate fetal distress.
3
Q
What is tachycardia in fetal heart rate monitoring?
A
FHR >160 bpm for >10 min
Tachycardia may also signal potential issues with the fetus.
4
Q
Define variability in fetal heart rate.
A
Fluctuations in baseline FHR, determined visually as amplitude of peak-to-trough in bpm
Variability indicates fetal well-being.
5
Q
What are the types of decelerations in fetal heart rate monitoring?
A
- Early
- Late
- Variable
Each type has different implications for fetal health.
6
Q
What does an early deceleration indicate?
A
Fetal head compression
Typically associated with uterine contractions.
7
Q
What does a late deceleration indicate?
A
Uteroplacental insufficiency
deceleration of the FHR happens after uterus contraction
This is a concerning sign requiring further evaluation.
8
Q
What does a variable deceleration indicate?
A
Umbilical cord compression
sudden decrease in FHR not correlated w/ uterine contractions
This can occur suddenly and is not always related to contractions.
9
Q
What is the purpose of monitoring fetal heart rate?
A
To assess fetal oxygen supply and detect hypoxia
Early detection of distress allows for timely intervention.
10
Q
What is the definition of chronic hypertension in pregnancy?
A
BP with systolic ≥ 140 and/or diastolic ≥ 90 mmHg prior to 20 weeks gestation
Chronic hypertension poses risks to both mother and fetus.
11
Q
What are the risks associated with chronic hypertension in pregnancy for the mother?
A
- Maternal mortality
- Cerebrovascular accidents
- Pulmonary edema
- Renal failure
- Planned cesarean section
- Postpartum hemorrhage
These risks necessitate careful management of blood pressure.
12
Q
What are the fetal risks associated with chronic hypertension in pregnancy?
A
- Preterm delivery
- Low birth weight
- Fetal growth restriction
- Perinatal mortality
- Stillbirth
- Congenital abnormalities
These outcomes underline the importance of monitoring and managing maternal blood pressure.
13
Q
What is the management goal for chronic hypertension in pregnancy?
A
120-139/80-89 mmHg
This target helps reduce risks to both mother and fetus.
14
Q
What is the diagnostic criteria for gestational hypertension?
A
BP with systolic ≥140 and/or diastolic ≥90 mmHg after 20 weeks gestation, without proteinuria
Diagnosis is often based on exclusion of other conditions.
15
Q
What is the management approach for preeclampsia without severe features?
A
- Complete H&P
- Lab work
- Assess fetal status
- Cure = delivery >37 weeks
- Monitor closely if between 34-37 weeks
- Consider steroids if <34 weeks
Delivery is the definitive treatment.
16
Q
What are the indications for magnesium sulfate in the management of preeclampsia?
A
Prevention and treatment of seizures
Magnesium sulfate is critical in severe cases to prevent eclamptic seizures.
17
Q
What does HELLP syndrome stand for?
A
- H: Hemolysis
- E: Elevated Liver enzymes
- L: Low Platelets
HELLP syndrome is a severe variant of preeclampsia.
18
Q
What are the end-stage consequences of severe preeclampsia for the mother?
A
- Cerebral hemorrhage
- Renal failure
- Pulmonary edema
- Seizures
- Liver rupture
- Thrombocytopenia/hemolysis
These complications highlight the need for close monitoring and timely intervention.
19
Q
What are the physiological effects of eclampsia?
A
New onset tonic-clonic seizures in absence of other causative conditions
Immediate intervention is necessary to stabilize the patient.
20
Q
What is the definition of eclampsia?
A
New onset tonic-clonic, focal or multifocal seizures
It occurs in the context of preeclampsia and requires urgent management.
21
Q
What is the definition of preeclampsia with severe features?
A
Preeclampsia with significant hypertension or end-organ dysfunction
This condition requires immediate delivery and management.
22
Q
What is the blood pressure reading of the patient during her first visit?
A
170/112
23
Q
What is the platelet count of the patient?
A
75,000
24
Q
What is the most likely diagnosis for the patient with elevated blood pressure and low platelet count?
A
Preeclampsia
25
What is the proper management for a patient diagnosed with preeclampsia?
Immediate delivery
26
What blood pressure reading did the patient have at her first follow-up visit?
183/111
27
What is the diagnosis if a patient has elevated blood pressure without symptoms like headache or blurry vision?
Gestational hypertension
28
Fill in the blank: The patient is a G2P0 female at ______ weeks gestation.
22
29
What lab work result returned for the patient after testing?
Normal
30
What is the correct management for a patient with chronic hypertension and low platelet count?
Platelet transfusion and delivery
31
True or False: Eclampsia can be diagnosed based solely on elevated blood pressure.
False
32
What physiological effects are associated with hypertensive disease in pregnancy?
Discuss physiological effects
33
What should be applied to diagnose hypertensive disease in pregnancy?
Diagnostic criteria
34
What is the blood pressure reading that indicates gestational hypertension?
