18 Questions
What is the primary reason for shallow placental implantation in preeclampsia?
Failure of trophoblasts to express cell adhesion molecules
What is the consequence of failed cytotrophoblast invasion in preeclampsia?
Narrow vessels and low perfusion
What is the outcome of placental hypoxia in preeclampsia?
Release of vasoconstrictors
Why is placental remodeling affected in preeclampsia?
All of the above
At what gestational age is normal placentation typically complete?
20 weeks
What is a risk factor for developing preeclampsia?
Current pregnancy with a new partner
What is the primary mechanism by which the placenta contributes to the development of preeclampsia?
Releasing mediators that damage vessels and inhibit vessel growth
What is the role of anti-AngII receptor antibodies in preeclampsia?
They activate receptors, contributing to vascular dysfunction
What is the primary consequence of vascular dysfunction in preeclampsia?
Hypertension, edema, and proteinuria
What is the primary complication of preeclampsia in terms of fetal development?
Slower fetal growth and development
What is the primary mechanism by which gestational diabetes develops?
Maternal insulin resistance increases during pregnancy
What is the primary long-term consequence of gestational diabetes for the mother?
Increased risk of maternal cardiovascular disease and type 2 diabetes
What is the normal duration of gestation from conception to birth in weeks?
38 weeks
Why do we calculate gestation from the first day of the last menstrual period?
Because it is 2 weeks before ovulation and fertilization
What is the term for delivery between 37-42 weeks?
Term
A woman has had three pregnancies, resulting in two spontaneous abortions and one term delivery. What is her gravidity and parity?
G3P1021
What does the 'P' in G4P1112 stand for?
Parity
What would be the gravidity and parity of a woman who has had two miscarriages and is currently pregnant with twins?
G3P0020
Study Notes
Pregnancy Dating
- Gestational period: normally 38 weeks (9 months) from conception to birth, but calculated from the first day of the last menstrual period (LMP) as 40 weeks (9.5 months or 280 days)
- Trimesters: 1st (12-14 weeks), 2nd (12-14 to 24-28 weeks), 3rd (24-28 to 37-42 weeks)
Pregnancy Terms
- Gravidity (G): number of times a woman has been pregnant (including current pregnancy)
- Parity (P): describes the outcomes of those pregnancies, including term deliveries, preterm deliveries, abortions, and living children
- Example: G4P1112 (4 pregnancies, 1 term delivery, 1 preterm delivery, 1 abortion, and 2 living children)
Preeclampsia
- Definition: BP changes of gestational hypertension and proteinuria (>300 mg/24hrs, >1+ dipstick)
- Severe Preeclampsia: BP >160/110 mmHg, severe proteinuria (>5g/day), edema, and end organ damage (neurological symptoms, renal failure, liver dysfunction, pulmonary edema)
- HELLP syndrome: associated with hypertensive states (10-20% of patients)
- Eclampsia: preeclampsia with seizures, stroke risk 2-3% of patients with severe preeclampsia
Preeclampsia Pathophysiology
- Normal placentation: invasion of cytotrophoblast tissue into maternal spiral arteries, allowing for remodeling of arteries to increase blood flow (occurs by 20 weeks gestation)
- Preeclampsia: cytotrophoblasts fail to fully invade spiral arteries, shallow placental implantation, and narrow vessels, leading to low perfusion and placental hypoxia
- Placenta releases vasoactive substances to alleviate hypoxia, causing vascular damage and other organ damage
Risk Factors
- Genetic risks: personal or family history, immunogenic, more common in first pregnancy or with new partner
- Maternal inflammation, disordered vessel growth, and failure of trophoblasts to express CAMs
- History of vascular diseases (lupus, hypertension, renal disease, diabetes, etc.)
Management
- Only "cure" is delivery and removal of placenta
- Depends on fetal age and maternal condition, balancing act between maternal and fetal health
- Mild/stable presentation: inpatient monitoring, magnesium sulfate for seizure prophylaxis, controlling maternal blood pressure, and providing corticosteroids for fetal lung development
- Severe disease or fetal distress: immediate delivery
Gestational Diabetes
- Maternal insulin resistance is normal in pregnancy, increasing available glucose for the fetus
- GDM occurs when maternal system can't compensate, affecting 10-15% of pregnancies and rising
- GDM increases likelihood of maternal DM and CVD up to 10X
Test your knowledge of preeclampsia, its symptoms, and complications such as gestational hypertension, proteinuria, and HELLP syndrome. Learn how to identify and manage this pregnancy complication.
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