Term
| Maternal death occurs during pregnancy or within __ days after termination of pregnancy. |
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Definition
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Term
| The Maternal Mortality Ratio is defined as __ __ per ____ ___ __. |
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Definition
- maternal deaths per 100,000 live births
(582 in 1935, 8.9 in 2002) |
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Term
| The maternal mortality ratio is __ times higher for African Americans than it is for Caucasians. |
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Definition
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Term
| Factors that increase maternal mortality ratio: |
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Definition
- African American
- Older than 30 for all races |
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Term
| Major causes of maternal mortality (excluding ectopic) in order of most to least: |
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Definition
1. Pulmonary Embolus
2. Hypertensive Disorders
3. Hemorrhage and Sepsis |
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Term
| How long does it take for physiology to return to normal after pregnancy? |
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Definition
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Term
| Perinatal Mortality is __ __ (after __ weeks or greater than __grams) plus __ __ (up to __ days after delivery)/__ __ __. |
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Definition
| - [fetal deaths (after 20 weeks or greater than 500g)+ neonatal deaths (up to 28 days (4 weeks) after delivery)]/(1000 live births) |
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Term
| perinatal mortality = (fetal deaths + neonatal deaths)/1000 live births |
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Definition
Decreased from 29 in 1970 to <10 in 2000
AA 2x higher than caucasians
Higher for those without prenatal care |
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Term
| Perinatal death is __ times higher for African Americans than it is for Caucasians. |
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Definition
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Term
| death of the fetus after 20 weeks or 500 grams is fetal death. Prior to 20 weeks, this is considered miscarriage or abortion. |
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Definition
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Term
| When should high risk pregnancies be identified? |
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Definition
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Term
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Definition
- general history
- obstetrical history
- medical history
- physical exam
- laboratory studies |
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Term
| High risk pregnancy factors from general history: |
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Definition
- low socioeconomic status increases perinatal morbidity and mortality
- age
- substance abuse
- environmental factor
- domestic violence |
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Term
| Perinatal = __weeks pregant up to __ weeks after delivery. |
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Definition
| 20 weeks pregnant up to 4 weeks after delivery |
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Term
| Age younger than __ increases ones risk for: |
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Definition
- younger than 20
- premature births
- late prenatal care
- low birth weight
- uterine dysfunction
- fetal deaths
- neonatal deaths |
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Term
| Age greater than __ increases your risk for: |
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Definition
- 35
- first trimester abortion (40 3x higher than 30)
- Genetically abnormal conceptuses (trisomy 21, 18, 13, sex chro)
- Medical complications (HTN, DM, preeclampsia)
- Multiple gestations and its complications (3/1000 at age 20, 14/1000 at age 35)
- Higher rates of C-sections
- fetal morbidity and mortality |
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Term
| When __ and older, there is a greater risk that amniocentesis will damage the fetus. |
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Definition
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Term
| There is a tobacco __ __ __ between smoking and fetal m&m. |
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Definition
| dose response relationship |
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Term
| Cocaine, heroin, and marijuana are associated with ___. |
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Definition
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Term
| __ and __ cause neonatal withdrawal. |
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Definition
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Term
| __ can lead to premature labor and abruption. |
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Definition
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Term
Alcohol- FAS 0.1% of pregnancies. 2% drink daily. No known safe level. TACE questions
Caffiene- no increase in abnormalities, may be a higher rate of SAB with heavy use |
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Definition
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Term
KNOW THIS.