175/107
35
Fill in the blank: The patient denies any headache or ______.
blurry vision
36
What is the objective related to electronic fetal monitoring?
Definitions and nomenclature
37
What should be characterized regarding fetal heart rate tracing?
Physiologic cause of abnormalities
38
What is the management plan that should be developed for hypertensive disease in pregnancy?
Management plan
39
T or F: Blood flow to the uterus peaks with every contraction.
false
there is no blood flow to the uterus during contraction
peak blood flow when uterus is in its most relaxed state
40
severe hypoxia of the fetus cause what to occur?
anaerobic metabolism kicks in leading to fetal acidosis
41
what is the long-term consequence of fetal hypoxia?
neurologic impairment
42
w/ intermittent auscultation, how do you calculate the fetal HR?
listen for 15 seconds then multiply that number by 4
43
what are CIs for internal fetal monitoring?
HIV
Hepatitis C
(device must come into contact w/ fetal scalp)
44
how is baseline fetal HR defined?
average FHR over a 10-minute period
45
what is absent variability?
amplitude range is undetectable
46
minimal FHR variability is defined as....
< 5 bpm
47
moderate FHR variability is defined as....
6-25 bpm
48
marked FHR variability is defined as....
> 25 bpm
49
what are accelerations?
abrupt increases in the FHR that is visually apparent on the monitor;
onset to peak is < 30 sec.
50
T or F: accelerations depend on gestational age
true
51
What is considered the normal acceleration from baseline before and after 32 weeks gestation?
before: FHR increase of at least 10 bpm for 10 sec
after: 15 bpm above baseline for 15 sec
52
T or F: accelerations that last b/t 2 & 10 minutes are considered to be a change in the baseline
false
in order to baseline to change, the accelerations have to last longer than 10 min
53
what are the parameters for a prolonged acceleration?
last more than 2 min but less than 10 min
54
what are the parameters for recurrent decelerations?
occur with >50% of contractions in a 20 min window
55
what are the parameters for intermittent decelerations?
occur with <50% of contractions in a 20 min window
56
T or F: the FHR is at its lowest point when the uterus is contracted
true
57
what are the parameters for normal uterine contraction intervals?
<5 contractions in 10 minutes averaged over 30 min
58
what are the parameters for tachysytole?
> 5 contractions in 10 min averaged over 30 min
59
tachystyole increases the frequency of what?
late decelerations
60
T or F: if fetal acid-base status reaches a Cat. 2, preventative measures must be taken to deliver the baby?
false
Cat 2 is indeterminate
cat 3 is when intervention becomes necessary
61
what are the parameters for reactive for a non-stress test?
2 accelerations of at least 15 bpm in a 20 min period
non-reactive is not good
62
BP medication should be considered when it reaches what parameters?
>140 systolic
or
> 90 diastolic
63
T or F: low-dose aspirin can delay the onset of preeclampsia if taken b/t 12-28 weeks gestation
true
64
what are the BP parameters for preeclampsia w/ severe features?
BP > 160 systolic and/or >110 diastolic
65
what are the postpartum signs of recovery from preeclampsia?
urine output- polyuria to get rid of excess fluid from the preeclampsia
also:
RR
patellar reflexes
66
What is the antidote for Magnesium sulfate toxicity?
calcium gluconate
67
what is given to stop eclampsia convulsions?
magnesium sulfate
68
T or F: Vaginal delivery is a CI for preeclampsia
false
69
What is the significance of amniotic fluid on fetal health?
Protection, freedom of movement, lung development, musculoskeletal development.
70
What are the methods for assessing amniotic fluid volume?
* Maximum vertical pocket (MVP)
* Four-quadrant assessment/amniotic fluid index (AFI).
71
Define oligohydramnios.
Too little amniotic fluid.
72
What are the clinical criteria for oligohydramnios?
* MVP < 2 cm
* AFI < 5 cm.
73
What are potential complications of oligohydramnios?
* Stillbirth
* Neonatal mortality
* Delayed/incomplete lung maturation
* Fetal distress during labor.
74
What is polyhydramnios?
Too much amniotic fluid.
75
What are the clinical criteria for polyhydramnios?
* MVP > 8 cm
* AFI > 25 cm.
76
List common etiologies for postpartum hemorrhage.
* Uterine atony
* Trauma
* Tissue (retained products of conception)
* Thrombin (coagulation disorders).
77
What is the definition of premature rupture of membranes (PROM)?
Any spontaneous rupture of membranes that occurs before the onset of labor.
78
What are major risk factors for PROM?
* History of preterm birth or PPROM
* Uterine overdistension
* Low BMI
* Nutritional deficiencies
* Cigarette smoking
* Short cervical length.
79
What is the management for term PROM?
* Induction of labor
* Assess fetal presentation and status
* Group B Streptococcus prophylaxis if indicated.
80
What is chorioamnionitis?
Infection of the uterine decidua, placenta, amniotic fluid, or membranes.
