12. Medical Conditions in Pregnancy

Question 1

Gestational diabetes GDM, is defined as glucose intolerance during preganancy, screening between 24-28 weeks, 50gm one hour oral glucose test (abnl 130-140), if abnl, followed by 3hour 100 gram oral glucose tolerance test, abnl is ?

Answer 1

130-140

Question 2

Gestational diabetes GDM causes increased risk of HTN, preeclampsia, c section delivery, risk of DM in later life, Child: hypoglycemia, hyperbilirubinemia, operative delivery, shoulder dystocia, birth trauma, still birth and? *

Answer 2

Macrosomia

Question 3

If testing, growth and glycemic control are good, can wait until spontanenous labor, what weight do we recommend C-section?

Answer 3

greater than 4500gm

Question 4

Diabetes DM (not gestational) can cause congenital anomalies (6 fold), maternal complications include nephropathy, retinopathy, increased risk preeclampsia, DKA, fetal complications include inc risk of SAB, anatomic birth defects, fetal growth restriction, and?

Answer 4

Prematurity

Question 5

Management of preexisting DM includes 24 hour urine collections q trimester, EKG, detailed eye exam 1st trimester, glycemic control (daily finger stick), fetal: early dating US, detailed anatomical fetal US, growth US q 2-4 weeks, fetal testing (NST/BPP) 1 week at 32 weeks, delivery options depend on estimated fetal weight and?

Answer 5

glycemic control

Question 6

Hyperpthryroidism have sx similar to preganancy and dx made via elevated free T4 and suppressed TSH, tx with Propylthiouracil (PTU) and methimazole- in 2nd/3rd trimester can cause aplasia cutia and choanal atresia in 1st trimester, monitor TSH througout preg, meds may cross palcenta and cause fetal hypothyroidism and goiter, increased risk of prematurity, IUGR preeclampsia and?

Answer 6

Stillbirth

Question 7

What is triggered by infection, labor, c section, noncompliance of meds, with signs and symptoms of hyperthermia, tachycardia, perspiration, high output cardiac failure, and maternal mortility of 25%?

Answer 7

Thyroid Storm
tx w B blockers, block thyroid hormone sectrion, stop synthesis of PTU, halt conversion of T4 to T3, replacing loss fluids and bringing down temp

Question 8

Hypothyroidism if treated can expect normal pregnancy, if untreated increased risk of SAB, preeclampsia, abruption, low birth weight infants, still birth and lower intelligence levels, tx with ? (monitor TSH / free T3/4 monthly)

Answer 8

Levothyroxine

Question 9

What is the most common lesion-mtral stenosis (90%), with high risk of developing heart failure, subacute bacterial endocarditis, and thromboembolic disease?

Answer 9

Rheumatic Heart Disease

Question 10

Arryhthmias are common- MC is supraventricular tachycardia- benign. postpartum cardiomyopathy occurs with no underlying cause, develops in last weeks of preg, women w preeclampsia, HTN and poor nutritition are at risk, mortality rate is?

Answer 10

10%

Question 11

What immune DO causes immunoglobulins to attach to maternal platelets, confused with gestational thrombocytopenia, tx : platelets drop after 50,000- prednisone, IV IG, platelet transfusion, splenectomy?

Answer 11

Immune Idiopathic Thrombocytopenia

Question 12

What syndrome is the presence of lupus anticoagulant or anticardiolipin ab, can coexist with SLE< assoc w arterial or venous thormbosis, increased risk of miscarriage, preeclampsia, fetal growth restriction, tx during preg w heparin/low dose aspiring?

Answer 12

Antiphospholipid Syndrome

Question 13

What is persistent N/V associated with greater than 5% loss of weight, ketonuria and dehydration (longer than week 8-12), causes by psychological, hormonal changes, gastric dysrhythmias, hyperacuity of olfactory, subclinical vestibular DOs?

Answer 13

Hyperemesis Gravidarum (1-2% incidence)

Question 14

What syndrome is also known as acid aspiration syndrome, pregnant women at greater risk due to delayed gastric emptying and increased intrabdominal pressure, can result in adult respiratory syndrome - tx w suppl oxygen, maintain airway, tx for acute resp failure, prevention via decrase acid in stomach and do not feed during labor?

Answer 14

Mendelson’s Syndrome

Question 15

What is SCARY, diffuse fatty infilitration of liver resulting in hepatic failure, 1per14000 pregs, cause is unknown, sx include abd pain, N/V, jaundice, irritability, polydipsia, HTN/proteinuria, inc PTT and PT, bilirubin, ammonia, uric acid?

Answer 15

Acute fatty liver of pregnanacy

(TX W TERMINATION OF PREGNANCY

Question 16

Anemia is defined as hemotocrit (HgB) less than 30% or HGB concentration less than 10, MCC iron deficiency, screened at prenatal visit and 26-28weeks, tx w?

Answer 16

Iron supplementation oral or IV

Question 17

Preganancy is a hypercoaguable state and increases VT up to 5x, greatest risk 1st 5 weeks postpartum. What is MC in patients with varicose veins, obesity, and low activity, MC in calf, no pulm embolism, sx includ swelling/tenderness, tx with bed rest, pain meds, local heat and support hoes?

Answer 17

Superficial Thrombophlebitis

Question 18

DVT 1/2000 during and 1/700 after pregnancy, MC pain in LEFT leg than right, pain in calg with dorsiflexion (homans sign), dull ache, tingling, pain w walking, dx via compression US with doppler flow or mRI, tx with anticoaf such as unfractioned heparin or?

Answer 18

Lovenox (follow factor Xa values)

(aPTT with heparin to be followed)

*no coumadin during preg, used 6 weeks post preg

Question 19

Pt with DVT/PE require thrombophilia work up including lupus anticoag, anticardiolipin ab, factor V leiden, protein C and S, antithrombin III, prothrombin G20210A, all patients with a history of this require what?

Answer 19

Prophylactic anticoag

Question 20

What is the MC pulmonary disease in preg, incidence between 3-9%, severe cases associated with miscarriage, preeclampsia, IU fetal demis, IU fetal growth restiriction and preterm delivery- treated the same as nonpreg?

Answer 20

Asthma

Question 21

If has epilepsy, use lowest dose if havent had seizure in 2 years, do NOT use valproate, MC meds are dilatin and phenobarbital, should be taking 1-4mg of folic acid, same complications including, preeclampsia, placental abruption, hyperemeisis, premature labor, and incresed risk of congential malformations such as?

Answer 21

cleft lip/palate and cardiac anomalies (4-6%)

Question 22

How do you treat GDM?

Answer 22

1. education + diet
2. insulin
3. metformin

Question 23

Fasting glucose normally is less than 95 and what should 2 hour post prandial measurement of glucose be?

Answer 23

less than 120

Question 24

50% of women who have GDM get DM later in life, and a very common associated with GDM and babies is macrosomia (>4000gm) and?

Answer 24

shoulde dystocia