Maternal, Perinatal, and Neonatal Complications and Care

Vocabulary practice flashcards covering maternal hematologic, hypertensive, and gastrointestinal complications, labour management, and neonatal transition, encephalopathy, and feeding disorders.

Thalassemias

A group of inherited autosomal recessive quantitative hemoglobin disorders caused by reduced or absent synthesis of normal globin chains ($\alpha$ or $\beta$), leading to an imbalance between chains, ineffective erythropoiesis, hemolysis, and microcytic hypochromic anemia.

$\alpha$-Thalassemia

A quantitative hemoglobin disorder resulting from deleted or non-functional $\alpha$-globin genes (out of $4$ normal genes located on chromosome $16$), where clinical severity correlates directly with the number of deleted genes.

Cis $\alpha$-Globin Deletion

A deletion of two $\alpha$-globin genes on the same chromosome ($--/αα$), prevalent in individuals of Southeast and East Asian ancestry, which places a couple at risk of having a fetus with Hb Bart hydrops fetalis if both partners carry the deletion.

Hemoglobin H (HbH) Disease

A condition caused by the deletion or disruption of three $\alpha$-globin genes ($\alpha-/--$), producing unstable $\beta_4$ tetramers (HbH) that result in chronic moderate-to-severe hemolytic anemia, splenomegaly, and worsening anemia during pregnancy.

Hb Bart Hydrops Fetalis

The most severe form of $\alpha$-thalassemia caused by deletion of all four $\alpha$-globin genes ($--/--$), leading to accumulation of $\gamma_4$ tetramers with extremely high oxygen affinity, tissue hypoxia, severe fetal anemia, high-output cardiac failure, hydrops, and in utero or neonatal death.

Mirror Syndrome (Ballantyne Syndrome)

A rare maternal condition that mirrors fetal hydrops, characterized by severe generalized maternal edema, hypertension, proteinuria, hemodilution, and rapid weight gain.

$\beta$-Thalassemia Minor (Trait)

A carrier state typically involving one affected $\beta$-globin gene ($\beta/\beta^+$ or $\beta/\beta^0$), characterized by asymptomatic or mild microcytic hypochromic anemia ($\text{MCV} < 80\,\text{fL}$, $\text{MCH} < 27\,\text{pg}$), a relatively preserved RBC count, and elevated $\text{HbA}_2$ ($> 3.5\%$ or $> 4\%$).

$\beta$-Thalassemia Major (Cooley Anemia)

A severe hemoglobinopathy characterized by absent or near-absent $\beta$-globin chain synthesis, marked ineffective erythropoiesis, severe chronic hemolytic anemia requiring lifelong blood transfusions, and secondary iron overload leading to cardiac and endocrine dysfunction.

Brilliant Cresyl Blue Smear

A supravital blood stain used to detect intra-erythrocytic inclusion bodies (H bodies) in red blood cells when suspecting $\alpha$-thalassemia in the setting of unexplained microcytosis with normal hemoglobin electrophoresis.

Fetal Cardiothoracic Ratio

An ultrasound measurement used as an alternative surveillance parameter when invasive testing is declined in pregnancies at risk for Hb Bart hydrops fetalis; values $\ge 0.5$ indicate cardiomegaly and significant fetal anemia (normal is $< 0.5$).

Heartburn (Pyrosis)

A burning retrosternal sensation rising toward the throat caused by the reflux of acidic gastric contents, exacerbated in pregnancy by progesterone-mediated relaxation of the lower esophageal sphincter and mechanical pressure from the enlarging gravid uterus.

Hyperemesis Gravidarum (HG)

The severe form of nausea and vomiting of pregnancy characterized by intractable vomiting, weight loss ($> 5\%$ of pre-pregnancy weight), dehydration, ketosis, electrolyte derangements, hypokalemic hypochloremic alkalosis, and starvation acidosis.

Mallory-Weiss Tear

A mucosal laceration at the gastroesophageal junction caused by severe retching or vomiting, presenting with hematemesis.

Boerhaave Syndrome

A life-threatening, transmural spontaneous rupture of the esophagus resulting from violent retching and increased intrathoracic pressure.

Wernicke Encephalopathy

An acute, life-threatening neurological complication of prolonged vomiting and thiamine (vitamin B1) deficiency, classic triad comprising ocular signs, ataxia, and confusion.

Acute Fatty Liver of Pregnancy (AFLP)

A rare, life-threatening obstetric emergency typically occurring in the third trimester, characterized by microvesicular fatty infiltration of hepatocytes and progressive liver failure due to impaired mitochondrial fatty-acid $\beta$-oxidation.

LCHAD Deficiency

Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, an autosomal recessive mitochondrial defect (commonly G1528C mutation) in the fetus that results in toxic maternal fatty-acid metabolite accumulation and strongly predisposes to AFLP.