81
What are the key symptoms of chorioamnionitis?
* Fever
* Maternal tachycardia
* Uterine tenderness
* Malodorous/purulent discharge.
leukocytosis
82
What is the treatment for postpartum endometritis?
Antibiotic therapy.
symptoms are same as chorioamnionitis
83
What are the complications of cord prolapse?
Vulnerable to complete occlusion which can compromise fetal oxygenation.
84
Define placental abruption.
Separation of placenta from inner wall of the uterus before delivery.
85
What are the risk factors associated with placental abruption?
* Chronic hypertension
* Preeclampsia
* Abdominal trauma.
tobacco and cocaine use
86
What is the definition of postpartum hemorrhage?
Cumulative blood loss of 1000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process.
87
What are the '4 T's' that cause postpartum hemorrhage?
* Tone (uterine atony)
* Trauma (lacerations)
* Tissue (retained products of conception)
* Thrombin (coagulation disorders).
88
What is the gold standard for assessing amniotic fluid volume?
Inject inert dye into amniotic cavity via amniocentesis.
89
What is the expected management for patients with signs of infection during preterm PROM?
Deliver the patient.
90
What is the clinical definition of uterine atony?
Failure of the uterus to contract effectively after delivery.
91
What is the most common cause of postpartum hemorrhage?
Uterine atony
## Footnote
Uterine atony occurs when the uterus fails to contract effectively after delivery.
92
What are the risk factors for postpartum hemorrhage?
* Nulliparity
* Polyhydramnios
* Fetal macrosomia
* Placenta accreta
* Rapid labor and delivery
## Footnote
These factors increase the likelihood of complications during and after delivery.
93
What are the secondary complications of postpartum hemorrhage?
* RDS
* Shock
* DIC
* ARF
* Loss of fertility
* Sheehan syndrome
## Footnote
These complications can arise due to significant blood loss and may affect maternal health.
94
What are the 4 T's that cause postpartum hemorrhage?
* Tone – uterine atony
* Trauma – lacerations, rupture, hematoma
* Tissue – retained products of conception or invasive placenta
* Thrombin – coagulopathies
## Footnote
Understanding these causes helps guide treatment and management.
95
What is the management for uterine atony?
* Bimanual uterine massage
* Uterotonic agents (e.g., oxytocin)
* Surgery if refractory
## Footnote
Effective management is crucial to prevent severe complications.
96
What is the definition of uterine rupture?
Complete nonsurgical disruption of all uterine layers
## Footnote
This can lead to severe maternal and fetal complications.
97
What are the risk factors for uterine rupture?
* Scarred uterus (e.g., prior cesarean deliveries)
* Previous rupture in pregnancy
## Footnote
These factors increase the likelihood of uterine rupture occurring during labor.
98
What is placenta previa?
Presence of placental tissue over the internal cervical os
## Footnote
This condition can lead to significant bleeding during pregnancy.
99
What are the risk factors for placenta previa?
* Prior placenta previa
* Prior cesarean delivery
* Maternal factors
* Fetal factors
## Footnote
Understanding these risk factors is important for monitoring and management.
100
What are the types of placenta accreta?
* Accreta: attached to myometrium
* Increta: attached and penetrated the myometrium
* Percreta: penetrates through the myometrium and invades entire uterine wall
## Footnote
These classifications help in determining the management approach.
101
What is retained placenta?
Failure of the placenta to be expelled within 30 minutes of delivery
## Footnote
This condition requires prompt management to prevent complications.
102
What is the management for retained placenta?
* Manual removal
* Dilation and curettage (D&C)
## Footnote
These procedures help ensure complete removal of placental tissue.
103
What are the escalated interventions for postpartum hemorrhage?
* Hysterectomy
* Intrauterine tamponade
* Uterine artery embolization (UAE)
* B-Lynch procedure
* Bilateral uterine artery ligation (O’Leary sutures)
## Footnote
These interventions are critical in severe cases of hemorrhage.
104
What symptoms are indicative of Sheehan's syndrome?
* Dizziness
* Weakness
* Difficulty breastfeeding
* Skin dryness
* Sparse axillary and pubic hair
## Footnote
These symptoms suggest pituitary gland failure following severe postpartum hemorrhage.
105
What is the definition of a threatened abortion?
Presumed with any bleeding seen before 20 weeks of pregnancy
## Footnote
This condition is common and often resolves without further complications.
106
What is the most likely diagnosis for a woman with bright red vaginal bleeding and mild uterine cramping at 33 weeks gestation?
Placental Abruption
## Footnote
This condition is characterized by the premature separation of the placenta from the uterus.
107
What defines a complete abortion?
Complete expulsion of all products of conception (POC) before 20 weeks gestation
## Footnote
In this case, no further treatment is necessary after expulsion.