SMOKING INCREASES RISK FOR __ __. |
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Definition
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Term
| Radiation is associated with __ __, __ __, and __ __ (not seen with less than 5 rad). |
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Definition
- birth defects
- spontaneous abortion
- childhood leukemia |
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Term
| Noxious chemicals may make mom sick, but not known to harm baby |
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Definition
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Term
| High risk factors from Obstetric history: |
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Definition
- Parity
- Ectopic pregnancies
- Preterm deliveries
- Second trimester losses
- Macrosomnia
- History of perinatal death
- Cesarean delivery
- PIH
- chronic HTN |
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Term
| Nulliparous women have increased rates of __ __ __. |
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Definition
| pregnancy induced hypertension (PIH) |
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Term
| Grand Multiparas is defined as __ or more pregnancies resulting in viable fetuses have higher rates of __, __, and __ __. |
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Definition
- 5
- previa
- hemorrhage
- dizygotic twins |
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Term
| If one has history of ectopic pregnancy, increased likelihood of recurrence. |
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Definition
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Term
| If one has a history of preterm delivery, there is a _ to __% recurrence. |
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Definition
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Term
| PIH: gestational hypertension: high blood pressure 140/90 twice at least 6 hours apart, |
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Definition
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Term
| If a patient has HTN prior to 20 weeks of gestation, it is __ __ not __ __ __. |
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Definition
| - chronic hypertension NOT pregnancy induced hypertension |
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Term
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Definition
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Term
WHAT ARE THE NUMBER 1 AND NUMBER 2 RISK FACTORS FOR PRETERM DELIVERY:
TEST KNOW THIS |
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Definition
1. MULTIPLE GESTATIONS
2. HISTORY OF PRETERM DELIVERY |
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Term
| High risk from obstetric history, factors associated with history of second trimester loss: |
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Definition
- genetic problem with fetus
- problem with mother: incompetent cervix, may need cerclage |
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Term
| Macrosomnia is a risk factor from obsetric history, expand on this: |
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Definition
macrosomnia (>4000 g)
- previous glucose intolerance
- shoulder dystocia
- Cesarean delivery
- Postpartum neonatal hypoglycemia |
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Term
| After 10 weeks, chances of miscarriage decreases quite a bit. |
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Definition
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Term
| Mom’s feels lots of contractions and passes baby at 22 weeks and she HURTS |
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Definition
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Term
| If PAINLESS DILATION AND GOES INTO SEE DOCTOR |
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Definition
| incompetent cervix- put in cerclage at 14 weeks |
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Term
| In normal babies, the head should be the biggest part. With glucose intolerance/macrosomnia, sometimes the trunk is biggest part, so have to worry about it getting stuck. |
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Definition
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Term
| Postparum neonatal hypoglycemia: moms sugar high, baby sugar high, baby has insulin high, even after delivery insulin high> low blood glucose |
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Definition
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Term
| History of perinatal death may indicate underlying problems such as: |
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Definition
Glucose intolerance/ GDM
Collagen vascular dz
Congenital anomalies
Chromosomal abnormalities
Preterm labor
Hemolytic disease
Abnormal labor
Antiphosphilipid syndrome (APS)
Thrombophilia |
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Term
Cesarean delivery
Usually recommend attempted vaginal delivery unless: |
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Definition
Classical uterine incision
Active herpes infection
Sub adequate HIV control
Previous myomectomy with penetration into myometrium |
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Term
| previous C section deliveries are high risk deliveries. |
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Definition
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Term
| Classical uterine incision is going up and down> cannot deliver vaginally after that b/c high risk of uterine hemorrhage. |
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Definition
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Term
| If the viral load is less than ___ with HIV, the baby can still be delivered vaginally. |
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Definition
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Term
Rupture less than 1% with LTCS
transverse incision c section much less likely to rupture than classical incision |
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Definition
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Term
If you have severe pre-eclampsia in pregnancy> the chances of getting it next pregnancy is higher and more likely to get it earlier on in pregnancy.