Swansea Criteria

A diagnostic framework for Acute Fatty Liver of Pregnancy supported when $\ge 6$ features are met in the absence of another cause, including vomiting, abdominal pain, polydipsia/polyuria, encephalopathy, bilirubin $> 14\,\mu\text{mol/L}$, glucose $< 4\,\text{mmol/L}$, uric acid $> 340\,\mu\text{mol/L}$, WBC $> 11 \times 10^9\text{/L}$, AST/ALT $> 42\,\text{IU/L}$, ammonia $> 47\,\mu\text{mol/L}$, creatinine $> 150\,\mu\text{mol/L}$, coagulopathy ($\text{PT} > 14\,\text{s}$ or $\text{aPTT} > 34\,\text{s}$), bright liver/ascites, or microvesicular steatosis.

Microvesicular Steatosis

The histological hallmark of AFLP, characterized by diffuse accumulation of tiny intracytoplasmic fat droplets in hepatocytes that crowd out organelle function without displacing the nucleus.

Severe Hypertension in Pregnancy

Systolic blood pressure $\ge 160\,\text{mmHg}$ and/or diastolic blood pressure $\ge 110\,\text{mmHg}$, representing an obstetric emergency requiring prompt antihypertensive therapy to reduce the risk of maternal stroke.

Placental Growth Factor (PlGF)

A pro-angiogenic protein produced by the placenta that reflects placental vascular development; abnormally low serum levels indicate syncytiotrophoblast stress and heightened risk for preeclampsia and fetal growth restriction.

Pregnancy-Associated Plasma Protein A (PAPP-A)

A placenta-derived glycoprotein measured during first-trimester aneuploidy screening; low levels (e.g., $< 0.3-0.5\,\text{MoM}$) serve as a biochemical risk marker for impaired trophoblastic invasion, preeclampsia, and fetal growth restriction.

HELLP Syndrome

A severe obstetric multisystem disorder within the preeclampsia spectrum characterized by microangiopathic Hemolysis, Elevated Liver enzymes, and Low Platelets.

Tennessee Diagnostic Criteria

The standard diagnostic triad for complete HELLP syndrome: platelets $\le 100 \times 10^9\text{/L}$, AST $\ge 70\,\text{IU/L}$, and LDH $\ge 600\,\text{U/L}$, with laboratory evidence of intravascular hemolysis (e.g., schistocytes, bilirubin $\ge 20.5\,\mu\text{mol/L}$, low haptoglobin).

Mississippi Triple-Class System

A classification scheme for HELLP syndrome stratified primarily by platelet nadir: Class 1 (platelets $\le 50 \times 10^9\text{/L}$, AST/ALT $\ge 70\,\text{IU/L}$, LDH $\ge 600\,\text{U/L}$), Class 2 (platelets $> 50\,\text{to} \le 100 \times 10^9\text{/L}$, AST/ALT $\ge 70\,\text{IU/L}$, LDH $\ge 600\,\text{U/L}$), and Class 3 (platelets $> 100\,\text{to} \le 150 \times 10^9\text{/L}$, AST/ALT $\ge 40\,\text{IU/L}$, LDH $\ge 600\,\text{U/L}$).

Eclampsia

New-onset generalized tonic-clonic, focal, or multifocal seizures in a pregnant or postpartum person with a hypertensive disorder of pregnancy, unrelated to other cerebral conditions.

Magnesium Sulfate

The neuroprotective anticonvulsant of choice used to prevent and treat eclamptic seizures, typically loaded as $4\,\text{g}$ IV over $20-30\,\text{minutes}$ followed by $1\,\text{g/h}$ IV maintenance, targeting therapeutic serum levels of $2.0-3.5\,\text{mmol/L}$ ($4-7\,\text{mEq/L}$).

Craniosynostosis Head Shapes

Specific abnormal cranial conformations resulting from premature fusion of cranial sutures: metopic fusion results in trigonocephaly; sagittal fusion results in scaphocephaly; unilateral lambdoid or coronal fusion results in plagiocephaly; and bicoronal fusion results in brachycephaly.

Caput Succedaneum

Edema of the presenting part of the fetal scalp caused by mechanical compression restricting venous and lymphatic drainage during labour; it pits on pressure, crosses cranial suture lines, and resolves spontaneously within a few days.

Cephalhematoma

A traumatic subperiosteal accumulation of blood over a skull bone (most commonly parietal or occipital) bounded strictly by cranial suture lines, which may take weeks to months to resorb.

Subgaleal Hemorrhage

Bleeding into the loose connective tissue of the subaponeurotic space between the galea aponeurotica and periosteum, capable of holding the newborn's entire blood volume and presenting as a fluctuant, ballotable fluid mass crossing suture lines and orbital ridges.

