OB HTN, Preecclampsia, low birth weight, macrosomia
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| Why is syphilis a predisposing factor for preeclampsia? | larger placenta.
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| Woman under 20 seizing is presumed to be | eclampsia
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| Underlying chronic hypertension that antecedes pregnancy | Coincidental HTN (ex: SLE, Collagen dz, renal transplant)
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| Underlying hypertension worsened by pregnancy | Pregnancy-aggravated HTN
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| Mild hypertension that develops after the mid-trimester that does not compromise pregnancy. Regresses after delivery | Transient HTN
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| Preconceptional and/or chronic risk factors | Partner related factors: nulliparity/primipaternity, limited sperm exposure, teenager, donor insemination, partner fathering preeclamptic pregnancy with another woman
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| 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)
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| 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
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| HELLP Syndrome (complication in 10% of severe preeclampsia/eclampsia) | Hemolysis, Elevated, Liver Enzymes, Low, Platelets. (major factor for maternal morbidity and mortality)
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| Classic presentation of HELLP | Primary sx: Malaise, fatigue. N/V, HA, RUQ Abd pain, Severe increase in BP, 3+ protein, 85% of the time
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| 1/3 of patients who seize, seize | after they deliver (post-partum)
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| 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.
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| Eclampsia worse if | Worse outcomes if occurs before 28 wk, if mother > 25 yr. multigravid, with pre-existing renal or hypertensive disease
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| Abruptio Placenta | Partial or complete detachment of placenta from uterine wall, after 20 wk gestationRisk factors: Cocaine use, maternal HTN, trauma
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| Sx of Abruptio Placenta | Bleeding, but may be entrapped (behind the placenta). May have pain. May get hypovolemic or shocky
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| Prevention of Preeclampsia | low dose ASA
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| Eclampsia | Distinction is the presence of a seizure.
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| Preeclampsia | risk of having a seizure
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| 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.
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| 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
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| 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
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| 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
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| Tx for GDM | Diet: 2000-25000, 3 meals and 2 snacks, blood glucose monitoring, insulin, exercise
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| FBG and 2 hr postprandial goals in pregnant DM | <100, <120
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| 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)
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| Birth Trauma | Brachial plexus injury (2.4%), Clavicular fx (1.7%), facial nerve injury (7.2%)
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| Macrosomia | Amniotic fluid volume: vertical pocket>8.0cm (33% incidence of macrosomia)vs. 7.8% normal fluid
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| Amniotic Fluid Abnormality | Polyhydramnios: DM, Fetal abnormalities, twins, hydrops. >25cm AFl on US
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| Amniotic Fluid Abnormality | Oligohydramnios: post dates, fetal growth restriction, renal abnormalities, premature rupture of membranes. <5cm AFl on US
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| Normal Amniotic fluid volume at term | 1L.
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| 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
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| 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
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| Diagnosis of FGR | return to
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| Starving baby | asymmetric growth: head is big, body is small
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| Etiology of Fetal Growth Restriction | Genetic factors, Infections, multifetal gestation
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| Greatest infx leading to FGR | Rubella (40-60% of cases)
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| 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
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| Doppler used | to measure perfusion. High S/D ration means baby is underperfusing
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| 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
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| 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
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