Only way to cure preeclamplsia is delivery. |
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Definition
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Term
| Chronic HTN predisposes pts to the following when pregnant: |
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Definition
- Superimposed preeclampsia
- Placental abruption
- Perinatal loss
- Maternal morbidity
- Myocardial infarction
- Uteroplacental insufficiency
- CVA |
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Term
Cardiac Disease
May worsen in pregnancy because of the hemodynamic changes of pregnancy the following are associated with a high maternal mortality and termination usually recommended:
Eisenmenger syndrome
Primary Pulmonary Hypertension
Marfan with aortic root dilation
Hemodynamically significant mitral or aortic stenosis
Fetus depends on adequate supply of oxygenated blood, if not present, retarded growth may occur, or even death
Infants of parents with cardiac abnormalities have increased chances of cardiac disease |
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Definition
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Term
| The following cardiac diseases are associated with high maternal mortality and termination is recommended: |
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Definition
- Eisenmenger syndrome
- Primary Pulmonary HTN
- Marfan with aortic root dilation
- Hemodynamically significant mitral or aortic stenosis |
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Term
| Pulmonary diseases have unpredicatable responses with pregnancy |
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Definition
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Term
| Renal disease with pregnancy usually has good outcomes if the Cr is below __. Up to _ is normal in pregnancy b/c of the ___ GFR. |
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Definition
- below 1.5
- up to 1
- increased GFR |
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Term
| Diabetes in pregnancy increases risk of: |
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Definition
- congenital anomalies (2-3x)
- fetal mortality
- neonatal morbidity- RDS, macrosomnia, hypoglycemia, hyperbilirubinemia, hypocalcemia |
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Term
| Caudal regression syndrome and cardiac anomalies tend to occur in babies whose moms were ___. |
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Definition
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Term
| Thyroid disease in pregnancy if untreated is very bad. |
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Definition
| just don't give radioactive iodine to pregnant woman |
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Term
| SLE in pregnancy increases __ __, ___, and ___. |
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Definition
- placental abruption
- IUGR
- preeclampsia |
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Term
PREGNANCY IS A HYPER-COAGULABLE STATE.
OCPS INCREASE RISK OF THROMBOEMBOLIC EVENTS, BUT NOT EVEN CLOSER TO WHAT PREGNANCY DOES. |
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Definition
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Term
| Thromboembolic disease- pregnancy alone will predispose women to TE. Usually need anticoagulant prophylaxis if previous history of TE/PE. Warfarin causes birth defects. Heparin does not cross the placenta. |
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Definition
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Term
| If pregnant patient has history of PE or TE, probably needs to be on anticoagulant therapy. Put them on __ NOT __. |
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Definition
| heparin NOT warfarin b/c heparin does not cross placenta |
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Term
Genetic diseases- such as PKU can result in malformation if diet not followed
Consanguinity- increases SAB and recessive diseases
Ethnicity
Tay-Sachs (Ashkenazi Jews and French Canadians)
Canavan disease (Ashkenazi Jews)
Thalassemias (Mediterranean, SE Asian, Indian, African)
Sickle cell (African, Mediterranean, Caribbean, Latin American, Indian)
Cystic Fibrosis (Caucasian) |
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Definition
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Term
| Infectious diseases can place mother and fetus at risk if they occur during pregnancy |
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Definition
Cytomegalovirus-increased congenital anomalies
Herpes simplex virus- neonatal infection, potentially devastating
Toxoplasmosis- another reason to not like cats
Parvovirus- severe anemia, hydrops, fetal death
VZV- limb hypoplasia, neonatal disseminated infection
HBV- Vertical transmission
HIV |
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Term
| Toxoplasmosis: have lady with cat NOT change litter box and have person that changes it do it outside, people from France who eat raw meats are also at risk, also people on farms at risk. So if new onset of seizure not automatically preeclampsia, could be this. |
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Definition
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Term
| Parvovirus: pregnant woman who has been exposed to parvo> IgG and IgM to parvo and get an ultrasound to look for hydropic changes: edema that occurs due to severe anemia (antibodies destroying own blood cells> high output cardiac failure> third spacing). Tell them to be washing their hands and that they will probably be fine just do all these tests. |
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Definition
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Term
| VZV: limb hypoplasia, those motheres that have chicken pox and just delivered a couple of days ago> those are the babies you really worry about |
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Definition
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Term
| Autoimmune disorders may lead to: |
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Definition
