Gestational Risk in Pregnancy

What are gestational conditions?

Disorders that did NOT exist before pregnancy and put mother and fetus at risk

What is hyperemesis gravidarum?

Excessive vomiting with dehydration, electrolyte imbalance, and ketonuria

When does hyperemesis gravidarum peak?

First trimester

Etiology of hyperemesis gravidarum?

Unknown; possible hormonal, GI, or psychosocial causes

When do most hyperemesis cases resolve?

By 12 weeks

Clinical manifestations of hyperemesis gravidarum?

Weight loss, dehydration, ↑ pulse, inability to tolerate PO, electrolyte imbalance

Initial treatment for hyperemesis gravidarum?

IV fluids, electrolyte replacement

Dietary management for hyperemesis?

Small frequent meals, high-protein snack before bed, bland foods, ginger

What medication is preferred for hyperemesis?

Diclegis

What medication is NOT safe in pregnancy for hyperemesis?

Zofran

When is hospitalization needed in hyperemesis?

Severe dehydration requiring IV fluids

What are hemorrhagic disorders in pregnancy?

Medical emergencies involving bleeding

Is bleeding in pregnancy normal?

No, ALWAYS requires investigation

Why is bleeding dangerous in pregnancy?

↓ oxygen-carrying capacity → ↓ O2 to mother and fetus

Maternal risks of hemorrhage?

Hypovolemia, anemia, infection, preterm labor

Fetal risks of hemorrhage?

Anemia, hypoxia, anoxia, preterm birth

What is miscarriage?

Spontaneous abortion

When do most miscarriages occur?

First trimester (8-12 weeks)

Most common cause of miscarriage?

Chromosomal abnormalities (50%)

Other causes of miscarriage?

Infection, immune, genetic, uncontrolled diabetes

What is a threatened miscarriage?

Spotting, closed cervix, fetal heartbeat present

Management of threatened miscarriage?

Bed rest, hydration, progesterone if low

What is inevitable miscarriage?

Open cervix, bleeding, cramping; loss unavoidable

What is incomplete miscarriage?

Some POC remain → requires D&C

What is complete miscarriage?

All POC expelled; closed cervix

What is missed miscarriage?

Fetus dead but retained; no symptoms; closed cervix

What is habitual aborter?

≥3 miscarriages

How is miscarriage viability assessed?

HCG levels 48 hours apart

What indicates viable pregnancy with HCG?

HCG doubles

What is D&C used for?

Remove retained products of conception

Why must POC be removed?

Prevent infection and hemorrhage

What is incompetent cervix?

Premature cervical dilation without contractions

When does incompetent cervix occur?

Around 16-20 weeks

Causes of incompetent cervix?

Cervical weakness, prior surgery, uterine anomalies

Treatment for incompetent cervix?

Cerclage

When is cerclage placed?

12-15 weeks

What is key teaching after cerclage?

Nothing in vagina

What is ectopic pregnancy?

Implantation outside uterus

Most common ectopic site?

Fallopian tube (ampulla)

Risk factors for ectopic pregnancy?

PID, STDs, tubal damage

Why is ectopic pregnancy dangerous?

Risk of rupture, hemorrhage, maternal death

Key symptom of ectopic pregnancy?

Unilateral severe abdominal pain

Other symptoms of ectopic pregnancy?

Spotting, missed period, adnexal fullness

What lab finding suggests ectopic pregnancy?

HCG >1500 with no intrauterine pregnancy

Treatment for ectopic pregnancy?

Methotrexate or salpingectomy

What is molar pregnancy?

Abnormal trophoblast growth with no fetus

What is hallmark of molar pregnancy?

Very high HCG

Clinical signs of molar pregnancy?

Dark brown bleeding, large uterus

Treatment for molar pregnancy?

Suction curettage

Why monitor HCG after molar pregnancy?

Detect recurrence or cancer

What is GTN?

Malignant trophoblastic disease

Cure rate of GTN?

100% if low-risk

What must patient avoid after molar pregnancy?

Pregnancy for 1 year

What is placenta previa?

Placenta over/near cervical os

Key sign of placenta previa?

Painless bright red bleeding

Risk factors for placenta previa?

Previous C-section, smoking, AMA

Diagnosis of placenta previa?

Ultrasound

Treatment for placenta previa?

Bed rest or C-section

What is placental abruption?

Premature separation of placenta

Key sign of abruption?

Painful dark bleeding

Other signs of abruption?

Boardlike abdomen, contractions

Risk factors for abruption?

Trauma, smoking, cocaine

What is velamentous cord insertion?

Cord inserts into membranes

Why is velamentous cord dangerous?

No Wharton's jelly → rupture risk

What is battledore cord insertion?

Marginal insertion of cord

Risk of battledore insertion?

Fetal hemorrhage

What is DIC?

Pathologic widespread clotting + bleeding

Cause of DIC?

Massive inflammatory response

Trigger of DIC?

Thromboplastin release

Signs of DIC?

Abnormal bleeding everywhere

Treatment of DIC?

Blood products, treat cause, O2

What is von Willebrand disease?

Clotting disorder affecting women

When does von Willebrand present?

Often postpartum

What is trauma in pregnancy?

Any injury threatening mother/fetus

What determines trauma severity?

Gestation, type, severity

Priority in trauma?

Stabilize mother first

Why stabilize mother first?

Fetal survival depends on maternal survival

What is most common cause of death in pregnant women?

Trauma

What monitoring is used after trauma?

Fetal monitoring

What is chronic hypertension in pregnancy?

HTN before pregnancy or before 20 weeks

What is gestational hypertension?

HTN after 20 weeks without proteinuria

What is preeclampsia?

HTN after 20 weeks with systemic symptoms

Pathophysiology of preeclampsia?

Vasospasm → ↓ perfusion → ischemia

Cause of preeclampsia?

Abnormal placental arteries

Risk factors for preeclampsia?

Obesity, age, infection, genetics

Severe preeclampsia BP?

≥160/110

Key symptoms of severe preeclampsia?

HA, blurred vision, RUQ pain

Lab findings in preeclampsia?

↑ AST/ALT, ↑ creatinine, ↓ platelets

Treatment for severe preeclampsia?

MgSO4, antihypertensives, delivery

Purpose of MgSO4?

Prevent seizures

Signs of Mg toxicity?

↓ RR, ↓ LOC, absent DTRs

Antidote for Mg toxicity?

Calcium gluconate

What is eclampsia?

Seizures in preeclampsia

Treatment of eclampsia?

MgSO4, seizure precautions, O2

What is HELLP syndrome?

Hemolysis, Elevated liver enzymes, Low platelets

Symptoms of HELLP?

RUQ pain, N/V, fatigue

Risks of HELLP?

Stroke, renal failure, death

Treatment of HELLP?

Delivery + stabilization

Fetal risks of hypertension?

IUGR, preterm birth, death

What is fetal kick count used for?

Assess fetal well-being