common problems in pregnancy Flashcards
Gestational HTN is defined as appearing between week ___ and ___ -___days postpartum; resolving by wk __.
20 wk and 2-3 days postpartum, resolving by 12 wk postpartum
defining preclampsia vs gestational HTN
preclampsia has proteinuria
can you distinguish between preclampsia and gestational HTN early on in pregnancy?
no (often retrospective dx)
what is preclampsia? when does it usually occur and at what levels?
High BP and proteinuria during pregnancy
May occur after 20 wk, but usually after 32 wk
BP ≥140/90, or 160/100 for severe
>300 mg/d proteinuria
definitive txt for preeclampsia
delivery
what meds often used to manage preclampsia before delivery?
labetolol or nifedipine
3 types of DM with pregnancy
pre-existing DM, pregestational DM , GDM
how does insulin resistance change in pregnancy?
Cortisol rises during pregnancy, as does insulin resistance
what is most common the problem with pregestational DM?
hypoglycemia - b/c of efforts of tight control
at what weeks are GDM screenings done?
24-28 wk (1st prenatal visit)
txt for GDM? what is the gold standard, what is usually used?
Insulin is gold standard
glyburide and metformin - common
how do thyroid diseases occur in pregnancy?
increase in GFR that occurs during pregnancy, renal excretion of iodine increases
**(Iodide freely crosses the placenta, but TSH does not)
what is the only accurate method of estimating thyroid function?
free T4
fetal complications from DM
Fetal complications include macrosomia, incr. abortion, anatomic birth defects
4 things maternal hyperthyroidism can cause for fetus
Prematurity
intrauterine growth restriction (lUGR)
superimposed preeclampsia
Stillbirth
what maternal problems actually improve in pregnancy? how?
Graves disease (and maybe other autoimmune) often improves during pregnancy -increased immunologic tolerance during pregnancy and a subsequent decrease in thyroid antibodies
pregnant women taking PTU (propylthiouracil) and methimazole can cause what for the fetus? how?
fetal hypothyroidism
-Thyroid hormone analogues with smaller molecular weights, cross the placental barrier.
how do we prevent fetal hypothyroidism from PTU and methimazole?
txt mom minimally, screen babies whose mom’s are taking these
*rather have mom with slight hyperthyroidism than fetal hypothyroidism.
at what trimesters do you take PTU and methimazole?
PTU: 1st trimester
methimazole: after 1st trimester
* PTU has lower placental transfer but more liver damage risk to mom.
txt for maternal HYPOthyroidism
Levothyroxine is safe, but need to check TSH monthly in pregnancy due to physiological changes
is it more important to txt hyperthyroid or hypothyroid mom? why?
hypothyroid- fetus is more at risk if mom is NOT txted.
- fetal low intellect (cretinism)
how are underlying heart disease problems “unmasked” in pregnancy?
increased cardiac output
what are the risks with peripartum cardiomyopathy (dilated cardiomyopathy)?
kills young healthy women; >20% mortality
key to avoid heart disease in pregnancy?
Avoid excess weight gain and edema
why do autoimmune disorders get better with pregnancy?
Pregnancy is a condition of relative immunocompromise, in order to allow existence of a uterine “parasite”
systemic lupus erythematosus; what happens when these women get pregnant?
Rule of Thirds (⅓ improve, ⅓ get worse, ⅓ stay the same)
Serious problems with fetus:
preterm delivery, fetal growth restriction, stillbirth
what is the main concern with rheumatoid arthritis (and other autoimmune disorders) pts and pregnancy?
Main issue is that many immunomodulators and immunosuppressants are toxic to the fetus; get the high-risk OB people involved
what is the main concern with seizures during pregnancy?
risk of hypoxia to fetus
txt for seizure disorders in pregnant women
monotherapy: Phenytoin (Dilantin) or phenobarbital
HIV; what women are tested?
ALL pregnant women (unless they refuse)
HIV in pregnancy: C-section should be offered if > ____ copies/ml
C-section should be offered if > 1000 copies/ml (reduced transmission compared with vaginal delivery)
what is the most common congenital viral infection in the US?
CMV
CMV: For primary infection (first infection occurs during pregnancy), vertical transmission is __ - ____%
40-50%
what can happen to SYMPTOMATIC infants infected with congenital CMV?
Sensineural hearing loss in 40-50% of those who are symptomatic
are more infants symptomatic or asymptomatic with congenital CMV?
asymptomatic
*but they still are associated with later problems
screening for infant CMV
U/S to look for IUGR, hydrocephaly, etc; if normal, amniocentesis should be done, with testing for CMV DNA by PCR
txt for infant CMV (maybe weeds)
Possible treatment with immune globulin, ganciclovir, also termination if serious abnormalities
what 3 things can chicken pox cause in pregnancy?
preterm labor, encephalitis, and varicella pneumonia
at what stage of pregnancy is it most risky to have a chicken pox infection? why?
if near delivery time (5 d before to 2 d after), no maternal antibodies are transferred and risk of neonatal fulminant varicella infection is high
mortality % of newborns affected with neonatal fulminant varicella (chicken pox infection at birth)
~30%
what are the risks with primary genital HSV? what about recurrent genital genital herpes?
primary: risk for spontaneous abortion, IUGR, and preterm labor.
recurrent: complications rare, tranmission risk only 4%
___% of infants born vaginally to mothers with a primary infection at delivery may develop HSV infection (can even become systemic)
50%
what % of neonatal herpes is peripartum?
85%
what portion of babies with disseminated HSV die? why?
⅓ to ½ (because baby has basically no immune system)
3 types of neonatal herpes?
Can be disseminated, CNS/encephalitis, or skin/eye/mouth
prevention/txt for neonatal herpes
If mother has recurrent outbreaks, put them on Antivirals from 36 wk to term
C-section for active genital outbreak at delivery
asymptomatic bacteria in the urine. when is it txted?
ONLY if the woman is pregnant
maternal UTI txt
Nitrofurantoin or ampicillin or a cephalosporin
at what gestational age can syphillis be transmitted to the baby?
Vertical transmission at any gestational age
are all pregnant women screened for syphilis?
yes!
when should flu vaccine be given?
any time in pregnancy
what are the presentations of pregnant women with asthma?
Rule of Thirds again- some get better, some get worse, some stay the same
txt for pregnant women with asthma?
Basics of treatment are unchanged in pregnancy
(ICS + LABA)
(avoid antihistamines, epinephrine and ASA/NSAIDs)
