B8-018 Diseases/Disorders of Gestation Flashcards
2 screening options for gestational diabetes
Two step approach: 1 hr glucose challenge test
One-step approach: 2 hr glucose tolerance test
what medication is the “gold standard” for controlling hyperglycemia in pregancy?
insulin
(metformin is a safe oral alternative)
advanced maternal age is considered any mother who will be […] or older at time of delivery
35
risk factors associated with AMA [4]
aneuploidy
early onset gestational diabetes
preterm delivery
stillbirth
preeclampia is new onset HTN on two separate occasions […] hours apart after […] weeks gestational age plus proteinuria
4 hours
20 weeks
new onset HTN with either proteinuria or end-organ dysfunction after 20 weeks gestation
preeclampsia
only intervention shown to decrease the risk of preeclampsia in subsequent pregnancies
aspirin
(decreases thromboxane: prostacyclin)
risk factors for the development of preeclampsia
hx of preeclampsia
multifetal gestation
chronic HTN
diabetes
kidney disease
autoimmune diseases
AMA
obesity
aspirin should be given to women at a high risk of developing preeclampsia beginning at […] weeks gestation
12
BP > 140/90 after 20 weeks gestation
no preexisting hypertension
no proteinuria or end-organ damage
gestational hypertension
hypertension prior to 20 weeks gestation suggests
chronic (overt) hypertension
antihypertensives safe in pregnancy [4]
hydralazine
a-methyldopa
labetalol
nifedipinie
(Hypertensive Moms Love Nifedipine)
caused by abnormal placement of the placental spiral arteries causing endothelial dysfunction, vasoconstriction, and ischemia
preeclampsia
prophylaxis for preeclampsia
aspirin
treatment for preeclampsia
antihypertensives
IV magnesium sulfate
delivery
preeclampsia with seizures
eclampsia
preeclampsia with thrombotic microangiopathy of the liver
HELLP syndrome
what does HELLP syndrome stand for?
Hemolysis
Elevated
Liver enzymes
Low
Platelets
blood smear in HELLP syndrome will show
shistocytes
treatment for HELLP syndrome
immediate delivery
hormone that promotes insulin resistance to supply the growing fetus with glucose and amino acids
human placental lactogen
(implicated in gestational diabetes)
PPROM is anytime before […] weeks gestational age
37
preterm labor is defined as regular contraction that induce […]
cervical change
signs of PPROM on speculum exam [3]
fluid pooling in vaginal vault
ferning on light microscopy
positive nitrazine pH test
(also can send fluid to lab form specific protein testing)
if GBS status is unknown, what is should be done?
give antibiotics
intraamniotic infection associated with significant maternal fetal mortality
chorioamnionitis
signs of chorioamnionitis [5]
fever
changes in fetal heart rate
high maternal WBC with left shift
purulent fluid on speculum exam
fundal tenderness to palpation
treatment of chorioamnionitis
delivery
administration of […] decreases premature infant mobidity/mortality [2]
mag sulfate
corticosteroids
fluorinated steroids [2]
betamethasone
dexamethasone
(can cross the placenta)
there is no benefit to giving corticosteroids before […] weeks gestational age
22-23
magnesium sulfate given within […] hours of delivery lowers the incidence of cerebral palsy and infant death
24 hours
magnesium sulfate should be given to any pregnancy threatened to deliver before […] weeks gestational age to decrease chance of cerebral palsy/fetal death
32 weeks
neurologic morbidity significantly decreases after […] weeks gestational age
32
what is the definition of hypertension in a pregnant mother?
BP > 140/90 on more than one occasion
a creatinine level that doubles from baseline or is greater than 1.1 mg/dl indicates severe
preeclampsia
severe features of preeclampsia
thrombocytopenia
doubling of liver enzymes
pulmonary edema
papilledema
headaches
hyperreflexia
hemolysis
proteinuria is defined as a 24 hour urine collection containing greater than […] mg of protein
300
patients of AMA should be offered […] screening
aneuploidy
(higher incidence of trisomies 13, 18, 21)
risks to the fetus associated with maternal hyperglycemia [4]
congenital anomalies
newborn episodes of hypoglycemia
newborn hyperbilirubinemia
injury during delivery due to size
most appropriate test for determining if amniotic membranes have ruptured
sterile speculum exam
definition of preterm labor
regular, painful contractions accompanied by cervical change prior to 37 weeks
interventions shown to improve outcomes in PPROM [3]
antibiotics
corticosteroids
magnesium sulfate
