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25 Cards in this Set

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Pregnancy Blood changes
– Increase in fibrinogen, and all coag factors except II, V, XII
– Fall in protein S and sensitivity to APC (these are anti-coagulants)
– Fall in platelets and factor XI and XIII
- increase in WBCs
Quinidine and pregnancy
increased uterine activity
Digoxin and pregnancy
way increased doses required
ASA and pregnancy
low dose OK
b-blockers and pregnancy
increased risk for IUGR (growth restriction)
ACEI’s and ARBs in pregnancy
- OK in 1st trimester
- avoid in 2nd and 3rd trimesters due to oligohydramnios and renal dysplasia
Indomethacin
used for Superficial Thrombophlebitis
Warfarin and pregnancy
– in 1st trimester it causes embryopathy
– in 2nd trimester it causes optic atrophy, IVH
hydantoin syndrome
- from Dilantin, phenobarbital/carbamazepine (anti-seizure)
- Craniofacial defects (Hypertelorism, Cleft palate, Broad nasal bridge)
– Fingernail hypoplasia
– Developmental delay
renal diseases that Worsen with Pregnancy
– Reflux nephrology
– IgA nephropathy
– Focal glomerular sclerosis
– Membranoproliferative glomerulonephritis
cholestasis tx in pregnancy
– Cholestyramine is a bile resin you can try
– Ursodiol (Actigall) is a newer one but costs almost $500 a month
Chorion
– outermost membranous sac enclosing the embryo
– maternal blood fills villus space
– inside the villus are the fetal vessels
Amnion
innermost membranous sac enclosing the embryo
Chorionic villus
– placental structure where nutrient and gas exchange occurs
– core made of loose mesenchyme and fetal BVs and the villus
- surfaced by cytotrophoblast (CT) and syncytiotrophoblast (ST)
Accessory Placental Lobes
– risk of fetal bleeding when membrane ruptures
– may -> retained placental tissue
Chorioamnionitis
– Ascending infection from lower GU
– Maternal PMNs in fetal membranes respond to bacteria in amniotic fluid
– associated w/ PPROM
– Chorionic villi uninvolved
– from GBS, (-) enteric, anaerobes
Funisitis
– inflamm of umbilical cord
– Neutrophils in fetal vessels are fetal in origin and indicate that the fetus is responding to the bacteria in the amnionic cavity
Villitis
– Transplacental hematogenous dissemination
– bacteria, viruses, parasites, fungi
– TORCH most common (toxo, other, rubella, CMV and HSV)
– unknown etiology
– chronic inflamm in the villi
– can cause infection, IUGR, Fetal distress or demise
Atherosis
– maternal vessels in decidua
– Acute atherosis occurs in preeclampsia and causes a reduction in uteroplacental blood flow
– micro shows foamy histocytes
Abruptio placenta
clinical term for premature separation of placenta characterized by pain, uterine tetany, fetal distress & +/- DIC
Retroplacental hematoma
- pathologic correlate to abruption
– hematoma along maternal surface that can compress it
– associated with pre-eclampsia, trauma, ocaine use – can cause maternal blood loss, fetal hypoxia, preterm delivery, fetal death
Complete Hydatidiform mole
– Diploid, 46XX (46 XY) all paternal
– High HCG
– Diffusely hydropic villi
– Diffuse trophoblastic proliferation & atypia
– Embryo absent
– 20% persist post Rx
– 2% (1:40) develop choriocarcinoma
Partial Hydatidiform mole
– Triploid, 69XXX or XXY, dispermy
– Less elevated HCG
– Focal hydrops
– Focal trophoblastic proliferation
– Embryo present
– 7% persist post Rx
– Choriocarcinoma very rare
Maternal Serum Screen
– 2nd trimester (15-20 weeks)
– AFP, Estriol, bHCG (+/-inhibin A)
- good for detecting Spina bifida, Trisomy 18 and 21, and Smith Lemli Opitz
1st trimester Screening
– In Nuchal translucency, CRL is 39-79 mm and 10.5-14 wks gestation
– Serum analytes are PAPP-A and free beta hCG