108
what is the major source of amnionic fluid?
fetal urine
regulated via fetal swallowing
109
T or F: amnionic fluid increases throughout the pregnancy
false
the increase plateaus at about 20 weeks gestation then steadily declines until birth
110
what are the main causes of polyhydramnios?
uncontrolled DM
congenital anomalies
aneuploidy
infection
111
What is the MOA of indomethacin?
PG inhibitor that decreases fetal urine
precaution: prolonged use can cause the ductus arteriosus to close prematurely
112
AROMs are done via what procedure?
amniotomy
113
what is the definition of a PROM?
spontaneous rupture of membranes before onset of labor
114
what is the definition of a PPROM?
rupture of membranes before 37 weeks gestation
115
PROMs increase the risk for what pregnancy complications?
risk of perinatal infection and umbilical cord compression
116
A + nitrazine paper test indicates what?
+ test = amniotic pH of 6-6.5
presence of amniotic fluid in vaginal canal
117
management of PPROM includes all that is done for PROM and the addition of what else?
PPROM defined b/t 34-37 weeks gestation
admin. betamethozone or dexamethasone to increase fetal lung development
118
What is the management protocol for PPROMs b/t 24-34 weeks gestation?
admin ABxs & corticosteroids to prolong latency to at least 34 weeks gestation
119
what is the purpose of admin. of magnesium <32 weeks gestation?
provides neuroprotection for the fetal and decreases the risk of cerebral palsy
120
T or F: it is not recommended to admin. GBS prophylaxis, corticosteroids, and magnesium before viability has been reached (currently defined as < 24 weeks gestation).
true
121
what is cord prolapse?
when the umbilical cord descends through the cervix before the fetal head
122
what is cord compression?
when there is a lack of amnionic fluid to protect the cord from compression b/t the fetus and uterine wall
123
what are the complications of placental abruption?
DIC, hypovolemic shock, fetal death, fatal hemorrhage, PROM
124
what is the definition of an inevitable abortion or miscarriage?
vaginal bleeding assoc. w/ cervical dilation before 20 weeks gestation
125
what is the definition of an incomplete abortion?
partial expulsion of some but not all uterine contents before 20 weeks gestation
assoc. w/ very heavy bleeding and cervical os is always dilated
126
what is the definition of a missed abortion?
no fetal heart tones detected before 20 weeks gestation
fetus has passed away in utero but is still in the uterus w/ cervical os closed
127
What is the difference between dizygotic and monozygotic twins?
Dizygotic twins arise from fertilization of two separate ova, while monozygotic twins arise from a single fertilized ovum that divides.
128
What factors influence the incidence of dizygotic twinning?
* Race
* Sex
* Heredity
* Nutrition
* Maternal age
* Parity
* Fertility treatment
129
True or False: The incidence of monozygotic twin births is generally independent of demographic factors.
True
130
What is the typical incidence of monozygotic twins worldwide?
Approximately 1 set per 250 births.
131
What does monochorionicity indicate?
Monochorionicity indicates monozygosity.
132
What are the types of placentation in twin gestation?
* Diamniotic Dichorionic (Di-Di)
* Diamniotic Monochorionic (Di-Mono)
* Monoamniotic Monochorionic (Mono-Mono)
* Conjoined Twins
133
Fill in the blank: Twins of opposite sex are almost always ______.
dizygotic
134
What is superfetation?
An interval as long as or longer than a menstrual cycle intervenes between fertilizations during an established pregnancy.
135
What is superfecundation?
Fertilization of two different ova at two separate acts of intercourse within the same menstrual cycle.
136
What is the significance of chorionicity in twin pregnancies?
Chorionicity is the more important determinant of twin-specific complications.
137
What are some common diagnostic methods for multifetal gestation?
* Palpation of fetal parts
* Fundal height measurement
* Doppler ultrasonic equipment
138
What is the typical fundal height measurement in multifetal pregnancies compared to singletons?
Fundal heights averaged approximately 5 cm greater than expected for singletons.
139
True or False: Accurate diagnosis of twins by palpation of fetal parts is reliable before the third trimester.
False
140
What is a characteristic ultrasound marker for dizygotic twins?
Dividing membrane thickness greater than 2mm.
141
What is the prevalence of congenital heart defects in monozygotic twins compared to the general population?
12-fold greater than the general population rate.
142
What is the mechanism behind spontaneous reduction in monozygotic twin pregnancies?
Occurs when one twin's heart is stronger, monopolizing the placenta's blood supply, causing the other twin to atrophy.
143
What is the estimated percentage of IVF twin pregnancies that may experience spontaneous reduction?
15 to 36 percent.
144
How can zygosity be determined in twin pregnancies?
Twins of opposite sex are almost always dizygotic. Rare instances may show different karyotypes or phenotypes.
145
What does the term 'vanishing twins' refer to?
A phenomenon where one twin atrophies due to unequal sharing of blood supply in single-ovum twins.
146
What is the role of assisted reproductive technology (ART) in monozygotic twin births?
Incidence of monozygotic twins is increased two- to fivefold in pregnancies conceived using ART.
