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NNP I > PT, Biomarkers, Maternal Morality WK1 > Flashcards

PT, Biomarkers, Maternal Morality WK1 Flashcards

1
Q

PT: Incidence

A
  • Incidence - 11% preg
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2
Q

PT: Types

A
  • Spontaneous PT labor 45%
  • PPROM - <37wk, before onset labor, 25%
  • Medically indicated 30% PT birth
    • C/s
    • Induction labor
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3
Q

Spontaneous PT: Patho

A
  • Processes induce uterine contractions, cervical dilation, ROM
  • Decrease progesterone →
    • Inflammatory cytokines - TNF alpha, IL 10
    • Inhibition natural killer cells
  • Decrease maternal-fetal tolerance
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4
Q

PT: Risk Factors Race

A
  • AA
    • PT 18% vs 11% (esp EPT)
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5
Q

PT: Risk Factors SDOH

A
  • Education
  • Abnormal maternal age
  • <6m between preg
  • Single
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6
Q

PT: Risk Factors Enviornmental

A
  • Tobacco*
  • Cocaine
  • Air pollution - ozone, carbon monoxide, sulfur dioxide, lead
  • Toxicants - pesticides, heavy metals

NOT alcohol

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7
Q

PT: Risk Factors Nutrition

A
  • BMI >30
    *
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8
Q

PT: Risk Factors Infection

A
  • Intraamniotic infection
  • Mycoplasma species
  • Bacterial vaginosis (esp AA)
  • STI (esp AA)
  • Periodontal dx
  • UTI
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9
Q

PT: Risk Factors Genetic

A
  • Family hx
  • Hx PT
  • Gene to gene interactions

NOT single nucleotide polymorphisms

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10
Q

PT: Risk Factors OB

A
  • Abnormal vascular development placenta
  • Abnormal placentation
  • Vaginal bleeding
  • Overdistention uterus
  • Abnormal amniotic fluid volume
  • Anatomic abnormalities uterus
  • Hx cervical surgical intervention
  • Short cervix
  • Cervical insufficiency
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11
Q

Stillbirth: Defintion

A
  • >20wk in utero demise
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12
Q

Stillbirth: Incidence

A
  • Incidence - 5-6:1000 US preg
  • 80% stillbirths delivered <37wk
  • 50% stillbirths IUGR
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13
Q

Stillbirth: Association (3)

A

PT, Stillbirth, IUGR

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14
Q

IUGR: Biomarkers (2)

A
  • Decrease maternal serum PlGF placental growth factor predict severe IUGR
  • mass spectrometry - App C11/C11i0
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15
Q

Early Onset PE <34wk: Biomarkers (3)

A
  • PlGF
  • PAPP-A
  • Upregulation miR-210
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16
Q

PT before onset labor: Biomarkers (4)

A
  • C reactive protein
  • Corticotropin releasing hormone CRH
  • Neutrophil to lymphocyte ratio
  • HLA panel reactive antibodies
17
Q

Chorio: Biomarkers (2)

A
  • Amniotic fluid IL 6
  • IL 1beta (proinflammatory cytokine)
18
Q

PT: Biomarkers (2)

A
  • IL1RLI transcripts increase
  • Altered miRNA expression
19
Q

Autism: 2 Associations (4) (3)

A
  • Autism, PT, chorio, VLBW
  • Autism, maternal metabolic dx (obesity, DM), PE
20
Q

Metabolic Dx: Biomarkers (3)

A
  • Altered placental morphology - high BP child/adults, chronic heart failure adult
  • Placental CRH - decrease BMI but increase central adiposity child
  • Altered expression 8 miRNA - maternal obesity, weight gain parameters offspring
21
Q

Maternal Death: Definition

A
  • Maternal death - preg - <1yr end of preg
22
Q

Maternal Death: Types

A
  • Preg associated - NOT rt preg
  • Preg related - rt preg or aggravated by preg or its mgmt
23
Q

Maternal Mortality: GA Incidence

A
  • Top 10 maternal mortality rate
  • 60% preg related deaths preventable
24
Q

Maternal Mortality: Causes

A
  • Cardiomyopathy
  • Hemorrhage (very preventable)
  • CV dx
  • Embolism
  • PE and eclampsia (esp AA)
  • Amniotic fluid embolism
25
Q

Maternal Mortality: Risk Factors

A
  • AA
  • >35yr
  • Rural (esp AA)
26
Q

Maternal Mortality: GA Committee Recommendations

A
  • Extend medicaid coverage
  • Postmortem exam any maternal death
  • DPH develop model prenatal, postpartum, telehealth care for county health departments
  • Fund MMRC, GaPQC, AIM bundles
  • Statewide group prenatal care models
  • Obesity epidemic
  • RN home visit programs
  • GA rural healthcare workers
  • Medicaid streamline to enroll in WIC
  • Reach SDOH, disparities, genetics
  • CV and mental health telemedicine
  • Long acting reversible contraceptives
  • Public health awareness campaigns
  • Hospital hemorrhage bundle cart
  • Healthcare workforce racial sensitivity training
  • EMS expansion
  • Preg and postpartum data collection and analysis
  • Triton technology
  • Detailed death certificate reporting

NNP I (9 decks)

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