common problems in pregnancy Flashcards by Jacqui Joseph

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

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defining preclampsia vs gestational HTN

preclampsia has proteinuria

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can you distinguish between preclampsia and gestational HTN early on in pregnancy?

no (often retrospective dx)

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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

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definitive txt for preeclampsia

delivery

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what meds often used to manage preclampsia before delivery?

labetolol or nifedipine

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3 types of DM with pregnancy

pre-existing DM, pregestational DM , GDM

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how does insulin resistance change in pregnancy?

Cortisol rises during pregnancy, as does insulin resistance

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what is most common the problem with pregestational DM?

hypoglycemia - b/c of efforts of tight control

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at what weeks are GDM screenings done?

24-28 wk (1st prenatal visit)

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txt for GDM? what is the gold standard, what is usually used?

Insulin is gold standard

glyburide and metformin - common

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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)

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what is the only accurate method of estimating thyroid function?

free T4

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fetal complications from DM

Fetal complications include macrosomia, incr. abortion, anatomic birth defects

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4 things maternal hyperthyroidism can cause for fetus

Prematurity
intrauterine growth restriction (lUGR)
superimposed preeclampsia
Stillbirth

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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

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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.

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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.

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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.

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txt for maternal HYPOthyroidism

Levothyroxine is safe, but need to check TSH monthly in pregnancy due to physiological changes

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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)

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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)