147
What equipment can differentiate fetal heartbeats?
Doppler ultrasonic equipment
## Footnote
It can differentiate heart rates if they are distinct from each other and the mother's.
148
What percentage of women with undiagnosed twin pregnancies are diagnosed only at 26 weeks' gestation?
37 percent
## Footnote
This statistic applies to women who did not have a screening ultrasound examination.
149
What is the significance of fundal height measurement?
Fundal height exceeds gestation age in weeks
## Footnote
It is measured from the pubic symphysis to the top of the uterus.
150
What can sonography detect in the first trimester?
Fetal number, estimated gestational age, chorionicity, and amnionicity
## Footnote
Sonography has 98% accuracy in determining chorionicity in the first trimester.
151
What features are used to assess chorionicity after 10 to 14 weeks’ gestation?
Number of placental masses, thickness of the membrane, presence of an intervening membrane, fetal gender
## Footnote
These features help distinguish between dichorionic and monochorionic pregnancies.
152
What indicates a dichorionic pregnancy?
A thick band of chorion (>2mm) separating two gestational sacs
## Footnote
Monochorionic twins have a single gestational sac.
153
What is the 'twin-peak' sign?
Also known as the 'lambda sign', it confirms dichorionic twinning
## Footnote
It is seen when tissue from the anterior placenta extends between the amnion layers.
154
What is the 'T' sign in monochorionic diamniotic gestation?
Twins are separated only by a membrane created by juxtaposed amnions; monochorionic
## Footnote
A 'T' is formed where the amnions meet the placenta.
155
What is the role of abdominal radiography in multifetal gestations?
Used if fetal number in higher-order multifetal gestation is uncertain
## Footnote
It generally has limited utility and can lead to incorrect diagnoses.
156
What biochemical tests reliably identify multifetal gestations?
None
## Footnote
Serum and urine levels of β-hCG and maternal serum alpha-fetoprotein levels are generally higher with twins.
157
What should be done before amniocentesis?
Perform ultrasound
## Footnote
Amniocentesis should only be done with visualized ultrasound guidance.
158
What is the risk of infant death for twins compared to single births?
More than four times higher
## Footnote
The risk increases with the number of fetuses.
159
What percentage of all live births in the U.S. are multifetal births?
3 percent
## Footnote
However, they account for 15 percent of all infant deaths.
160
What is the most likely complication of a twin pregnancy?
Preterm birth
## Footnote
More than 50% of twin births and 90% of triplet births are preterm.
161
What physiological changes occur in maternal blood volume during multifetal gestation?
Blood volume expansion averages 50-60%
higher levels of alpha-fetalprotein and bCG
## Footnote
This is compared to 40-50% in singleton pregnancies.
162
What is the impact of multifetal gestations on maternal health?
Greater likelihood of serious complications
## Footnote
Risks include preeclampsia, postpartum hemorrhage, and maternal death.
163
What are common maternal complications associated with multifetal pregnancies?
* Hyperemesis Gravidarum
* Hypertensive Disorders
* Polyhydramnios
* Iron Deficiency Anemia
* UTIs
* Cardiomyopathy
* Post-partum Hemorrhage
* Miscarriage
* Maternal Death
## Footnote
These complications highlight the increased burden of multifetal pregnancies.
164
What is the average gestation for twins that deliver prematurely?
35 weeks
## Footnote
58% of twins deliver prematurely.
165
What are the risks associated with preterm birth in multifetal gestations?
* Respiratory Distress Syndrome
* Intracranial Hemorrhage
* Cerebral Palsy
* Blindness
* Low Birth Weight
## Footnote
These risks are significant for infants born preterm.
166
What is the twin infant death rate compared to singletons?
Five times higher than those seen in singletons
167
What is the increased risk associated with multiple gestations from ART?
Increased risk of intrauterine death of one or more fetuses
168
How much higher is the incidence of cerebral palsy in twin infants compared to singletons?
Five to six times higher
169
What condition is more common in twins, especially monozygotic twins?
Congenital anomalies
170
What is the most common complication in mono-amniotic twins?
Intertwined cord entanglement
171
Define Twin-Twin Transfusion Syndrome.
Intrauterine blood transfusion from one twin to another
172
In which type of twins is Twin-Twin Transfusion Syndrome most common?
Monochorionic diamniotic twins
173
What are the two conditions typically observed in Twin-Twin Transfusion Syndrome?
* Polyhydramnios around the larger (recipient) twin
* Oligohydramnios around the smaller (pump) twin
174
What is a serious complication associated with MoMo twins?
Cord entanglement with high mortality rate
175
What defines concordant twins?
Weight of smaller baby is within 10% of weight of larger baby
176
What is the definition of discordant twins according to ACOG?
15-25% difference in actual weight among twins
177
What typically causes marked size discordancy in dizygotic pregnancies?
Unequal placentation
178
List some factors that can cause size differences in twins.
