Acute Complications of Pregnancy

Question 1

Key points

Answer 1

-Most radiologic interventions and meds and should be used in pregnancy
-Headaches are common and usually benign
-Always assume a woman of reproduction age is pregnant until excluded

Question 2

Chronic HTN

Answer 2

hx of (HTN) preceding the pregnancy with or without antihypertensive medication or a blood pressure ≥140/90 prior to 20 weeks gestation. AHA/ACC definition for stage I hypertension 130-139.

-Meds are recommended in cases with severe HTN SBP ≥160 or DBP ≥100 on two occasions.

Question 3

Preeclampsia w/out severe features

Answer 3

-Sustained (at least twice, six hours but not >7 days apart) BP ≥140/90 mmHg AND
-Proteinuria after 20 weeks of gestation in a woman with previously normal blood pressure.

Question 4

Preeclampsia w/ severe features

Answer 4

-BP ≥160/110 mmHg (two occasions, >4 hours apart).
-Thrombocytopenia and/or evidence of hemolytic anemia.
-Increased hepatic transaminases (AST and/or ALT) two times of the upper limit of normal
-Progressive renal insufficiency
-Persistent headache or other cerebral or visual disturbances
-Persistent epigastric (or right upper quadrant) pain.
-Pulmonary edema or cyanosis.

Question 5

HELLP Syndrome

Answer 5

-Elevated liver enzymes as evidenced by an AST or ALT two times the upper limit
-Platelets <100,000 cells/mm3.
-Hemolysis as evidenced by an abnormal peripheral smear in addition to either serum LDH >600 IU/L or total bilirubin ≥1.2 mg/dL
-HA, protineuria, htn, visual changes, n&v, RUQ/epigastric pain, mucosal bleeding, jaundice, malaise/viral symptoms,

Question 6

Eclampsia

Answer 6

-Seizures (grand mal) in the presence of preeclampsia and/or HELLP syndrome

Question 7

Management of Severe HTN

Answer 7

-Labetalol (alpha- and beta-blocker), Calcium channel blockers (nifedipine) are most commonly used medications
-Ace inhibitors are contraindicated .

Question 8

Prevention of Preeclampsia

Answer 8

-Low dose ASA
-Ca supplementation
-Diuretics or salt restriction
-Bed rest

Question 9

Treatment of Preeclampsia

Answer 9

-Delivery
-Mg

Question 10

UTI: Cystitis/Pyelonephritis

Answer 10

-Increased risk due to dilatation of upper renal tract.
-Treatment with appropriate antibiotics: b-lactams, macrolides, nitrofurantoin (avoid 3rd trimester), trimethoprim. Avoid tetracycline and fluoroquinolones.
-Asymptomatic bacteriuria: 4-7%
Most commonly E. coli
Should be treated due to increased risk of developing pyelonephritis.

Question 11

Placenta Abruption

Answer 11

-partial or complete separation of the placenta prior to delivery of the fetus.
-vaginal bleeding, abdominal pain, contractions, uterine rigidity and tenderness, and nonreassuring fetal heart rate (FHR) tracing
-A retro placental clot is the classic ultrasound finding of placental abruption

Question 12

Ectopic Pregnancy

Answer 12

-The most common clinical presentation of ectopic pregnancy is first trimester vaginal bleeding and/or abdominal pain, typically 6-8 weeks after LMP.
-Tubal rupture can result in life-threatening hemorrhage
-Treatment: medical (methotrexate) or surgical
-TVUS is the most useful imaging test for determining the location of a pregnancy.

Question 13

Toxoplasmosis

Answer 13

-Ingestion (from food, water, hands, or insects) of cysts from uncooked/undercooked meat of infected animals or contact with oocysts from infected cats or contaminated soil.
-Maternal infection treatment: spiramycin 3 to 4 g/day.
-Fetal infection treatment: sulfadiazine, pyrimethamine, and folinic acid

rarely maternal symptoms; occasionally flu/mononucleosis-like fever, fatigue, rash, and lymphadenopathy can be associated with maternal infection.

Question 14

Cytomegalovirus

Answer 14

-Most common cause of viral intrauterine infection
-Prevention (including avoiding intimate contact with children, frequent handwashing, and glove use) is associated with an 84% decrease in CMV.
-CMV is usually asymptomatic or with symptoms so mild that it goes undiagnosed

Question 15

Parvovirus

Answer 15

-Infection is by contact with young infected children. The infection is usually asymptomatic in the adults.
-Perinatal complications of fetal infection occur in about 10% of fetuses and include fetal anemia, myocarditis, hydrops (2% – 6%) and fetal death if infection occurs <20 weeks

Question 16

Herpes

Answer 16

-Rx primary genital HSV in pregnancy : acyclovir 400 mg po tid × 7–10 days or valacyclovir ( Valtrex) 1 g po tid × 7–10 days
-Suppression with acyclovir 400 mg po tid or valacyclovir 500 mg po bid at 36 weeks until delivery.

Question 17

Neonatal HSV

Answer 17

Disseminated or CNS disease(seizures, lethargy, irritability, tremors, poor feeding, temperature instability, and bulging fontanelles) in approximately 55% of cases.

30% infant mortality and >50% can have neurologic damage despite antiviral therapy.