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Endo/Repro II Test 1 > 11. Medical Conditions in Pregnancy > Flashcards

11. Medical Conditions in Pregnancy Flashcards

1
Q

Anemia:

  • Physiologically, anemia is _________.
  • Most common reason for anemia?
  • Screening
  • Treatment
    *
A
  • ↓ in Hgb/hematocrit during pregnancy (Hct <30% or Hgb concentration is <10g/dL)
  • Iron deficiency
  • Screening
      1. At prenatal visit
      1. 26-28 weeks
  • Treatment: IV/oral Iron supplement
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2
Q

Gestational DM

  • What is it?
  • Screening
A
  • Glucose intolerance during PG
  • Screening
    1. 24-28 weeks: perform a 1-hour 50g oral glucuse challenge test
    2. If 130-140 => abnormal
      1. => 3-hour 100 g oral glucose challenge test.
      2. If (2+ abnormal values) => FAIL.
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3
Q

Risk factors for Gestation DM

A
  1. Obesity
  2. Previous hx of GDM
  3. Strong family hx of DM
  4. Known glucose intolerance
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4
Q

Maternal Complications of Gestational DM

A

↑ risk of:

  1. Gestational HTN
  2. Preeclampsia
  3. C-section delivery
  4. Developing DM later in life
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5
Q

Fetal Complications of Gestational DM

A
  1. Macrosomia
  2. Neonatal hypoglycemia
  3. Hyperbilirubinemia
  4. Shoulder dystocia
  5. Operative delivery (bb is extracted from vagina w forceps)
  6. Birth trauma or stillbirth
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6
Q

Antepartum management in Gestation DM

A
  1. Diabetic teaching
  2. Monitor blood glucose
  3. Test fetal health weekly (biophysical profile and/or NST)
  4. US to determine weight
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7
Q

In a patient with gestation DM, when is it recommended to have the bb via c-section?

A

If in US, fetal weight is > 4500 grams.

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8
Q

If all testing, growth and glycemic control are good in a person with Gestational DM, the baby can be delivered via _______

A

Spontaneous labor/wait until due date.

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9
Q

Intrapartum (DURING childbirth) Managment of Gestation DM

A
  1. If diet controlled => monitor blood glucose.
  2. If on meds (oral or insulin) => monitor glucose hourly (80-120 mg/dL) or insulin drip
  3. Continous fetal monitoring in labor
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10
Q

Direct link between birth defects = ____________.

A

↑ HgBA1C during embryogenesis

=> Increase risk of congenital anomalies

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11
Q

Maternal Complications Pre-Gestational DM

A
  1. Worsening nephropathy and retinopathy
  2. Risk of developing preeclampsia
  3. Greater risk of DKA
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12
Q

Fetal Complications Pre-Gestational DM

A
  1. ↑ risk of SAB
  2. Anatomic birth defects (sacral agenesis, and cardiac)
  3. Fetal growth restriction
  4. Premature
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13
Q

What are the 2 classes of Gestational DB?

A
  1. Class A1: Gestational DB (diet controlled)
  2. Class A2: Gestational DB (insulin or oral-meds controlled), exists before PG
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14
Q

What is considered good glycemic control during pregnancy when fasting and 2-hours after eating?

A
  1. Fasting= less than 95 mg/dL
  2. 2 hour postprandial (2 hours after eating) = less than < 120 mg/dL
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15
Q

Management of pre-existing DB right before childbirth (antepartum)

A
  1. Every trimester: 24 hour urine collection
  2. 1st trimester: Ophthalamic- eye exam
  3. EKG
  4. Check glucose and HgBA1c levels daily using finger stick
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16
Q

How do insulin requirements change after delivery of the placenta and onward?

A
  • Insulin requirements drop significantly after the placenta = only need 2/3 of dose
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17
Q

How soon postpartum should a 2-hour glucose tolerance test be performed in mother who had GDM?

