Chap 466: Medical Disorders During Pregnancy

Question 1

In pregnancy, cardiac output increases by _____%, with most of the increase due to an increase in stroke volume. Heart rate increases by _____beats/min during the third trimester.

Answer 1

In pregnancy, cardiac output increases by 40%, with most of the increase due to an increase in stroke volume. Heart rate increases by ~10 beats/min during the third trimester.

Question 2

In the second trimester, systemic vascular resistance decreases or increases?

Answer 2

In the second trimester, systemic vascular resistance decreases, and this decline is associated with a fall in blood pressure.

Question 3

During pregnancy, a blood pressure of _____mmHg is considered to be abnormally elevated

Answer 3

During pregnancy, a blood pressure of 140/90 mmHg is considered to be abnormally elevated a

Question 4

Definition of pre-eclampsia

Answer 4

the new onset of hypertension (blood pressure >140/90 mmHg) and proteinuria (either a 24 h urinary protein >300 mg/24 h, or a proteincreatinine ratio ≥0.3) after 20 weeks of gestation.

Recent revisions to the diagnostic criteria include: proteinuria is no longer an absolute requirement for making the diagnosis;

Question 5

Pre-eclampsia can be classified as with or without severe features. Fetal growth restrition is no longer a defining criterion for preeclampsia with severe features. True or False?

Answer 5

True

Question 6

excessive placental production of antagonists to ______ and _________ disrupt endothelial and renal glomerular function resulting in edema, hypertension, and proteinuria—-leading to preeclampsia

Answer 6

Although the precise pathophysiology of preeclampsia remains unknown, recent studies show excessive placental production of antagonists to both vascular endothelial growth factor (VEGF) and transforming growth factor β (TGF-β). These antagonists to VEGF and TGF-β disrupt endothelial and renal glomerular function resulting in edema, hypertension, and proteinuria.

Question 7

The renal histological feature of preeclampsia is _________

Answer 7

The renal histological feature of preeclampsia is glomerular endotheliosis. Glomerular endothelial cells are swollen and encroach on the vascular lumen.

Question 8

What ages are considered as risk factors for development of preeclampsia?

Answer 8

Risk factors for the development of preeclampsia include:
>nulliparity
>diabetes mellitus
>a history of renal disease or chronic hypertension
>a prior history of preeclampsia
>extremes of maternal age (>35 years or <15 years), >obesity
>antiphospholipid antibody syndrome
>multiple gestation

Question 9

Which is a risk factor fro preeclampsia… nulliparity or multiparity?

Answer 9

Risk factors for the development of preeclampsia include:
>nulliparity
>diabetes mellitus
>a history of renal disease or chronic hypertension
>a prior history of preeclampsia
>extremes of maternal age (>35 years or <15 years), >obesity
>antiphospholipid antibody syndrome
>multiple gestation

Question 10

This drug modestly reduces the risk of preeclampsia in pregnant women at high risk of developing the disease

Answer 10

Low-dose aspirin (81 mg daily, initiated at the end of the first trimester) modestly reduces the risk of preeclampsia in pregnant women at high risk of developing the disease.

Question 11

Definition of preeclampsia with severe features

Answer 11

presence of new-onset hypertension and proteinuria accompanied by end-organ damage

Question 12

True or false: bed rest is recommended in preeclampsia

Answer 12

False

In general, prior to term, women with preeclampsia without severe features may be managed conservatively with limited physical activity, although bed rest is not recommended, close monitoring of blood pressure and renal function, and careful fetal surveillance.

Question 13

Timing of delivery of fetus in patients with preeclampsia without severe features vs preeclampsia with severe features

Answer 13

For women with p sia with severe features, delivery is recommended unless the patient is eligible for expectant management in a tertiary hospital setting. Expectant management of preeclampsia with severe features remote from term affords some benefits for the fetus, but significant risks for the mother. Postponing delivery beyond 34 weeks gestation in this group of patients is not recommended.

