Maryland CC Project Lankford – Physiologic Changes of Pregnancy Part II
Mar 28, 2022
Dr. Allison Lankford, an Assistant Professor and Maternal-Fetal Medicine expert, discusses fascinating aspects of pregnancy physiology. She highlights critical hematologic changes such as increased plasma volume and anemia thresholds. The conversation dives into complex cases like placenta previa and cesarean scar pregnancies, exploring their diagnosis and management. Additionally, Lankford addresses thyroid disease in pregnancy, detailing treatment options and fetal implications. Her insights into immune adaptations and nutritional recommendations round out this enlightening discussion.
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Physiologic Hemodilution Lowers Hemoglobin
- Pregnancy increases red blood cell mass by 20–30% but plasma volume rises more, causing physiologic hemodilution and a lower hemoglobin.
- Define anemia in pregnancy as hemoglobin <11 and always evaluate microcytic anemia for iron deficiency.
Ultrasound Clues For Placenta Accreta Spectrum
- Ultrasound signs of placenta accreta spectrum include previa, loss of the hypoechoic zone, multiple vascular lacunae, and hypervascularity at the bladder edge.
- Risk of PAS rises sharply with prior cesareans: 3% with none, >60% with three or four plus previa.
Plan Multidisciplinary Care For Suspected PAS
- When placenta accreta spectrum is suspected, arrange multidisciplinary preoperative planning with anesthesia and surgical teams.
- Preoperative diagnosis reduces maternal morbidity and enables strategies like ureteral stents or intraoperative vascular control.