A

6-12 weeks post-partum to look for pre-existing disease

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18
Q

Maternal Hyperthyroidism

  • Diagnosed
  • Treatment (when are they given and AE)
A
  • ↑ free T4 and suppressed TSH (dx based on sx is hard bc similar to PG)
  • Treatment:
      1. PTU (propylthiouracyl) and methimazole
        * PTU (1st trimester) only bc ↑ risk of liver toxicity
        * Methimazole (2nd/3rd trimester) bc ↑ risk of aplasia cutis and choanal atresia in 1st.
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19
Q

Which drug for maternal hyperthryroidism is contraindicated throughout pregnancy?

A

Radioactive iodine

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20
Q

Fetal effects due to Maternal Hyperthyroidism

A
  1. Meds cross placenta => cause fetal hypothyroidism and fetal goiter
  2. Prematurity, IUGR, preeclampsia, and stillbirth
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21
Q

Thyroid storm => life-threatening condition that is associated with untreated or undertreated hyperthyroidism

  • Triggers
  • Signs and sx
  • Maternal mortality = ___%
A
  • Triggers: infections, labor/c-section, not taking meds
  • Signs and sx:
      1. Tachycardia
      1. Hyperthermia and perspiration
      1. High-output cardiac failure
  • Maternal mortality = 25%
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22
Q

Tx of Thyroid Storm during pregnancy?

A
  1. Dexamethasone (stops conversion of T4 –> T3)
  2. PTU (stops making thyroid hormone)
  3. Propranolol
  4. Sodium iodide (blocks secretion of thyroid hormone)
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23
Q

What are the pregnancy outcomes of treated vs untreated hypothyroidism?

A
  1. Treated => NL outcomes
  2. Untreated => ↑ risk of
    1. SAB or stillbirth
    2. LBW bb
    3. Preeclampsia
    4. Abruption
    5. Lower IQ—cretinism
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24
Q

Maternal Hypothyroidism

  • Treat
  • Monitor
A
  • Treat: levothyroxine (thyroid replacement)
  • Monitor: check free T3/4 and TSH monthly
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25
Q

Neonatal thyrotoxicosis

  • How does it develop
  • How long does it last
  • Mortality rate
A
  • Thyroid stimulaing Abs are transferred to baby via the placenta.
  • Effects:
    • Lasts 2-3 months (transient)
    • Mortality rate of 16%.
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26
Q

Neonatal hypothryoidism

  • Causes:
  • Effects:
A
  • Thyroid dysgenesis, inborn errors of thyroid function, drugs
  • Generalized developmental retardation
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27
Q

Which pulmonary condition is a contraindication to pregnancy due to decompensation during pregnancy and a high mortality rate?

A

Primary pulmonary HTN

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28
Q

_________ = preferred anesthesia in patient with primary pulmonary HTN.

A

Epidural, allowing vaginal delivery to be an option.

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29
Q

What is the most common lesion caused by rhematic heart disease?

A

Mitral stenosis

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30
Q

What are the most common cardiac arrhythmias in pregnancy; which are most worrisome?

A
  1. SVT = most common and usually benign
  2. A. fib/flutter = more worrisome for underlying cardiac disease
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31
Q

Who is at greatest risk of developing postpartum cardiomyopathy?

A

Women with

  1. Preeclampsia
  2. HTN
  3. Poor nutrition
32
Q

Postpartum cardiomyopathy

  • When does it develop?
  • Mortality rate?
A
  1. Last weeks of pregnancy or 6 months postpartum
  2. 10%
33
Q

What is important to note about ALL PREGNANT CARDIAC PATIENTS?

A

Co-managed with a cardiologist.

34
Q

How should cardiac patients be delivered?

A

Vaginally, unless obstetric indications: DON’T push in 2nd stage of delivery.

35
Q

What type of cardiac condition is a medical emergency?

A

Acute cardiac decompensation w/ CHF

36
Q

Immune Idiopathic Thrombocytopenia

  • What is it?
  • How does neonatal thrombocytopenia develop?
A
  • Ig attach to moms platlets
  • Neonatal thrombocytopenia develops when anti-platelet AB go to bb via placenta.
37
Q

What is treatment for immune idiopathic thrombocytopenia during pregnancy?