* Fetal malformations
* Genetic syndromes
* Infection
* Umbilical cord abnormalities
179
At what gestational age do twin gestations typically deliver?
35-37 weeks
180
How do twins typically achieve lung maturity compared to singletons?
Two weeks early due to increased stress
181
What is the weight comparison between twins and singletons of the same gestational age?
Twins weigh less but are still within normal range
182
Is RH isoimmunization increased in twin gestations?
No, it is NOT increased
183
What type of twins are considered conjoined twins?
One ovum fertilized by one sperm with partial division after day 12
184
What can help reduce the risk of preterm labor in women carrying multiple gestations?
Adequate weight gain in the first 20 to 24 weeks of pregnancy
185
What does bed rest do in the context of preventing preterm labor?
Does not help and can lead to thromboembolic complications
186
What is the optimal mode of delivery for twins when one twin is in breech?
Cesarean Delivery
187
What are some problems associated with breech delivery?
* Head entrapment
* Umbilical cord prolapse
188
What is contraindicated in twins for the presenting twin?
External cephalic version
189
What should be done if one twin is head down?
Deliver twin and perform internal or external cephalic version
190
List different terms used to describe single pregnancies.
taber's
stedman's
191
T or F: 35 weeks is considered full term for twin pregnancies.
true
192
What preventative measures can be taken to avoid pre-term labor of twins
early adequate weight gain in the first 20 weeks gestation will help w/ placenta growth to deliver more nutrients to the twins
193
What are the risk factors for gestational diabetes?
* PMHx of GDM
* PMHx of Pregestational Diabetes Mellitus
* FHx of DM
* Previous birth of a baby weighing 9 lbs or more
* Pre-pregnancy BMI > 30 kg/m²
* Maternal age > 35 years
* Member of an ethnic group with high prevalence of Type 2 DM
* Polycystic Ovary Syndrome (PCOS)
* Hypertension
* Personal history of cardiovascular disease
* Physical inactivity
## Footnote
These factors increase the likelihood of developing gestational diabetes during pregnancy.
194
What is the pathophysiology of gestational diabetes?
* Exaggeration of physiologic changes of metabolism
* Insulin resistance due to human placental lactogen (hPL)
* Inability to overcome insulin resistance
* Beta-cell dysfunction in maternal pancreatic cells
Increased pancreatic insulin release
## Footnote
These mechanisms lead to persistent hyperglycemia and impaired glucose tolerance.
195
What are the adverse outcomes of hyperglycemia during pregnancy?
* Maternal:
* Hypertensive disorders (preeclampsia, gestational hypertension)
* Polyhydramnios
* Preterm contractions and labor
* Maternal respiratory compromise
* Placental abruption
* Umbilical cord prolapse
* Need for cesarean delivery
* Birth canal lacerations
* Hypoglycemia
* Fetal:
* Macrosomia
* Shoulder dystocia
* Brachial plexus injury
* Clavicle fractures
* Oxygen deprivation
* Premature birth
* Congenital malformations
## Footnote
These outcomes can significantly affect both maternal and neonatal health if not managed properly.
196
What is the recommended screening strategy for gestational diabetes?
* All patients at 24-28 weeks gestation
* One-Step Approach: 75g Oral Glucose Tolerance Test (OGTT)
* Fasting glucose, 1-hour, and 2-hour glucose measurements
* Two-Step Approach:
1. 50g non-fasting test
2. 100g fasting test if needed
## Footnote
The diagnosis is confirmed if one or more values exceed established thresholds.
197
What defines pre-gestational diabetes?
Diabetes diagnosed prior to pregnancy, encompassing Type 1 and Type 2 diabetes.
## Footnote
This condition requires careful management during pregnancy to prevent complications.
198
What are the categories of diabetes in pregnancy?
* Pre-gestational diabetes
* Gestational diabetes mellitus (GDM)
## Footnote
GDM is identified during pregnancy, while pre-gestational diabetes is diagnosed before conception.
199
What are the long-term maternal adverse outcomes associated with gestational diabetes?
* Type 2 diabetes mellitus (T2DM)
* Cardiovascular disease
## Footnote
These conditions may develop after pregnancy if gestational diabetes is not managed effectively.
200
What is the significance of early pregnancy in relation to glucose levels?
Increased pancreatic insulin release leads to lower glucose levels.
## Footnote
This metabolic adjustment is crucial for the health of both the mother and fetus.
201
Fill in the blank: Gestational diabetes affects approximately _____ of pregnancies in the United States.
8%
## Footnote
The incidence is rising due to factors like obesity and advanced maternal age.
202
True or False: Insulin resistance is the major mechanism seen during pregnancy.
True
## Footnote
This resistance necessitates increased insulin secretion to maintain normal glucose levels.
203
What is the cut-off for fasting glucose in the One-Step Oral Glucose Tolerance Test?
< 92 mg/dL
## Footnote
Values above this threshold indicate a positive test for gestational diabetes.
204
What are the short-term maternal adverse outcomes associated with gestational diabetes?
