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DEFINITION
A pregnancy in which the mother, fetus, or
newborn is or will be in a state of increased
jeopardy
75% of obstetric deaths are preventable &
most are a result of
HEMORRHAGE
INFECTION
HYPERTENSIVE states
Perinatal death
Breech
Placental separation
Pre-eclampsia/eclampsia
Twinning
Pyelonephritis
Placenta previa/abruptio
Hydramnios
INITIAL SCREENING
HISTORY
Maternal Age - young or old
Reproductive history
Medical complications
Physical Exam
TWINS
of the mom
one set of dyzotic twins twice as likely as general
population of doing it again!!
TWINS
Monozygotic - (identical)
Maternal Complications
Preterm labor
Hypertension
Abruption
Anemia
Hydramnios
Postpartum hemorrhage
Cesarean section
INFANT Complications
Prematurity
small infants weighing less than 2500 g
from a twin pregnancy fare better in the
nursery and have lower mortality rates than
comparable-weight infants from singleton
pregnancies.
INFANT Complications
Twin complications
Vanishing fetus
Locking Twins
Dead fetus syndrome
Delayed delivery of one twin
Cord clamping
Abruption
Epilepsy
Seizure Activity
Maternal injury
miscarriage
fetal hypoxia
Status epilepticus increases the mortality
rate for both mom & fetus!!
Seizures
May be related to hormone levels in some
women
90% will have a good outcome with
adequate planning
25%will have fewer seizures when pregnant
25%will have more
50% no change in seizure activity
Increased risk of
Pre-eclampsia
anemia
vaginal bleeding
C-section
abruption
hyperemesis gravidarum
phenobarbital
valproic acid
carbamazepine
THROMBOEMBOLIC
DISEASE
More estrogen
May occur at any stage but more common later
DVT!!!
VIRDOWs TRIAD
hypercoagulable state
venous stasis
endothelial injury
Hypercoagulation
Protective for delivery
Liver produces more clotting factors!