A
  1. - Begin after platelets <50,000 —> give prednisone
      • If severe, => IV immunoglobulin
      • Platelet transfusion
      • Splenectomy
38
Q

Antiphospholipid syndrome

  • What is present?
  • Can coexist with _____.
  • Associated with: __________
  • Treatment during pregnancy
A
  • Lipid anticoagulants and anticardiolipin AB
  • SLE
  • Arterial/venous thrombrosis
  • Treatment:
    1. Heparin/LMW heparin/ low-dose ASA
    2. If history of thrombosis => full anti-coagulant
39
Q

What are the 3 types of Acute Renal Failure seen in pregnant patients?

Treatment goals of each?

A
  1. Pre-renal: causes acute blood/fluid loss
    1. Restore volume (electrolytes!!!)
  2. Renal: d/t prexisting disease (lupus nephritis) or a hypercoagulable state)
    1. Prevent more damage (diuretics, fluid restriction)
  3. Post-renal: rare; kidney stones
    1. Remove obstruction (lay left lateral position)
40
Q

Which serum Cr level worsens the prognosis of chronic kidney failure during pregnancy?

A

Serum Cr. > 1.5 - 2

41
Q

What is asymptomatic bacteriuria more likely to cause in pregnancy?

A

Cystitis and pyelonephritis —> due to urinary stasis and glucosuria

42
Q

Culprit for causing Asymptomatic Bacteruria

A

E.coli

43
Q

Increased risk for what complications if pregnant woman has pyelonephritis?

A
  1. ↑ uterine contractions and preterm labor
  2. Can result in adult respiratory distress syndrome
44
Q

Treatment of N/V in pregnancy, which is most common in 8-12 weeks.

A
  1. Vit B6
  2. Doxylamine
  3. Promethazine
45
Q

What is hyperemesis gravidarum?

A

Persistent N/V assoc. with >5% loss of pre-pregnancy weight + ketonuria + dehydration

46
Q

What is treatment for hyperemesis gravidarum if severe (fails all conservative measures)?

A

May need nasogastric feeding or parenteral nutrition

47
Q

What is Mendelson’s Syndrome and what complications can it cause?

A
    • Acid aspiration syndrome that is more common in pregnant people because they have delayed gastric emptying and ↑ intra-abdominal pressure/intra-gastric pressure
  2. Complications: adult respiratory distress syndrome (ARDS)
48
Q

Treatment for Mendelsons Syndrome (acid aspiration)

A
  1. Supp O2
  2. Maintain airway
  3. Tx for acute respiratory failure
49
Q

Intrahepatic cholestasis of pregnancy

  • What is it?
  • Effects on mom and fetus?
A
  • Cholestasis and pruritis that occurs in 2nd half of pregnancy
  • Mom (benign); fetus (meconium stained amnoitic fluid and fetal demise)
50
Q

Intrahepatic cholestasis of pregnancy (ICP)

  • Sx
  • Tx
A
  • Sx: itching without abdominal pain or rash
  • Tx:
    • Cold baths/ bicarb washes
    • Ursodeocycholic acid
    • Watch fetus and deliver early (36-37 weeks)
51
Q

What liver disease is REALLY SCARY?

A

Acute fatty liver of pregancy => can cause liver failure

52
Q

What is treatment for acute fatty liver of pregnancy?

A
  1. Termination of pregnancy –> need to tx the Mom
  2. Supportive care —> IV fluids w/ 10% glucose; replace blood products (FFP and cryoprecipitate)
53
Q

What is the maternal and fetal mortality with Acute Fatty Liver of Pregnancy?

A
  • Maternal = 7-18%
  • Fetal= 9-23%
54
Q

What is the most common type of HA in pregnancy?

How is it treated?

