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Flashcards in Pregnancy Complications Deck (62)
1

Defn SGA

< 10%ile (can be symmetric or asymmetric)

2

Defn LGA

> 90%ile

3

Defn macrosomia

> 4500 g

4

Defn LBW

< 2500 g

5

2 types of SGA

IUGR = maternal systemic disease that causes decreased placental perfusion

low groth potential = congenital abnorlaities, teratogens, cigarettes

6

How is SGA managed

1. confirm accuracy of dating
2. serial US + umbilical artery doppler (checks underlying dz)

7

Serial US reults that differentiated IUGR vs low growth potential

IUGR = progressively falls off curve
low GP = stays small

8

What does revered diastolic flow on dopplar suggest

IUGR

9

What does low or absent diastolic flow on dopplar suggest

dec placental resitance

10

What are RF for having macrosomia baby

DM, maternal obesity, postterm preg, multiparity, advanced maternal age

11

Complications of macrosomia

birth trauma
hypoglycemia
jaundice
low apgars
childhood tumors
shoulder dystocia

12

How is LGA managed?

1. confirm accuracy of dating
2. consider IOL prior to macrosommia state

13

How is AFI calculated? Defn of oligiohydraminos and polyhydraminos

deepest pocket of amniotic fluid is found in each quadrant and added together to get AFI
AFI < 5 = oligio
AFI > 20 is poly

14

Causes of oligiohydraminos

ROM (MCC)
dec placental perfusion
dec fetal fluid prodiction
renal malformations (Potters seq)

15

Complications seen with oligiohydraminos

pulm hypoplasia
limb contractures
cord compression --> fetal asphyxiation --> death

16

oligiohydraminos + meconium in amniotic fluid, next step

anmioinfusion

17

Causes of polyhydraminos

congenital abn, diabets, Twin-Twin Transfusion Syndrome (TTTS), hydrops fetalis (edema, ascities, heart failure)

18

Complcations of polyhydraminos

cord prolapse

19

How is polyhydraminos managed

careful verification of presentation, obs for cord prolapse

20

What is erythroblastosis fetalis?

Rh- woman with Rh+ fetus, mom mans Abs to Rh factor,these cross the placenta --> hemolytic anemia in fetus --> hydrops fetalis (edema, ascities, heart failure)

21

What is the prevelance of Rh-?

15% in caucasions and lower in other races

22

When is rhogam administered

28 wks and postpartum if baby is Rh+

23

What is biggest risk with retained IUFD

DIC if fetus is left > 3 wks

24

What is the management of IUFD

deliver fetus and do autopsy to search for cause if unknonwn

25

What is defn of post term delivery

> 42 wks

26

What are complications of postterm delivery

macosomia, oligiohydraminoa, mecomium aspiration, IUFD, dysmaturity syndrome (see next card)

27

What is dysmaturity syndrome?

chronic IUGR from uteroplacental insufficiency

28

MCC post term delivery/pregnancy

inaccurate dating

29

When embryo undergoes cleavage, when does the chorion seperate and the amnion seperate?

chorion seperates day 4
amnion seperates day 8

30

When does cleavage happen to result in
Di di twins?
Mono-di-
Mono-Mono
Siamese twins?

Di di twins day 1-3
Mono-di day 4-8
Mono-Mono day 8-13
Siamese/conjoined twins day 13-15

31

mono vs di zygotic twins

mono = 1 sperm and 1 egg --> idential DNA (no predisposing factors)

dizygotic = 2 sperm an 2 ova

32

dizygotic twins have increased prevelance in

africans, IVF, clomiphene citrate

33

What are complications of multiple gestations

PTL, placental previa, postpartum hemorrhage, preE, cord prolapse, malpresentation, GDM, incompetent cervix

34

Management for....
Siamese/conjoined twins
mono-mono- twins
vertex/vertex twins
vertex, non-vertex twins
non-vertex/non-vertex twins
triplets and above

