Pregnancy Pathophysiology

Question 1

what is a spontanoues abortion

Answer 1

loss of pregnancy prior to 20weeks gestation

Question 2

what is a missed abortion

Answer 2

fetal demise without expulsion from uterine cavity

Question 3

what is threatened abortion

Answer 3

symptoms of abortion (bleeding/cramping) but fetus remains viable and os closed

Question 4

what can increase the risk of spontaneous abortion

Answer 4

advanced maternal age
infection
poorly controlled DM
ETOH
smoking
elicit drug use
obesity
thyroid dysfunction
medications

Question 5

what accounts for 70% of loss of pregnancy

Answer 5

genetic alterations

Question 6

what are maternal abnormalities that can lead to spontaneous abortion

Answer 6

fibroids
intrauterine scarring
trauma
cervical insufficiency

Question 7

what are causes of second-trimester miscarriage

Answer 7

chromosomal abnormalities
congenital brith defects
cervical insufficiency
placental problems
infections
abdominal trauma
thrombophilia
poorly controlled chronic condition
drug and alcohol use

Question 8

what is a septic abortion

Answer 8

infectious agent able to enter endometrium and/or myometrium
risk increased with unsafe abortion techniques, prolonged bleedings, surgical intervention

Question 9

what is the most common pathogens seen with septic abortion

Answer 9

enterobaceriaecaea, strep, staph
associated with procedure or retained products of conception

Question 10

what is the presentation of septic abortion

Answer 10

vaginal bleeding (POC), PID sxs, purulent vaginal discharge, fever, evidence of septicemia

Question 11

what is the inner layer of the fetal development

Answer 11

amnion

Question 12

what is the outer layer of the fetal development

Answer 12

chorion

Question 13

what is secreted that will cause continued stimulation to corpus luteum to secrete progesterone

Answer 13

chorionic gonadotropin

Question 14

what develops during the 2nd week of placental development

Answer 14

yolk sac and amnion development
yolk - nutrients initially
develop primordial germ cells
encourages development of vasculature, fetal RBC production

Question 15

when does the fetal heart begin to contract

Answer 15

day 21

Question 16

how does the blood get to the fetus

Answer 16

umbilical vein

Question 17

how does blood get from fetus to mom

Answer 17

via umbilical artery

Question 18

what does the placenta secrete

Answer 18

estrogens and progestins
takes over for corpus luteum at end of first trimester

Question 19

once the baby is developed, how much blood is exchanged every minute during the last week

Answer 19

625mL of blood

Question 20

what is premature separation of placental form to endo uterine lining

Answer 20

abruptio placentae - placental abruption

Question 21

what causes seperation of placenta from endometrium

Answer 21

break in vasculature
may be arterial or venous

Question 22

what is placenta previa

Answer 22

placenta develops over the cervix
thought to be associated with poor vascular supply in the typical upper uterine cavity attachment area

Question 23

what can increase the risk of placental previa

Answer 23

c-section or other trauma

Question 24

what is implantation of fertilized ovum outside of typical intrauterine site

Answer 24

ectopic pregnancy

Question 25

where is the most common location of ectopic pregnancy

Answer 25

fallopian tube may also occur within the cervix, ovary, abdominal cavity, previous scar tissue

Question 26

What is the presentation of ectopic pregnancy

Answer 26

POOP typically 6-8 weeks after LMP Pain typically along one of the lower quadrants vaginal bleeding may be in shock syncope

Question 27

what is the problem with cord prolapse

Answer 27

compression can cause occlusion of key vasculature - decreased O2 to fetus

Question 28

what are risks for cord prolapse

Answer 28

multiples premature delivery malformation of uterus low attached placenta prolonged labor long umbilical cord abnormal fetal presentation

Question 29

what can pre-eclampsia result in

Answer 29

maternal hypertension

Question 30

what occurs during preeclampsia

Answer 30

spiral artery remains narrow - placenta hypo-perfusion occurs 18-20 weeks gestation H20/Na retention- increased BP vascular dysfunction/inflammation - proteinuria

Question 31

What is HELLP syndrome

Answer 31

Hemolysis Elevated LiverEnzymes Low Platelets associated with preeclampsia

Question 32

what is eclampsia

Answer 32

extreme of preeclampsia severer HTN and seizures

Question 33

what is the treatment of eclampsia

Answer 33

magnesium* key

Question 34

what is normal amounts of amniotic fluid

Answer 34

500-1,000mL

Question 35

how often is amniotic fluid exchanged

Answer 35

every 3 hours, key electrolytes every 15 hours

Question 36

what are risk factors of PROM (premature rupture of membranes)

Answer 36

Trauma genetic predisposition inflammatory issues cigarette smoking

Question 37

what does PROM lead to

Answer 37

oligohydramnios

Question 38

what is oligohydramnios

Answer 38

loss of amniotic fluid

Question 39

when is primary postpartum hemorrhage usually seen

Answer 39

within 24 hours of delivery

Question 40

when is secondary postpartum hemorrhage usually seen

Answer 40

24 hours - 12 weeks after delivery

Question 41

What is am amniotic embolism

Answer 41

amniotic fluid is able to get into mom's circulation m/c occurs during labor or immediate postpartum

Question 42

when is amniotic embolism at an increased risk

Answer 42

premature delivery advanced maternal age abnormal attachment site of placenta preeclampsia c-section polyhydramnios

Question 43

what is heart failure seen in perimartum period

Answer 43

cardiomyopathy - typically third trimester

Question 44

what are risks for cardiomyopathy during pregnancy

Answer 44

advanced maternal age multiple gestation HTN african descent cocaine

Question 45

what is a compounded risk if mom already has a collagen disorder or cardiac malformation

Answer 45

arterial dissection/rupture

Question 46

what increases the risk of arterial dissection/rupture during pregnancy

Answer 46

increased abdominal pressure hormonal changes on vasculature

Question 47

when is intracerebral hemorrhage the highest risk

Answer 47

3rd trimester - also during postpartum period typically associated with preeclampsia/eclampsia