Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
10 Cards in this Set
- Front
- Back
|
Chronic Hypertension
|
Occurs prior to 20 week gestation
Separated into mild- BP 140/90 and severe- BP 180/110 Easy to diagnose if patient on prepregnancy antihypertensive Also if elevated BP persists after 12 weeks postpartum. Outcomes affected include an increased risk of Preterm labor Intrauterine growth retardation(IUGR) Fetal demise Placental abruption Cesarean section Useful evaluations may include laboratory testing including renal, liver function and blood clotting values Cardiac status-EKG, Echo Fetal status- serial US, nonstress testing(NST), doppler studies Institution of antihypertensive medication is dependent on Patient previously on treatment Worsening BP- over 160/100 Medications of choice include Aldomet(alphamethyldopa), labetalol(Beta blocker) ACE inhibitors are contraindicated Indication for delivery includes Term gestation Worsening hypertension unresponsive to treatment Superimposed preeclampsia Evidence of maternal or fetal compromise |
|
|
Pregnancy Induced Hypertension
|
Defined as hypertension after 20 weeks gestation without proteinuria and/or edema
Risk factors include theories of Immunological, genetic, dietary, vascular disruption, endothelial dysfunction and vasospasm Management similar to chronic hypertensives in terms of surveillance Modification of lifestyle may also play a role including diminished activities, decreased salt intake and addition of calcium or even aspirin products |
|
|
Preeclampsia
|
Hypertension
Proteinuria Edema Incidence 5% Risk factors Nulliparity Advanced maternal age Teenagers Chronic hypertension Renal disease Diabetes Family history Twins Molar pregancy Rare before 20 weeks Elevation of BP may be defined as a rise in the SBP of 30mmHg or 15mmHg DBP. Not always a BP of 140/90 Proteinuria defined as >300mg of protein in 24 hour period Severe defined as SBP>180, DBP>110 Proteinuria> 5 gms in 24 hours Oliguria- <400cc urine in 24 hours Associated with headache, blurred vision, and epigastric pain |
|
|
Eclampsia
|
All of the signs and symptoms of preeclampsia with the addition of generalized seizures
Marked increase in maternal and fetal morbidity and mortality-approaches 20% If remote from term- <35 weeks geatation- cautious observation with maternal and fetal surveillance is possible If term-deliver Vaginal delivery is preferred if cervix is favorable Magnesium Sulfate is the gold standard For prevention of eclampsia Should be started as soon as decision for delivery is made and continued for 24-48 hours after delivery Magnesium sulfate is excreted by the kidneys-must be careful since renal function is often compromised Side effects could include cardiac and respiratory suppression, pulmonary edema Calcium Gluconate is the antidote Close observation of the patient’s respirations, oxygenation, urine output and level of conciousness is necessary |
|
|
HELLP Syndrome
|
Hemolysis
Elevated liver enzymes Low Platelets Seen in 5% of severe preeclampsia Concern for DIC, placental abruption, liver capsular rupture |
|
|
Third Trimester Bleeding
|
Defined as bleeding occuring after 28 weeks gestation
Differential diagnosis includes Placental Abruption Placenta Previa Vasa Previa Trauma Tumor Rupture of Membranes Infection |
|
|
Placental Abruption
|
Occurs 1/200 deliveries
Etiology Advanced maternal age Grand multiparity Afroamerican race Pregnancy induced or chronic hypertension Premature rupture of menbranes Trauma Smoking Cocaine abuse Uterine fibroid Diagnosis Abdominal pain Bleeding Fetal distress DIC, Shock Workup includes exam and US Treatment If unstable deliver If stable and remote from term could observe Vaginal delivery is possible in some cases |
|
|
Placenta Previa
|
Incidence 1/300
Risk factors- Grand multiparity Advanced maternal age Smoking Prior uterine surgery (C/S) Diagnosis Painless vaginal bleeding US first! Vaginal US may play a role Mode of delivery C/S If patient stable and remote from term could manage expectantly with appropriate surveillance Use of steroids may be of benefit |
|
|
Abnormal Placentation
|
Placenta Accreta- growth of placenta through entire endometrium onto myometrium
Placenta increta- growth into the myometrium Placenta percreta- growth through the myometrium onto the serosa Frequent cause of postpartum hemorrhage May result in cesarean hysterectomy Risk from prior uterine surgery |
|
|
Vasa Previa
|
Rare cause of bleeding
Result of fetal vessels coursing over the amniotic membranes over the cervix High risk of fetal death Diagnosed by APT test with .25% NaOH Deliver by C/S |