In preeclampsia without severe features delivery at 37 weeks is recommended.

Question 14

Definitive treatment of preeclampsia

Answer 14

definitive treatment of preeclampsia is delivery of the fetus and placent

Question 15

2 drugs most commonly used to acutely manage severe hypertension in preeclampsia

vs

2 most commonly used medications for the treatment of chronic hypertension in pregnancy

Answer 15

IV labetalol or hydralazine is most commonly used to acutely manage severe hypertension in preeclampsia

Labetalol and nifedpine are the most commonly used medications for the treatment of chronic hypertension in pregnanc

Question 16

the preferred drug for the prevention and treatment of eclamptic seizures.

Answer 16

Magnesium sulfate is the preferred agent for the prevention and treatment of eclamptic seizures.

Question 17

How does magnesium sulfate prevent eclamptic seizures

Answer 17

Magnesium may prevent seizures by interacting with N-methyl-d-aspartate (NMDA) receptors in the CNS.

The universal use of magnesium sulfate for seizure p laxis in preeclampsia without severe features is no longer recommended by most experts. There is consensus that magnesium sulfate should be used in all cases of preeclampsia with severe features, or in cases of eclampsia.

Question 18

Target BP range in pregnancy:
SBP range ______
DBP range _______

Answer 18

Target BP range in pregnancy:
130–150 mmHg systolic and 80–100 mmHg diastolic.

Question 19

Definition of gestational hypertension

Answer 19

The development of elevated blood pressure after 20 weeks of pregnancy or in the first 24 h post-partum in the absence of preexisting chronic hypertension or proteinuria is referred to as gestational hypertension.

Question 20

In general, a prepregnancy serum creatinine level _______ mg/dLis associated with a favorable prognosis

Answer 20

In general, a prepregnancy serum creatinine level <133 μmol/L (<1.5 mg/dL) is associated with a favorable prognosis

Normal pregnancy is characterized by an increase in glomerular filtration rate and creatinine clearance. This increase occurs secondary to a rise in renal plasma flow and increased glomerular filtration pressures.

Question 21

_________ is the most common cardiac problem complicating pregnancy.

Answer 21

Valvular heart disease is the most common cardiac problem complicating pregnancy.

Question 22

This is the valvular disease most likely to cause death during pregnancy.

Answer 22

Mitral stenosis

Question 23

Women with moderate to severe mitral stenosis (mitral valve area ≤1.5 cm2 ) who are planning pregnancy and have either symptomatic disease or pulmonary hypertension should undergo ___________ (what treatment)

Answer 23

Women with moderate to severe mitral stenosis (mitral valve area ≤1.5 cm2 ) who are planning pregnancy and have either symptomatic disease or pulmonary hypertension should undergo valvuloplasty prior to conception, preferably with percutaneous balloon valvotomy (PBV).

Question 24

The immediate postpartum period is a time of particular concern secondary to rapid volume shifts. True or false

Answer 24

True. The immediate postpartum period is a time of particular concern secondary to rapid volume shifts.

Question 25

For women with severe aortic stenosis, treatment before pregnancy should be considered for a peak-to-peak valve gradient _____mmHg.

In women with aortic stenosis and a mean valve gradient ________mmHg, pregnancy is likely to be well tolerated.

Answer 25

For women with severe aortic stenosis, treatment before pregnancy should be considered for a peak-to-peak valve gradient >50 mmHg.

In women with aortic stenosis and a mean valve gradient <25 mmHg, pregnancy is likely to be well tolerated.

Question 26

For women with mitral or aortic regurgitation and left ventricular dysfunction (LVEF _______%) pregnancy should be avoided.

Answer 26

For women with mitral or aortic regurgitation and left ventricular dysfunction (LVEF <30%) pregnancy should be avoided.