Siamese/conjoined twins = C/S
mono-mono- twins = C/S
vertex/vertex twins = vaginal
vertex, non-vertex twins = vag or C/S
non-vertex/non-vertex twins = C/S
triplets and above = C/S +/- selective reduction

35

What is TTTS? what kind of twins are at risk for this?

unequal bloodflow in shared placenta of mono-di- twins thar results in one small/anemia twin and one large/polycythemic twin

36

What is the management of TTTS

serial US q2wks in all mono-di twins --> tx with serial amnioreduction in larger twin

37

What is severe n/v + intolerance of PO diet

hyperemesis gravidarum

38

What should you r/o in all pts with hyperemesis gravidarum

molar pregnancy (get b-hCG)

39

When does morning sickness typically resolve

week 16

40

seizure threshold lowered or inc when pregnant

lowered

41

What is the etiology of most seizures in pregnancy

inc epileptic medication metabolism, dec pt compliance, dec seizure threshold, hormonal changesz

42

what is the teratogenicty of anti-epileptic drugs

folate antagonism --> neural tube defects
epoxide generation --> fetal hydantoin syndrome (IUGR, craniofacial malformations, etc)

43

How is a seizure d/o mananged in pregancy

monotherapy with lowest dose of Rx
at 19-20 wks klook for congenital anomales w/ US
folate supplementation
vit K supp at 27 wks

44

What pre-ext maternal heart dz is high risk in preg

pulm HTN
Eisenmenger syndrome
severe MS or AS (wait 1 yr after correction to get pregers)
marfan syndrome

45

how is preg managed in pts with high risk heart dz

terminate preg = first line
basline EKG + medical stabilization
d/c teratogenic drugsa (ACEi/ARBs, diuretics, coumadin)
at delivery: early epidural, careful fluid monitorins, abx ppx for SBE (bac endocarditis)

46

Peripartum cardiomyopathy management

Dx with ECHO ( dilated heart with ECHO 34wks and medical management if < 34 wks

47

Pts with mild renal Dz are at risk for

preEclampsia and IUGR

48

Management of preg women with renal transplant

increase immunosuppressants (prednisone) dosage bc there is an inc risk of acute rejection in preg

49

GFR for
stage 1 CKD
stg 2
3
4
5 (ESRD)

stage 1 CKD = 90-100
stg 2 = 60-89
3 = 30-59
4 = 14-29
5 (ESRD) = < 15

50

Management of DVT in preg

heparin or lovenox (enoxapain)
**warfarin is CI

51

management of PE in preg

heparin or lovenox (enoxapain); t-PA if <3hrs

52

How is hyperthyroidism in pregnancy managed

screen for tyroid stimulating immunoglobulins (TSIs)
if elevated, give PTU and monitor fetus for goiter and IUGR

53

Treatment for thyroid storm in preg

Beta blockers

54

what is infanthyperthyroism/cause?.

maternal TSIs cross placenta and attack fetal thyroid gland

55

What are common pregnancy complications in women with lupus

inc risk preeclampsia
IUGR
spontaneous abortion

56

How is SLE managed in pregnancy

low dose aspirin, heparin, or corticosteroids for ppx

57

how to differentiate between lupus flare and pre eclampsia?

check complement levels (SLE will have dec C3-C5)

58

What is the management for a lupus flare in preg

high dose corticosteroids, cyclophosphamide is unresponsive

59

What is neonatal lupus syndrome

maternal Ag-Ab complex crosses placenta anf cause lupus in neonate
**baby can also have congenital heart block 2/2 anti-ro (SSA) cross placenta and attack fetal heart --> 3rd degree block

60

Fetal alcohol syndrome characteristics

abn facies, IUGR, MR, bad heart

61

effect of caffine on preg

inc risk Spontaneous Ab with > 150mg/day

62

Effect of nicotine on preg

IUGR, placental abruption, PTD