* Hypertensive disorders of pregnancy
* Polyhydramnios
* Preterm contractions and labor
* Maternal respiratory compromise
* Placental abruption
* Umbilical cord prolapse
* Need for cesarean delivery
* Birth canal lacerations
* Hypoglycemia
## Footnote
These complications can arise if gestational diabetes is not effectively managed.
205
What is the impact of polyhydramnios in gestational diabetes?
Excess amniotic fluid due to fetal hyperglycemia leading to fetal polyuria.
## Footnote
This condition can increase the risk of fetal anomalies and complications.
206
What are the screening recommendations for low-risk patients regarding gestational diabetes?
No past history of glucose intolerance or adverse pregnancy outcomes, normal BMI, and younger age (under 25).
## Footnote
Only 10% of the general obstetric population meets all criteria for low risk.
207
What is macrosomia?
Macrosomia is defined as a birth weight greater than 4000 g.
208
What are common complications associated with macrosomia?
* Shoulder dystocia
* Clavicle fracture
* Brachial plexus injury
* Intrauterine death
209
What is the most common complication of gestational diabetes mellitus (GDM)?
Macrosomia
210
What maternal condition leads to excessive fetal growth in GDM?
Maternal insulin resistance
211
What is the threshold for fetal weight to be classified as large for gestational age (LGA)?
Greater than the 90th percentile for gestational age
212
What are neonatal adverse outcomes associated with GDM?
* Hypoglycemia
* Polycythemia
* Hyperbilirubinemia
* Hypocalcemia
* Respiratory distress syndrome
213
What causes hypoglycemia in neonates born to mothers with uncontrolled GDM?
Excess insulin secretion in response to maternal hyperglycemia.
214
What is the clinical presentation of neonatal hypoglycemia?
* Jitteriness
* Tremor
* Diaphoresis
* Irritability
* Tachypnea
* Poor muscle tone
* Hypothermia
* Seizures
* Lethargy
* Coma
* Cyanosis
* Apnea
* Bradycardia
215
What defines neonatal polycythemia in terms of hematocrit?
Venous hematocrit greater than 65% within 12 hours of birth.
216
What leads to the development of hyperbilirubinemia in neonates of mothers with GDM?
Excess RBCs leading to increased bilirubin load.
217
When does hypocalcemia typically peak in neonates?
Between 24 and 72 hours after birth.
218
What condition causes respiratory distress syndrome (RDS) in infants born to diabetic mothers?
Surfactant deficiency due to delayed lung maturation.
219
What is the first-line treatment for managing gestational diabetes?
Lifestyle modification.
220
What dietary recommendations are made for gestational diabetes management?
* 1800-2500 calories/day
* 3 meals/day + 2-3 snacks
* Balanced nutritional plans
221
What is the first-line pharmacologic treatment for gestational diabetes if lifestyle modification is insufficient?
Insulin
222
What are the glycemic targets for maternal management in gestational diabetes?
* Fasting glucose < 95 mg/dL
* 1-hour postprandial < 140 mg/dL
* 2-hour postprandial < 120 mg/dL
223
What is recommended for fetal monitoring in gestational diabetes during the third trimester?
* Nonstress tests (1-2x/week)
* AFI serial measures
* Ultrasound at 36 to 39 weeks to estimate fetal weight
224
What is the recommended follow-up for patients with GDM postpartum?
* Monitor for neonatal hypoglycemia
* Screen for T2DM 4-12 weeks postpartum
225
At what BMI is a woman classified as obese in the context of gestational diabetes?
BMI ≥ 30 kg/m²
226
What is the appropriate next step in management for a woman with a 1-hour glucose challenge test result of 160 mg/dL?
Perform a 3-hour oral glucose tolerance test (OGTT).
227
True or False: Metformin crosses the placental barrier.
False
228
What are the clinical signs of respiratory distress syndrome in neonates?
* Tachypnea
* Nasal flaring
* Cyanosis
* Expiratory grunting
* Intercostal retractions
229
What is the best next step in management for a pregnant woman with gestational diabetes whose fasting blood glucose levels remain consistently above 95 mg/dL?
Start insulin therapy
## Footnote
Insulin therapy is often necessary when dietary modifications are insufficient to control blood glucose levels in gestational diabetes.
230
What is the most likely complication for a pregnancy diagnosed with gestational diabetes and an estimated fetal weight above the 90th percentile?
Macrosomia
## Footnote
Macrosomia refers to an excessive birth weight, often associated with gestational diabetes.
231
What best explains the pathophysiology of gestational diabetes mellitus?
Placental hormone-mediated insulin resistance
## Footnote
Hormones produced by the placenta can lead to insulin resistance, contributing to gestational diabetes.
232
Which is the most significant risk factor for gestational diabetes in a patient with a history of a large birth weight baby?
Past medical history
## Footnote
A history of a previous large baby (macrosomia) is a significant risk factor for developing gestational diabetes in subsequent pregnancies.
