3 medical disease

Question 1

chronic HTN in pregnancy

• BP goals
• medications

Answer 1

• goals are the same: 140/90
• methyldopa, then hydralazine, labetalol, nifedipine

(hypertensive moms love nifedipine)

Question 2

how to treat hypothyroidism in pregnancy? what to be aware of in assessing response of treatment?

Answer 2

Levothyroxine.

don’t wait for the TSH to go up to increase the dose; by then you’ve passed a whole trimester of low T4

Question 3

Thyroid disease during pregnancy:

1. what happens during pregnancy with thyroid levels?
2. danger of hypo and hyperthyroidism

Answer 3

1. Remember, during pregnancy there are more proteins. More RBCs, more estrogen, more thyroglobulin binding protein.

So, pregnancy woman has increased total T4, but normal TSH and Free T4.

2. Hypo: cretinism.

Hyper: fetal demise

Question 4

UTI in pregnancy

• why do asx screening?
• How to treat:
  1. asx bacteriuria
  2. cystitis
  3. pyelo

Answer 4

• Screen all pregnant moms, including asx. Baby pressing on bladder–> more stasis–> increased risk of pyelo–> increased risk of preterm labor.
  1. nitrofurantoin, ceftriaxone if resistant.
  2. same.
  3. Pip/tazo or ceftriaxone. Admit too hospital and reassess in 2 days (cultures back). If sx improved, it’s pyelo, so continue abx for 14 days. If sx not improved, suspect abscess. Do U/S and drain.

Question 5

Your diabetic patient wants to get pregnant. What to tell her/do for her?

Answer 5

• Transition off oral meds, to insulin only
• maintain strict control of BG <150

Question 6

How to treat hyperthryoidism in pregnancy?

1. what drug(s)?
2. surgery possible?
3. what to be careful of?

Answer 6

1. “PTU in Pregnancy.” (and methimazole). It’s safe b/c it’s protein bound and will not cross placenta.
2. surgery can be done in 2nd trimester. It’s after fetus has developed, but before it’s too big that resp status is compromised for mom.
3. no RAIU! nothing radioactive

Question 7

UTI in pregnancy:

1. what lab tests are positive in cystitis?
2. in pyelo?

Answer 7

1. leukocyte esterase +, nitrite +
2. leukocyte esterase +, nitrite +, WBC casts on U/A

Question 8

Seizures in pregnancy

• how to treat
• what to be careful of

Answer 8

1. “Phenobarbital for Pregnancy.” Actually Lamotrigine is better.
2. All anticonvulsants are teratogens. It’s all risk benefit analysis. In general, counsel moms to avoid pregnancy.

Question 9

Your patient in clinic says that she just missed her period and thinks she’s pregnancy. However, HPT is (-). She has bipolar. What’s happening?

Answer 9

She is taking an antipsychotic medication. DA blocker means increased prolactin, which causes amenorrhea+galactorhea.

Question 10

Hyperemesis gravidarum

1. signs/sx (3)
2. how to dx
3. tx

Answer 10

1. severe N/V into 2nd trimester. Morning sickness should resolve by end of 1st trimester.
   1) N/V that causes volume depletion
   2) starvation, leads to ketones in blood
   3) weight loss
2. Do B-HCG and U/S to rule out mole.
3. IVF, antiemetics.