Question 27

Treatment for SVT in pregnancy

Answer 27

Treatment is the same as in the nonpregnant patient, and fetal tolerance of medications such as adenosine and calcium channel blockers is acceptable

Question 28

This autosomal dominant disease is associated with an increased risk of aortic dissection and rupture.

Answer 28

Marfan Syndrome

Question 29

In Marfan syndrome, an aortic root diameter ____ mm is associated with a favorable outcome of pregnancy; conversely, an aortic root diameter ______mm is associated with an increased risk of aortic dissection

Answer 29

An aortic root diameter <40 mm is associated with a favorable outcome of pregnancy; conversely, an aortic root diameter >40 mm is associated with an increased risk of aortic dissection

Question 30

Prophylactic therapy with ______ has been advocated to reduce aortic dilation and the risk of dissection

Answer 30

Prophylactic therapy with beta blockers has been advocated to reduce aortic dilation and the risk of dissection

Question 31

Why is pregnancy relatively contraindicated in Ehlers Danlos syndrome (esp type IV EDS)

Answer 31

Ehlers-Danlos syndrome (EDS) may be associated with premature labor, and in type IV EDS there is increased risk of organ or vascular rupture that may cause death. For women with vascular EDS, pregnancy is relatively contraindicated because of the high risk of vascular and uterine rupture.

Question 32

In patients with pulmonary hypertension, vaginal delivery is less stressful hemodynamically than cesarean section… True or False?

Answer 32

In patients with pulmonary hypertension, vaginal delivery is less stressful hemodynamically than cesarean section, which should be reserved for accepted obstetric indications.

Question 33

In pregnancy, kelan most likely magkakaroon ng VTE

Answer 33

VTE occurs more commonly in the 6 weeks post-partum than antepartum.

Question 34

In pregnant women, most unilateral DVTs occur in the right leg.. True or False

Answer 34

In pregnant women, most unilateral DVTs occur in the left leg because the left iliac vein is compressed by the right iliac artery and the uterus compresses the inferior vena cava.

Question 35

LMWH may be associated with an increased risk of epidural hematoma in women receiving an epidural anesthetic in labor and must be discontinued at least _______hours before placement of an epidural catheter.

Answer 35

LMWH may be associated with an increased risk of epidural hematoma in women receiving an epidural anesthetic in labor and must be discontinued at least 24 h before placement of an epidural catheter.

Question 36

Warfarin may cause several congenital anomalies…

in the first trimester it can cause _________
2nd trimester ___________
3rd trimester _________

Answer 36

First trimester: fetal chondrodysplasia punctate

2nd/3rd trimester: fetal optic atrophy, mental retardation

Question 37

in pregnancy, fasting blood glucose levels should be maintained at ______mg/dL, with avoidance of values _______mg/dL

Answer 37

in pregnancy, fasting blood glucose levels should be maintained at <105 mg/dL, with avoidance of values >140 mg/dL

Question 38

How is the the two-step strategy for establishing the diagnosis of GDM being done

Answer 38

A typical two-step strategy for establishing the diagnosis of GDM is performed at 24–28 weeks of gestation and involves administration of a 50-g oral glucose challenge with a single serum glucose measurement at 60 min. If the plasma glucose is <7.8 mmol/L (<130 mg/dL) the test is considered normal. Plasma glucose >7.8 mmol/L (>130 mg/dL) warrants administration of a 100-g oral glucose challenge with plasma glucose measurements obtained in the fasting state and at 1, 2, and 3 h.