Recurrent fetal loss
Placental infarction
Preeclampsia in early pregnancy
Thromboembolic phenomena
Autoimmune thrombocytopenia |
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Term
| Being short and underweight increases the risk for: |
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Definition
- preinatal morbidity and morality
- LBW
- preterm delivery |
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Term
| Obesity increases the chance of: |
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Definition
- HTN
- DM
- aspiration with anesthesia
- wound complications
- thrombembolism |
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Term
| High risk from physical exam: |
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Definition
Obstructive lesions of vagina, vulva, cervix
Pelvimetry revealing contracted pelvis
Uterine evaluation
Fibroids associated with higher rates of: SAB, premature labor, dysfunctional labor, pp hemorrhage, obstruction of labor if in lower uterine segment, unstable lie, compound presentation and pain from degeneration
Incompetent cervix
Mullerian anomalies- septae, bicornuate uteri, etc. |
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Term
| Breeches are NOT delivered any more. Singleton breech delivery> poor neonatal outcomes are higher and higher risk of develomental delays |
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Definition
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Term
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Definition
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Term
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Definition
Blood Type/ Ab screen- Rh isoimmunization =>hydrops => fetal demise
Minor antigens (Kell, Kidd, Duffy) can cause severe hydrops from anemia
Syphilis screen- disease can result in SAB, IUFD, congenital infection
Gonorrhea may cause chorioamnionitis, PPROM, PTD, neonatal eye infection, sepsis, maternal arthritis, rash or peripartum fever
Chlamydia can cause neonatal conjuctivitis, pneumonia, late pp endometritis |
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Term
| every kid gets eryhtromycin in their eyes when delivered |
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Definition
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Term
| Rubella infection can cause early abortion or severe congenital anomalies. Can only give vaccine ___ because it is a ___ ___vaccine. |
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Definition
postpartum
live attenuated |
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Term
| Asymptomatic bacteriuria (3-5% of pregnant women) Treat it. Acute pyelo will develop in 20-40% of untreated women. |
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Definition
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Term
| With Trisomy 21 positive screening, there is low __ ___ and __ and high __. |
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Definition
- low alpha fetoprotein and estriol
- high hCG |
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Term
| What would markers show on a positive trisomy 18 screen? |
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Definition
- low alpha fetoprotein
- low estriol
- low hCG |
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Term
| High alpha feto protein can be seen with: |
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Definition
- neural tube defects
- multiple gestations
- fetal demise
- abruption
- ompthalmocele
- gastroschisis |
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Term
| Unexplained MSAFP may be associated with third-trimester complications |
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Definition
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Term
| Cannot treat mom with Hep B during pregnancy. So when baby is deliveried give baby Hep B ___ within __ __ of delivery and then start __ __ __after delivery, then at 2 months, and 6 months. |
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Definition
- immunoglobulins within 1 hour
- vaccine 12 hours after delivery |
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Term
| Assessments of fetal well being: |
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Definition
Self assessment
Nonstress Test
Ultrasound
Contraction stress test |
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Term
| With a Non-Stress Test, have the mom lay on her __ side. The bottom line is mom's ___ and the top is the __ __ __. |
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Definition
- left
- contractions
- fetal heart rate
want to see see 2 accelerations at least 15 minutes above baseline lasting for at least 15 seconds |
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Term
| Ultrasound-Biophysical Profile components: |
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Definition
- NST
- Amniotic fluid > 2 cm
- Tone-flexion or extension of extremity
- Movement
- Fetal breathing-1 or 2 30 seconds
each one counts for 2
8 or 10/10 is reassuring these scores mean less than 1/1000 chance baby has died
if score of 6 at 36-38 week> deliver
if score of 6 at 30 weeks> think it through |
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Term
| The Umbilical Artery Doppler looks at umbilical artery __ __. You want a normal systolic/diastolic ratio. A __ ratio or __ __ __ indicates compromise. |
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Definition
- vascular resistance
- reduced ratio or reversed diastolic flow
Looking for reverse end diastolic flow.
When go through diastole, should still have forward flow, its just a lot less. But if the bottom peak of triangles is crossing the line> reverse flow, need to be delivered |
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Term
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Definition
Rarely used anymore
Similar to NST
Ocytocin (pitocin) use
or manual stimulation
If not sure if they will tolerate labor well> 3 contractions in 10 minutes > probably will tolerate labor? |
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