Latent Phase of Labour

The initial period of labour characterized by regular or irregular uterine contractions that cause progressive effacement and slow cervical dilation from $0\,\text{cm}$ up to $4-6\,\text{cm}$.

Active Phase of Labour

The stage of labour characterized by regular, strong contractions and a faster rate of cervical dilation, proceeding from $6\,\text{cm}$ to full dilation ($10\,\text{cm}$).

Dystocia

Abnormally slow progress or lack of progress in labour (failure to progress), resulting from abnormalities of uterine contractions/expulsive forces (power), fetal size/presentation/position (passenger), maternal pelvis/soft tissue (passage), or maternal anxiety/fear (psyche).

Programmed Intermittent Epidural Bolus (PIEB)

An automated epidural local anesthetic delivery technique that administers scheduled bolus doses at set intervals, providing superior spread through the epidural space, improved pain control, lower total drug consumption, and reduced motor block compared with continuous epidural infusion.

Pudendal Nerve Block

A regional nerve block achieved by injecting local anesthetic ($10\,\text{mL}$ of $1\%$ plain lidocaine) bilaterally near the ischial spines through or just inferior to the sacrospinous ligament to anesthetize the perineum during the second stage of labour or perineal repair.

Apgar Score

A standardized clinical evaluation of a newborn's physical condition and transition at $1$ and $5\,\text{minutes}$ after birth (evaluating Appearance, Pulse, Grimace, Activity, and Respirations on a scale of $0-10$); it does not dictate when to begin resuscitation nor diagnose asphyxia alone.

Umbilical Artery Blood Gas

A blood gas sampled from the umbilical artery carrying deoxygenated blood from the fetus to the placenta, which provides the most accurate and clinically relevant biochemical measure of fetal tissue acid-base and metabolic status.

Metabolic Acidosis (Umbilical Cord)

A pathological cord gas state defined by low pH ($< 7.20$; severe if $< 7.00$) accompanied by a normal $\text{pCO}_2$ and an elevated base deficit ($\ge 12\,\text{mmol/L}$), indicating sustained tissue hypoxia, anaerobic glycolysis, and lactic acid accumulation.

Hypoxic-Ischemic Encephalopathy (HIE)

A clinical syndrome of abnormal neonatal central nervous system function occurring shortly after birth as a consequence of intrapartum asphyxia and impaired cerebral perfusion, presenting with altered consciousness, tone abnormalities, autonomic instability, and seizures.

Therapeutic Hypothermia

Controlled therapeutic whole-body cooling to a target core rectal temperature of $33.5^\circ\text{C} \pm 0.5^\circ\text{C}$ initiated within $6\,\text{hours}$ of birth and continued for $72\,\text{hours}$, proven to decrease mortality and moderate-to-severe neurodevelopmental delay in term/late-preterm infants with moderate-to-severe HIE.

Neonatal Hypernatremic Dehydration (NHD)

A dangerous electrolyte and dehydration disorder in newborns (commonly presenting on days $2-5$ of life) where serum sodium rises to $\ge 150\,\text{mmol/L}$ due to inadequate fluid/breast milk intake, causing cellular dehydration and water shifts out of brain cells.

Delayed Lactogenesis II

Failure of copious maternal milk production (secretory activation) to initiate within approximately $72\,\text{hours}$ postpartum, increasing the newborn's vulnerability to excessive weight loss and hypernatremic dehydration.

Ankyloglossia (Tongue-Tie)

A congenital anomaly where an unusually short, thick, or tight lingual frenulum tethers the underside of the tongue to the floor of the mouth, which may impair tongue mobility, latch, and milk transfer during breastfeeding.

Neonatal Abstinence Syndrome (NAS) / NOWS

A constellation of withdrawal signs affecting the central nervous, gastrointestinal, respiratory, and autonomic systems in a neonate following in utero exposure to addictive substances, primarily opioids.

Eat, Sleep, Console (ESC)

A family-centered, functional assessment model for neonatal opioid withdrawal syndrome focusing on the newborn's ability to eat adequately, sleep for at least one hour, and be consoled within $10\,\text{minutes}$, prioritizing dyad rooming-in and non-pharmacological care.

Neonatal Seizure

Abnormal, excessive paroxysmal synchronous neuronal discharge in the neonatal brain, defined and confirmed primarily by continuous video electroencephalography (cEEG) and frequently presenting as subtle or electrographic-only events.

Electroclinical Dissociation

The phenomenon occurring following antiseizure medication administration wherein outward clinical seizure movements cease while electrical seizure activity continues unchecked on the electroencephalogram.

Perinatal Arterial Ischemic Stroke

A focal cerebrovascular thromboembolic occlusion presenting in an otherwise healthy-appearing term newborn as unilateral, repetitive, focal clonic seizures that do not suppress when the limb is held.