233
Which complication is most likely to occur in a third-trimester pregnancy with gestational diabetes and a high BMI?
Shoulder dystocia
## Footnote
Shoulder dystocia is a potential complication during delivery due to the larger size of the baby associated with gestational diabetes.
234
What is the recommended next step in management for a patient diagnosed with gestational diabetes who is not on any medications?
Diet and exercise
## Footnote
Lifestyle modifications including diet and exercise are first-line management strategies for gestational diabetes.
235
What is the classification of newly-onset glucose intolerance occurring in the second or third trimester of pregnancy?
Gestational Diabetes Mellitus (GDM)
## Footnote
GDM is characterized by glucose intolerance that develops during pregnancy.
236
What percentage of pregnancies in the US are affected by gestational diabetes?
Almost 8%
## Footnote
The prevalence of gestational diabetes is notable and varies with factors such as age and ethnicity.
237
What are the common risk factors for gestational diabetes?
* Past medical history
* Family history
* Ethnicity
* Maternal age
* Body Mass Index
## Footnote
These factors can contribute to the risk of developing gestational diabetes during pregnancy.
238
What is the typical screening period for gestational diabetes during pregnancy?
24-28 weeks
## Footnote
Screening for gestational diabetes typically occurs between the 24th and 28th weeks of gestation.
239
What type of glucose management is recommended for gestational diabetes?
* Lifestyle changes
* Insulin or oral agents
* Close monitoring
* Postpartum screening
## Footnote
Effective management of gestational diabetes often includes a combination of lifestyle changes and medical interventions.
240
What is the focus of preconception counseling in relation to diabetes?
Evaluation and management of preexisting or gestational diabetes
## Footnote
This counseling is crucial to optimize maternal and fetal health before pregnancy.
241
Shoulder dystocia is associated with which key aspects during childbirth?
Intrapartum diagnosis, management, and outcome
## Footnote
Understanding these aspects is essential for effective intervention during delivery.
242
What does the initial assessment in prenatal care include?
Comprehensive evaluation of maternal and fetal health
## Footnote
Initial assessments help establish a baseline for ongoing prenatal care.
243
What is the main concern of gestational diabetes?
It affects glucose metabolism during pregnancy
## Footnote
Management is crucial to prevent complications for both mother and child.
244
What is preeclampsia characterized by?
Hypertension and proteinuria during pregnancy
## Footnote
It poses significant risks to both mother and fetus if not managed properly.
245
Fill in the blank: The last update for shoulder dystocia management was in _______.
June 2024
246
True or False: Prenatal care does not require any initial assessments.
False
247
What is the publication date of the article on gestational diabetes in the British Journal of Midwifery?
August 2, 2018
## Footnote
This article contributes to clinical practice knowledge on managing gestational diabetes.
248
What is the significance of the Access to Medicines Platform in relation to preeclampsia?
It aims to improve access to medications and health systems strengthening
## Footnote
This initiative supports universal health coverage in Kenya.
249
What is the primary goal of preconception counseling for women with diabetes?
To optimize health outcomes before pregnancy
## Footnote
This includes managing diabetes effectively to prevent complications.
250
What type of diabetes occurs during pregnancy?
Gestational diabetes
## Footnote
It can develop in women who did not have diabetes before becoming pregnant.
251
what is GDM?
hyperglycemia first identified during pregnancy
252
What factors are considered protective against GDM?
no PMHx of glucose intolerance
No FHx of DM
females < 25 yrs. of age
normal BMI
non-hispanic white people
253
If blood glucose measures > 140 mg/dL what is the next step?
give 100 g oral glucose challenge
if 2 or more values are elevated for fasting - 3 hrs., the GTT is positive
254
how is preeclampsia defined?
HTN and proteinuria after 20 weeks gestation
255
The ADA recommends what for prophylaxis of preeclampsia?
preggies w/ preexisting DM should begin low dose aspirin at 12-16 weeks gestation
256
What is Erb palsy?
upper brachial trunk injury resulting in internally rot. and abducted arm
extended and pronated forearm
flexed wrist
water's tip posture
257
what is Klumpke palsy?
lower brachial trunk injury resulting in extended MCP joints and flexed IP joints
claw hand deformity
258
what complication can arise from fetal hyperinsulinemia in GDM?
chronic intrauterine hypoxemia leading to increased RBC production and polycythemia-leads to subsequent hyperbilirubinemia due t o excess heme break down
259
what are the signs and symptoms of neonatal hypocalcemia?
jitteriness, apnea, tachypnea, seizures respiratory distress, asphyxia
260
What are the parameter goals for managing GDM throughout the pregnancy?
fasting < 95
1 hr. postprandial < 140
2 hr. postprandial < 120
checks levels 4 times daily
261
what are the DM screening recommendations for the neonate?
continue screening 4-12 weeks postpartum and then every 1-3 yrs. after that since the baby will be at increased risk for DM
