Complications of Pregnancy – Week 5 Lecture

Vocabulary flashcards covering key terms, conditions, medications, risks, assessments, and treatments discussed in the Week 5 ‘Complications of Pregnancy’ lecture.

Preterm Labor (PTL)

Regular uterine contractions with cervical change occurring between 20 0/7 and 36 6/7 weeks’ gestation.

Viability (pregnancy)

Gestational age at which a fetus is considered capable of survival outside the uterus; lecture reference ≈ 25 weeks.

Very Preterm

Birth that occurs before 32 0/7 weeks’ gestation.

Late Preterm

Birth that occurs from 34 0/7 to 36 6/7 weeks’ gestation.

Tocolytic

Medication used to suppress uterine contractions for up to 48 h to allow steroid administration; e.g., terbutaline, nifedipine, magnesium sulfate (tocolytic use), indomethacin.

Magnesium Sulfate (neuro-protection)

IV medication given <32 weeks to reduce risk of cerebral hemorrhage and cerebral palsy in preterm neonates; therapeutic level 4-8 mEq/L.

Magnesium Sulfate (tocolysis)

High-dose IV magnesium used to relax uterine muscle; nursing priority is monitoring for respiratory depression and absent DTRs.

Calcium Gluconate

Antidote for magnesium-sulfate toxicity; keep 1 g IV at bedside.

Betamethasone

Antenatal corticosteroid: 12 mg IM q24 h × 2 doses to accelerate fetal lung maturity (24-34 weeks).

Dexamethasone (antenatal)

Four 6 mg IM doses q12 h used as an alternative corticosteroid for fetal lung maturity.

Progesterone Therapy

Weekly 17-OH progesterone injections or vaginal suppositories used in women with prior preterm birth to reduce recurrence risk.

Cerclage

Suture placed around the cervix (usually ≤24 weeks) to treat cervical insufficiency; removed at 36-37 weeks or earlier for labor, bleeding, or infection.

Contraindications to PTL Treatment

Situations in which stopping labor is unsafe: IUFD, lethal anomaly, non-reassuring status, severe pre-e/ eclampsia, significant bleeding, chorioamnionitis, or pre-viable PPROM.

Premature Rupture of Membranes (PROM)

Spontaneous rupture of fetal membranes ≥18-24 h before labor at any gestation; ↑infection risk after 24 h.

Preterm PROM (PPROM)

Membrane rupture before 37 weeks; often infection-related and managed with antibiotics, steroids, and neuro-protection versus delivery.

Ampicillin–Erythromycin Regimen

Standard IV antibiotics for PPROM and chorioamnionitis (broad G-positive and atypical coverage).

Chorioamnionitis (Intra-Amniotic Infection)

Bacterial infection of amnion/chorion; treated with Ampicillin 2 g q6h + Gentamicin 5 mg/kg daily and prompt delivery.

Incompetent (Insufficient) Cervix

Painless cervical dilation in 2nd trimester leading to pregnancy loss/pre-term birth; diagnosed by funneling/short cervix on transvaginal US.

Cervical Funneling

Sonographic hour-glass opening of internal os; >50 % funnel before 25 weeks ≈80 % preterm-birth risk.

Multiple Gestation

Pregnancy with ≥2 fetuses; ↑maternal risks (PTL, pre-e, PPH) & fetal risks (PTB, IUGR, anomalies).

Monozygotic Twins

Result from one fertilized ovum; genetically identical, always same gender.

Dizygotic Twins

Result from two ova & two sperm; genetically different, may be same or different sex; always di-chorionic, di-amniotic.

Monochorionic

Twins sharing one chorion (placenta); higher risk for twin-to-twin transfusion syndrome.

Dichorionic

Twins with two separate placentas/chorions.

Monoamniotic

Twins sharing one amniotic sac; very high cord-entanglement mortality.

Diamniotic

Twins with two separate amniotic sacs.

Twin-to-Twin Transfusion Syndrome (TTTS)

Placental vascular imbalance in monochorionic twins causing donor anemia & recipient overload/heart failure.

Hyperemesis Gravidarum

Severe, persistent N/V causing weight loss > 5 %, dehydration, electrolyte imbalance, and ketonuria; peaks 9 wks, resolves by 20 wks.

Cholestasis of Pregnancy

Hormone-triggered impaired bile flow in late 2nd/3rd trimester; intense pruritus, bile acids > 40 μmol/L; treated with ursodeoxycholic acid & delivery 37-38 wks.

Ursodeoxycholic Acid (Ursodiol)

Bile-acid sequestrant used to relieve itching and lower bile acids in cholestasis of pregnancy.

Type 1 Diabetes Mellitus

Autoimmune insulin-deficient diabetes existing before pregnancy; requires exogenous insulin.

Type 2 Diabetes Mellitus

Insulin-resistant diabetes; may be managed by oral agents or insulin; often worsens in pregnancy.

Pre-Gestational Diabetes

Type 1 or Type 2 diabetes diagnosed before pregnancy; associated with congenital anomalies, macrosomia, stillbirth if poorly controlled.

Gestational Diabetes Mellitus (GDM)

Glucose intolerance first recognized in pregnancy; classified as diet-controlled (A1) or insulin-controlled (A2).

Glucose Tolerance Test (GTT)

Two-step screening: 50 g 1-h test (≥130-140 mg/dL abnormal) followed by diagnostic 100 g 3-h test; ≥2 elevated values confirms GDM.

