Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
OB Preeclampsia
OB HTN, Preecclampsia, low birth weight, macrosomia
| Question | Answer |
|---|---|
| Why is syphilis a predisposing factor for preeclampsia? | larger placenta. |
| Woman under 20 seizing is presumed to be | eclampsia |
| Underlying chronic hypertension that antecedes pregnancy | Coincidental HTN (ex: SLE, Collagen dz, renal transplant) |
| Underlying hypertension worsened by pregnancy | Pregnancy-aggravated HTN |
| Mild hypertension that develops after the mid-trimester that does not compromise pregnancy. Regresses after delivery | Transient HTN |
| Preconceptional and/or chronic risk factors | Partner related factors: nulliparity/primipaternity, limited sperm exposure, teenager, donor insemination, partner fathering preeclamptic pregnancy with another woman |
| Preconceptional and/or chronic risk: Maternal-specific risk factors | hx of prior preeclampsia, increasing maternal age, interval between pregnancy, fm hx, underlying maternal disorders (i.e. - CHBP, renal dz, DM, hereditary thrombophilias) |
| Severe PreEclampsia signs and symptoms | HA, Hyperreflexia (3+, ankle clonus), visual changes: photophobia, blurry, blind spots, Irritability, Epigastric (hepatic) pain of elevated liver enzymes, Edema: face, hands and abdomen; oliguria |
| HELLP Syndrome (complication in 10% of severe preeclampsia/eclampsia) | Hemolysis, Elevated, Liver Enzymes, Low, Platelets. (major factor for maternal morbidity and mortality) |
| Classic presentation of HELLP | Primary sx: Malaise, fatigue. N/V, HA, RUQ Abd pain, Severe increase in BP, 3+ protein, 85% of the time |
| 1/3 of patients who seize, seize | after they deliver (post-partum) |
| Eclampsia Definition | Seizure-->anoxia-->hypoxia-->hypoxemia-->uteroplacental insufficiency, possibly abruptio->fetal distress->fetal growth restriction, preterm brith, low birth wt. Can lead to maternal and/or fetal death. |
| Eclampsia worse if | Worse outcomes if occurs before 28 wk, if mother > 25 yr. multigravid, with pre-existing renal or hypertensive disease |
| Abruptio Placenta | Partial or complete detachment of placenta from uterine wall, after 20 wk gestationRisk factors: Cocaine use, maternal HTN, trauma |
| Sx of Abruptio Placenta | Bleeding, but may be entrapped (behind the placenta). May have pain. May get hypovolemic or shocky |
| Prevention of Preeclampsia | low dose ASA |
| Eclampsia | Distinction is the presence of a seizure. |
| Preeclampsia | risk of having a seizure |
| Risk factors for gestational diabetes | fm hx, overweight, >25, ethnic risk, prior macrosomic infant, prior stillbirth, chronic htn, glycosuria, BMI >/= 27. 4% of all pregnancies have gestational diabetes. |
| Screen at 24-48 wks with 1 hour glucola if >25 or fm hx of DM or ethnic risk. NML FBS and 2 HR GTT | not at risk. 2 Abnls or FBS>199, =GDM |
| maternal complications of GDM | Pre-eclampsia 4x more likely, bacterial infxn, macrosomia/shoulder dystocia, polyhydramios, ketoacidosis, preterm labor, 30-50% develop DM II in 10 yrs, 50-100% develop DM II in 20 yrs |
| Neonatal complications of GDM include: macrosomia (2-3x more likely: birth injury, hypoglycemia), Major anomalies (3x more likely: cardiac, neural, tube defects, skeletal) and | predisposition to DM and obesity, polycythemia, hyperbilirubinemia, pernatal moratlity 4x more likely |
| Tx for GDM | Diet: 2000-25000, 3 meals and 2 snacks, blood glucose monitoring, insulin, exercise |
| FBG and 2 hr postprandial goals in pregnant DM | <100, <120 |
| Shoulder Dystocia risk factors include: macrosomia (diabetes and postdates), maternal obesity adn excessive weight gain, previous infant>40000g, and | DM, prolonged second stage, prolonged deceleration phase (8-10cm), instrument midpelvic delivery, rapid descent of fetal head (vacuum, forceps) |
| Birth Trauma | Brachial plexus injury (2.4%), Clavicular fx (1.7%), facial nerve injury (7.2%) |
| Macrosomia | Amniotic fluid volume: vertical pocket>8.0cm (33% incidence of macrosomia)vs. 7.8% normal fluid |
| Amniotic Fluid Abnormality | Polyhydramnios: DM, Fetal abnormalities, twins, hydrops. >25cm AFl on US |
| Amniotic Fluid Abnormality | Oligohydramnios: post dates, fetal growth restriction, renal abnormalities, premature rupture of membranes. <5cm AFl on US |
| Normal Amniotic fluid volume at term | 1L. |
| Fetal growth restriction | specific pathologic term. birth weight at or below the 10th percentile for gestational age and gender occurs as a result of a pathologic process that inhibits expression of normal growth potential |
| Fetal growth restriction definition | weight<10th percentile. Risk factors: chronic vascular dz, htn, smoking, fetal abnormalities, multifetal gestation, abnormal placentation, poor maternal weight gain or nutrition |
| Diagnosis of FGR | return to |
| Starving baby | asymmetric growth: head is big, body is small |
| Etiology of Fetal Growth Restriction | Genetic factors, Infections, multifetal gestation |
| Greatest infx leading to FGR | Rubella (40-60% of cases) |
| Management of Fetal Growth Restriction | US for growth assessment, Antenatal testing (nonstress testing, biophysical profile, umbilical doppler), delivery with maturity or by 35 wks if evidence of compromise or poor growth |
| Doppler used | to measure perfusion. High S/D ration means baby is underperfusing |
| Long-term follow-up of FGR | high mortality in the first 2 years of life, decreased height and head circumference measurement at 4 years of age, intellectual deficits |
| PIH: Pregnancy Induced HTN: develops as a consequence of pregnancy and regresses post partum. NOTES: | HTN w/o proteinuria or pathologic edema; Preeclampsia- proteinuria and/or pathologic edema (mild or severe); Eclampsia: proteinuria and/or pathologic edema WITH convulsions |
Created by:
ltm12