A

Tension HA

Acetaminophen

55
Q

Due to pregnancy being a hypercoagulable state there is a 5-fold increase in venous thrombosis and the greatest risk is when?

A
  • First 5 weeks postpartum
56
Q

Superficial thrombophlebitis is most common in pregnant pt’s with what characteristics;

  • MC in the _____, which ______ risk of PE
A
  • Most common in those w/ varicose veins, obesity and little physical activity
  • Most common in calf => NO inc risk of PE
57
Q

Superficial Thrombophlebitis

  • Sx
  • Treatment
A
  • Sx: swelling and tender
  • Treat:
    • bed rest, pain meds, local heat, NO anticoag, support hose
58
Q

DVT’s during pregnancy most commonly occur in which leg and what are the signs/sx’s?

A
  • More common in LEFT leg
  • Pain in the calf w/ dorsiflexion (Homans sign)
  • May also have dull ache, tingling, or pain w/ walking
59
Q

If patient has DVT, what values should you follow if you give LMW lovenox vs. unfractionated heparin to assure therapeutic levels?

A
  • aPTT values => heparin
  • Factor Xa values => lovenox
60
Q

When should coumadin be used during pregnancy for DVT’s?

A

6 weeks postpartum but NOT during pregnancy due to risk of fetal hemorrhage or teratogenesis

61
Q

Diagnosis of DVT in pregnant patient

A
  • Difficult to dx because 50% are asx
    1. Compression US + doppler
    1. If suspect pelvic thrombosis => MRI
62
Q

Why is treatment of a PE supppper important?

A
  • Treat early = 1% of dying
  • Untx = 80% of dying
63
Q

PE is most often due to _____

A

DVT

64
Q

What are sx’s of PE during pregnancy?

A
  1. Pleuritic chest pain
  2. Shortness of air/ air hunger
  3. Palpitations
  4. Hemoptosis
65
Q

What 5 things used for diagnosis/evaluation of suspected PE?

A
  1. EKG
  2. CXR
  3. ABG’s
  4. VQ scan
  5. HELICAL CT
66
Q

ALLLLLL pregnant pt’s with DVT or PE require what?

A

Thrombophilia work-up, which includes

  1. Lupus anticoagulant
  2. Anticardiolipin antibody
  3. Factor V leiden
  4. Protein C /S
  5. Antithrombin III
  6. Prothrombin G20210A
67
Q

Pregnant person presents with a history of thromboembolism, what do we do?

A

Give them a prophylactic anticoagulant

68
Q

What is the most common pulmonary disease in pregnancy?

A

Asthma

69
Q

If pregnant patient w/ asthma has been using daily inhaled steroids or high potency oral for more than 3 weeks what is done during labor and delivery?

A

Stress dose of IV steroids to prevent adrenal crisis

70
Q

All anti-epileptics have teratogen risk, but what 2 are most commonly used during if pregnancy if needed?

Avoid what>

A
  1. Dilantin
  2. phenobarbital

Avoid: Valproate

71
Q

What is the course of asthma during prengnacy?

A

Variable: 1/3 improve; 1/3 worsen; 1/3 stay the same

72
Q

Severe asthma is associated with what complications? (5)

A
  1. Miscarriage
  2. Preclampsia
  3. Intrauterine fetal demis
  4. Intrauterine fetal growth restriction
  5. Preterm delivery
73
Q

Treatment of asthma in PG vs nonpregnant pt

A

same

74
Q

SEIZURES

  • How does the frequency change when PG?
  • If on anti-epileptic, should also be on ______
  • How does labor and delivery change?
A
  • does not
  • folic acid (1-4 mg)
  • does not ; dec anti-epleptic dose after surgery
    *
75
Q
  • Avoid taking antidepressants in ____ trimester.
  • If used in ___ trimester => greater risk of neonatal withdrawal
  • Post-partum depression is a concern if baby blues persists for ____ after birth
A
  • 1st
  • 3rd
  • 2 weeks

Endo/Repro II Test 1 (23 decks)

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