Question 39

A typical two-step strategy for establishing the diagnosis of GDM is performed at 24–28 weeks of gestation and involves administration of a 50-g oral glucose challenge with a single serum glucose measurement at 60 min. If the plasma glucose is ____ mg/dL the test is considered normal. Plasma glucose ____mg/dL warrants administration of a 100-g oral glucose challenge

Answer 39

A typical two-step strategy for establishing the diagnosis of GDM is performed at 24–28 weeks of gestation and involves administration of a 50-g oral glucose challenge with a single serum glucose measurement at 60 min. If the plasma glucose is <7.8 mmol/L (<130 mg/dL) the test is considered normal. Plasma glucose >7.8 mmol/L (>130 mg/dL) warrants administration of a 100-g oral glucose challenge

Question 40

Plasma glucose >7.8 mmol/L (>130 mg/dL) warrants administration of a 100-g oral glucose challenge with plasma glucose measurements obtained in the fasting state and at 1, 2, and 3 h.

Normal plasma glucose concentrations at these time points are:
Fasting : ____ mg/dL
1st hr ____mg/dL
2nd hr ____ mg/dL
3rd hr. ____mg/dL

Answer 40

Plasma glucose >7.8 mmol/L (>130 mg/dL) warrants administration of a 100-g oral glucose challenge with plasma glucose measurements obtained in the fasting state and at 1, 2, and 3 h.

Normal plasma glucose concentrations at these time points are:
Fasting : <95 mg/dL
1st hr <180 mg/dL)
2nd hr <155 mg/dL
3rd hr. <140 mg/dL

Question 41

In the typical two-step strategy for establishing the diagnosis of GDM, how many serum glucose values should be elevated for the px to be positive for GDM

Answer 41

Two elevated glucose values indicate a positive test

Question 42

Oral h cemic agents such as ____ and ____ have become more commonly utilized for managing GDM refractory to nutritional management, but most experts favor insulin therapy

Answer 42

Oral hypoglycemic agents such as glyburide and metformin have become more commonly utilized for managing GDM refractory to nutritional management, but most experts favor insulin therapy

Question 43

All women with GDM should have a formal glucose tolerance test (GTT) to screen for T2DM at ____ weeks post-partum.

Answer 43

All women with GDM should have a formal glucose tolerance test (GTT) to screen for T2DM at ~6 weeks post-partum.

Question 44

Kelan dapat mag buntis after bariatric surgery

Answer 44

Following bariatric surgery, women should delay conception for 1 year

Question 45

guidelines for weight gain during prenancy as per BMI range:

BMI <18.5 - _______kg
18.5–24.9 - _______kg
25.0–29.9 - _______kg
≥30 kg/m2 - _______kg

Answer 45

guidelines for weight gain during prenancy as per BMI range:

BMI <18.5 - 12.5 to 18 kg
18.5–24.9 - 11.5 to 16 kg
25.0–29.9 - 7 to 11.5 kg
≥30 kg/m2 - 5 to 9 kg

Question 46

2 mechanisms thyroid hormones are increased in pregancy

Answer 46

1. In pregnancy, the estrogen-induced increase in thyroxine-binding globulin increases circulating levels of total T 3 and total T4
2. Placental human chorionic gonadotropin (hCG) directly stimulates the thyroid causing an increase in free T 3and and T4

Question 47

Methimazole crosses the placenta to a greater degree than propylthiouracil and has been associated with ____. However, propylthiouracil can be associated with _____

(anong mga sakit)

Answer 47

Methimazole crosses the placenta to a greater degree than propylthiouracil and has been associated with fetal aplasia cutis. However, propylthiouracil can be associated with liver failure

Question 48

When should methimazole vs PTU be given in pregnacy

(what trimesters)

Answer 48

propylthiouracil in the first trimester and methimazole thereafter

Question 49

In women with high-titer thyroid stimulating antibodies, the newborn may be born with ____ (what disease)

Answer 49

In women with high-titer thyroid stimulating antibodies, the newborn may be born with neonatal Graves’ disease.

Question 50

Benign g tational thrombocytopenia is unlikely if the platelet count is less than ______ (number)

Answer 50

Benign g tational thrombocytopenia is unlikely if the platelet count is <100,000 per μL.

