Question

A 35-year-old woman presented to the prenatal clinic after missing her last two menstrual cycles. Her home pregnancy test was positive and an ultrasound confirmed the pregnancy. Gestational age was calculated to be at 10 weeks. An initial assessment of the woman’s medical and obstetric history included the following: She smoked tobacco for 15 years and currently smokes one pack per day; she had recently used cocaine but stated it is not frequent; she denied alcohol use. Her obstetric/gynecologic history included an uncomplicated spontaneous vaginal delivery at 35 weeks’ gestation 4 years ago and 2 years later a cesarean section at 36 weeks’ gestation for nonre- assuring fetal heart tones. Her medical history included chronic hypertension and a history of asthma, for which she had never been intubated or hospitalized. Her vital signs were as follows: temperature 36.7°C, respiratory rate of 20 breaths per minute, heart rate of 86 beats per minute, BP 142/79 mm Hg. Lab results: hemoglobin 13.0 g/dL, hematocrit 37%, white blood cell count 8000, blood type A–, Rh antibody screen positive. She was negative for gonorrhea, chlamydia, and HIV.

1. What fetal complications are associated with this patient’s presentation?

Answer 1

Risk factors associated

1.maternal age

Complications associated with this condition

• Multiples
  The likelihood of having twins or multiples increases as you age. It also increases with the use of fertility treatments, which are more common with older women. The risks with multiples include premature birth, preeclampsia, gestational diabetes and fetal growth problems.
  
• Diabetes
  Older women are more likely to have preexisting diabetes or to develop diabetes during pregnancy (gestational diabetes). Untreated, diabetes can lead to serious complications including birth defects, excessive fetal growth (baby is too large), miscarriage and preeclampsia.
  
• High blood pressure
  As women age they are more like to have high blood pressure (hypertension), or to develop high blood pressure during pregnancy (gestational hypertension). The risks can be life-threatening, including preeclampsia, problems with the placenta and fetal growth, preterm delivery, and placental abruption.
  
• Birth defects
  Babies born to older women are at greater risk of birth defects caused by genetic disorders or chromosome problems, such as Down syndrome. Present at birth, these defects can cause problems in the baby’s overall health, how the body develops, or how the body functions.
  
• Pregnancy loss
  Aging increases the risk of losing your baby through miscarriage or stillbirth.
  
• Preeclampsia
  Preeclampsia is a high blood pressure disorder that develops during pregnancy. It is a leading cause of pregnancy-related deaths for both mother and baby. Risks include reduced blood supply to the fetus, problems with organ function in the mother, placental abruption, and pregnancy loss.
  
• Premature birth and low birthweight
  Premature babies may face serious health problems at birth and later in life.

2.smoking

• Mothers who smoke are more likely to deliver their babies early. Preterm delivery is a leading cause of death, disability, and disease among newborns.
• One in every five babies born to mothers who smoke during pregnancy has low birth weight. Mothers who are exposed to secondhand smoke while pregnant are more likely to have lower birth weight babies. Babies born too small or too early are not as healthy.
• Both babies whose mothers smoke while pregnant and babies who are exposed to secondhand smoke after birth are more likely to die from sudden infant death syndrome (SIDS) than babies who are not exposed to cigarette smoke.Babies whose mothers smoke are about three times more likely to die from SIDS.
• Affects lung maturity which increases the risk for many health problems associated with immunity and respiratory pathologies

3 cocaine abuse

premature membrane rupture, and separation of the placental lining from the uterus prior to delivery.

Babies born to mothers who use cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are shorter in length than babies born to mothers who do not use cocaine.

Meconium staining: passage of meconium into the uterus, which can lead to the baby potentially swallowing it prior to birth, causing breathing problems

Microcephaly: small head size of the baby, possibly due to abnormal brain development in utero

Structural and/or congenital anomalies of renal or gastrointestinal system: stunted development of internal systems in utero, causing potential birth defects

Neurodevelopmental delays: hyperactivity, learning difficulties, behavioral problems, or other issues (These are not fully understood and require more research.)

Fetal death

4 previous preterm delivery

effects

A preterm delivery is a risk factor for subsequent preterm birth

5

medical history included chronic hypertension and a history of asthma,

• causes IUGR
• perinatal asphyxia
• multi organ dysfunction
• pulmonary artery hypertension
• hypoxic ischemic encephalopathy

6. Rh incompatibility

might lead toErythroblastosis fetalis which is hemolytic anemia in the fetus (or neonate, as erythroblastosis neonatorum) caused by transplacental transmission of maternal antibodies to fetal red blood cells. The disorder usually results from incompatibility between maternal and fetal blood groups, often Rho(D) antigens.