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clin med > common problems in pregnancy > Flashcards

common problems in pregnancy Flashcards

1
Q

Gestational HTN is defined as appearing between week ___ and ___ -___days postpartum; resolving by wk __.

A

20 wk and 2-3 days postpartum, resolving by 12 wk postpartum

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2
Q

defining preclampsia vs gestational HTN

A

preclampsia has proteinuria

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3
Q

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

A

no (often retrospective dx)

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4
Q

what is preclampsia? when does it usually occur and at what levels?

A

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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5
Q

definitive txt for preeclampsia

A

delivery

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6
Q

what meds often used to manage preclampsia before delivery?

A

labetolol or nifedipine

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7
Q

3 types of DM with pregnancy

A

pre-existing DM, pregestational DM , GDM

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8
Q

how does insulin resistance change in pregnancy?

A

Cortisol rises during pregnancy, as does insulin resistance

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9
Q

what is most common the problem with pregestational DM?

A

hypoglycemia - b/c of efforts of tight control

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10
Q

at what weeks are GDM screenings done?

A

24-28 wk (1st prenatal visit)

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11
Q

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

A

Insulin is gold standard

glyburide and metformin - common

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12
Q

how do thyroid diseases occur in pregnancy?

A

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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13
Q

what is the only accurate method of estimating thyroid function?

A

free T4

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14
Q

fetal complications from DM

A

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

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15
Q

4 things maternal hyperthyroidism can cause for fetus

A

Prematurity
intrauterine growth restriction (lUGR)
superimposed preeclampsia
Stillbirth

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16
Q

what maternal problems actually improve in pregnancy? how?

A 
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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17
Q

pregnant women taking PTU (propylthiouracil) and methimazole can cause what for the fetus? how?

A

fetal hypothyroidism

-Thyroid hormone analogues with smaller molecular weights, cross the placental barrier.

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18
Q

how do we prevent fetal hypothyroidism from PTU and methimazole?

A

txt mom minimally, screen babies whose mom’s are taking these
*rather have mom with slight hyperthyroidism than fetal hypothyroidism.

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19
Q

at what trimesters do you take PTU and methimazole?

A

PTU: 1st trimester

methimazole: after 1st trimester
* PTU has lower placental transfer but more liver damage risk to mom.

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20
Q

txt for maternal HYPOthyroidism

A

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

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21
Q

is it more important to txt hyperthyroid or hypothyroid mom? why?

A

hypothyroid- fetus is more at risk if mom is NOT txted.

- fetal low intellect (cretinism)

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22
Q

how are underlying heart disease problems “unmasked” in pregnancy?

A

increased cardiac output

23
Q

what are the risks with peripartum cardiomyopathy (dilated cardiomyopathy)?

A

kills young healthy women; >20% mortality

24
Q

key to avoid heart disease in pregnancy?

A

Avoid excess weight gain and edema

25
Q

why do autoimmune disorders get better with pregnancy?

A

Pregnancy is a condition of relative immunocompromise, in order to allow existence of a uterine “parasite”

26
Q

systemic lupus erythematosus; what happens when these women get pregnant?

A

Rule of Thirds (⅓ improve, ⅓ get worse, ⅓ stay the same)
Serious problems with fetus:
preterm delivery, fetal growth restriction, stillbirth

27
Q

what is the main concern with rheumatoid arthritis (and other autoimmune disorders) pts and pregnancy?

A

Main issue is that many immunomodulators and immunosuppressants are toxic to the fetus; get the high-risk OB people involved

28
Q

what is the main concern with seizures during pregnancy?

A

risk of hypoxia to fetus

29
Q

txt for seizure disorders in pregnant women

A

monotherapy: Phenytoin (Dilantin) or phenobarbital

30
Q

HIV; what women are tested?

A

ALL pregnant women (unless they refuse)

31
Q

HIV in pregnancy: C-section should be offered if > ____ copies/ml

A

C-section should be offered if > 1000 copies/ml (reduced transmission compared with vaginal delivery)

32
Q

what is the most common congenital viral infection in the US?

A

CMV

33
Q

CMV: For primary infection (first infection occurs during pregnancy), vertical transmission is __ - ____%

A

40-50%

34
Q

what can happen to SYMPTOMATIC infants infected with congenital CMV?

A

Sensineural hearing loss in 40-50% of those who are symptomatic

35
Q

are more infants symptomatic or asymptomatic with congenital CMV?

A

asymptomatic

*but they still are associated with later problems

36
Q

screening for infant CMV

A

U/S to look for IUGR, hydrocephaly, etc; if normal, amniocentesis should be done, with testing for CMV DNA by PCR

37
Q

txt for infant CMV (maybe weeds)

A

Possible treatment with immune globulin, ganciclovir, also termination if serious abnormalities

38
Q

what 3 things can chicken pox cause in pregnancy?

A

preterm labor, encephalitis, and varicella pneumonia

39
Q

at what stage of pregnancy is it most risky to have a chicken pox infection? why?

A

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

40
Q

mortality % of newborns affected with neonatal fulminant varicella (chicken pox infection at birth)

A

~30%

41
Q

what are the risks with primary genital HSV? what about recurrent genital genital herpes?

A

primary: risk for spontaneous abortion, IUGR, and preterm labor.
recurrent: complications rare, tranmission risk only 4%

42
Q

___% of infants born vaginally to mothers with a primary infection at delivery may develop HSV infection (can even become systemic)

A

50%

43
Q

what % of neonatal herpes is peripartum?

A

85%

44
Q

what portion of babies with disseminated HSV die? why?

A

⅓ to ½ (because baby has basically no immune system)

45
Q

3 types of neonatal herpes?

A

Can be disseminated, CNS/encephalitis, or skin/eye/mouth

46
Q

prevention/txt for neonatal herpes

A

If mother has recurrent outbreaks, put them on Antivirals from 36 wk to term
C-section for active genital outbreak at delivery

47
Q

asymptomatic bacteria in the urine. when is it txted?

A

ONLY if the woman is pregnant

48
Q

maternal UTI txt

A

Nitrofurantoin or ampicillin or a cephalosporin

49
Q

at what gestational age can syphillis be transmitted to the baby?

A

Vertical transmission at any gestational age

50
Q

are all pregnant women screened for syphilis?

A

yes!

51
Q

when should flu vaccine be given?

A

any time in pregnancy

52
Q

what are the presentations of pregnant women with asthma?

A

Rule of Thirds again- some get better, some get worse, some stay the same

53
Q

txt for pregnant women with asthma?

A

Basics of treatment are unchanged in pregnancy
(ICS + LABA)
(avoid antihistamines, epinephrine and ASA/NSAIDs)

clin med (88 decks)

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