Question 51

The four cancers that occur most commonly in pregnancy are

Answer 51

The four cancers that occur most commonly in pregnancy are
1. cervical cancer
2. breast cancer
3. melanoma
4. lymphomas (particularly Hodgkin’s lymphoma)

Question 52

If valproate is continued during pregnancy, folic acid s plementation should be increased to ____mg daily.

Answer 52

If valproate is continued during pregnancy, folic acid s plementation should be increased to 4 mg daily.

Question 53

Patients with preexisting multiple sclerosis experience a gradual decrease in the risk of relapses as pregnancy progresses and, conversely, an increase in attack risk during the postpartum period. TRUE OR FALSE

Answer 53

TRUE

Question 54

Treatment for moderate to severe relapses of multiple sclerosis during pregnancy

Answer 54

pulse glucocorticoid therapy

Question 55

Treatment for Bell’s palsy during pregnancy

Answer 55

GLUCOCORTICOIDS

Question 56

What is Meralgia paresthetica

Answer 56

Meralgia paresthetica (lateral femoral cutaneous nerve entrapment) consists of pain and numbness in the lateral aspect of the thigh without weakness.

Question 57

____ is the most common peripheral nerve and movement disorder in pregnancy.

____ is the suspected etiology

Answer 57

Restless leg syndrome is the most common peripheral nerve and movement disorder in pregnancy.

Disordered iron metabolism is the suspected etiology

Question 58

What trimester of pregnacy do Chron’s vs Ulcerative Colitis exacerbate

Answer 58

Chron’s dse during 2nd and 3rd trimester

UC during 1st trimester and early post partum period

Question 59

What trimester does intrahepatic cholestasis of pregnany generally occur

Answer 59

3rd trimester

Question 60

Infants born to mothers who are carriers of hepatitis B surface antigen should also receive hepatitis B immune globulin when? ___________

Answer 60

Infants born to mothers who are carriers of hepatitis B surface antigen should also receive hepatitis B immune globulin as soon after birth as possible and preferably within the first 72 h.

Question 61

2 mechanisms by which asymptomatic bacteriuria occur

Answer 61

asymptomatic bacteriuria, most likely due to stasis caused by progestational effects on ureteral and bladder smooth muscle and later in pregnancy due to compression effects of the enlarging uterus

Question 62

Pregnant women with recurrent urinary tract infections, or one episode of pyelonephritis, should be considered for daily antibiotic suppressive treatment throughout the remainder of their pregnancy. True or false

Answer 62

True

Question 63

The most common cause of congenital viral infection in the United States is ______

Answer 63

The most common cause of congenital viral infection in the United States is cytomegalovirus (CMV)

Question 64

Women with a primary CMV infection should delay conception for ____ months.

Answer 64

Women with a primary CMV infection should delay conception for 6 months.

Question 65

All women who might become pregnant and who are not immune to rubella should be vaccinated when?

Answer 65

All women who might become pregnant and who are not immune to rubella should be vaccinated at least 3 months before conception.

Question 66

The risk of active genital herpes lesions at term can be reduced by prescribing what AND when

Answer 66

The risk of active genital herpes lesions at term can be reduced by prescribing acyclovir for the last 4 weeks of pregnancy to all women who had an episode of genital herpes during the pregnancy

Question 67

associated Fetal complication of parvovirus infection in mothers

Answer 67

fetal hydrops secondary to erythroid aplasia and profound anemia.

Question 68

For women with a viral load of ≥1000 copies/mL prior to ____ weeks of gestation, a scheduled prelabor cesarean at ____weeks is recommended to reduce the risk of HIV transmission to the newborn.

Answer 68

For women with a viral load of ≥1000 copies/mL prior to 38 weeks of gestation, a scheduled prelabor cesarean at 38 weeks is recommended to reduce the risk of HIV transmission to the newborn.

Question 69

definition of maternal death

Answer 69

Maternal death is defined as death occurring during pregnancy or within 42 days of completion of pregnancy from a cause related to or aggravated by pregnancy,