Chronic Hypertension (CHTN)

BP ≥ 140/90 diagnosed before 20 weeks or persisting ≥12 weeks postpartum; baseline labs usually normal.

Gestational Hypertension

New BP ≥ 140/90 after 20 weeks without proteinuria or lab changes; may progress to preeclampsia.

Preeclampsia

BP ≥ 140/90 after 20 weeks plus proteinuria or organ/lab changes (e.g., ↓PLT, ↑LFTs).

Preeclampsia with Severe Features

Preeclampsia plus any of: BP ≥ 160/110, Cr > 1.1, PLT < 100 K, severe headache, visual changes, epigastric pain.

Eclampsia

Onset of generalized seizures in a woman with preeclampsia.

Magnesium Sulfate (preeclampsia)

Anticonvulsant used to prevent/treat eclamptic seizures; loading 4-6 g IV over 15-20 min then 1-2 g/h.

Magnesium Toxicity Signs

RR < 12, SpO₂ < 95 %, absent DTRs, cardiac arrest; STOP infusion & give calcium gluconate.

HELLP Syndrome

Severe form of preeclampsia: Hemolysis, Elevated Liver enzymes, Low Platelets; requires immediate delivery.

Placenta Previa

Placenta implants over or near cervical os; painless vaginal bleeding; avoid vaginal exam; plan C-section.

Placental Abruption

Premature separation of placenta from uterine wall; painful bleeding, uterine tachysystole; emergency C-section.

Placenta Accreta

Abnormal placental invasion into myometrium; massive postpartum hemorrhage; often managed by hysterectomy.

Ectopic Pregnancy

Implantation outside uterus (95 % tubal); abdominal pain & shoulder pain; treated with methotrexate or surgery.

Methotrexate (ectopic)

Folate antagonist chemotherapeutic used to dissolve early, unruptured ectopic pregnancies.

Gestational Trophoblastic Disease (GTD)

Group of placental tumors; includes hydatidiform mole (benign) and malignant trophoblastic neoplasia.

Hydatidiform Mole

Benign GTD with cystic “grape-like” villi, vaginal bleeding, high hCG, risk of choriocarcinoma; managed by D&C and serial hCG.

TORCH Infections

Group of maternal infections—Toxoplasmosis, Other (HBV), Rubella, Cytomegalovirus, Herpes simplex—capable of causing severe fetal harm.

Group B Streptococcus (GBS)

Normal vaginal/rectal flora colonizing 30-50 % of women; IV Ampicillin 2 g then 1 g q4h during labor; ≥2 doses before delivery ideal.

Urinary Tract Infection (UTI) in Pregnancy

Most common bacterial infection (often E. coli); untreated can lead to pyelonephritis and preterm labor.

Pyelonephritis

Upper urinary tract infection with flank pain, fever; may require hospitalization and IV ceftriaxone 1 g q24h.

Ondansetron

Serotonin-receptor antagonist antiemetic (Zofran) used for severe N/V and hyperemesis gravidarum.

Misoprostol

Prostaglandin E1 analog used for labor induction, PPH control, and medical management of miscarriage.

Oxytocin

Pituitary hormone (Pitocin) used to induce or augment labor and control postpartum hemorrhage.

Methylergonovine

Ergot alkaloid (Methergine) given IM/PO for uterine atony; contraindicated in hypertension.

Carboprost Tromethamine

Prostaglandin F2α analog (Hemabate) used for refractory PPH; causes bronchospasm & diarrhea.

Terbutaline

β2-adrenergic agonist tocolytic (Brethine); hold if HR > 120; may cause tachycardia & hyperglycemia.

Nifedipine

Calcium-channel blocker tocolytic; 10-20 mg PO; avoid with magnesium or hypotension.

Azole Antifungals

Ketoconazole, miconazole, clotrimazole: topical or oral agents to treat candidiasis in pregnancy.

Desmopressin (DDAVP)

Synthetic vasopressin analogue used to raise Factor VIII & vWF in bleeding disorders during pregnancy.

Factor VIII & IX Concentrates

Plasma-derived or recombinant factors (Hemofil-M, Advate, AlphaNine, BeneFix) used to treat hemophilia complicating pregnancy.

Nonbiologic DMARD – Methotrexate

Traditional disease-modifying antirheumatic drug; teratogenic, used therapeutically for ectopic pregnancy or autoimmune diseases.

Bed Rest (PTL)

Formerly common PTL therapy; evidence shows no benefit and potential harm (thromboembolic risk, deconditioning).

Antenatal Testing (NST/BPP/AFI)

Non-stress test, biophysical profile, and amniotic-fluid index used to assess fetal well-being in high-risk pregnancies.

Trauma in Pregnancy

Maternal injury (MVC, violence) requires maternal stabilization and continuous fetal monitoring for abruption.

Substance Use Disorder (Pregnancy)

Use of alcohol or drugs leading to maternal & fetal risks; management includes counseling and screening.

Cardiovascular Disease in Pregnancy

Leading maternal death cause; requires multidisciplinary management and monitoring for decompensation.

Pulmonary Disorders in Pregnancy

Asthma, cystic fibrosis, etc.; risk of hypoxia & pre-e; manage with bronchodilators, steroids, ABG monitoring.