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OB > complications2-Table 1 > Flashcards

complications2-Table 1 Flashcards

1
Q

What is the effect of asthma on pregnancy?

A

Rule of thirds

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2
Q

How is asthma managed in pregnancy?

A

maintain adequate oxygenation, use of inhaled B-agonists (albuterol), steroids &/or nebulizers PRN - depending on severity

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3
Q

What do influenza A/B increase the risk of in preggos?

A

Susceptibility to pneumonia

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4
Q

Can pregnant women get the flu vaccine?

A

Yes at any time

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5
Q

If you suspect your pt has been exposed to influenza, what can you do?

A

Chemoprophylaxis

tamiflu

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6
Q

What heat disease is common in pregnancy?

A

Rheumatic heart dz

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7
Q

What can rheumatic heart dz cause?

A

subacute bacterial endocarditis, HF, pulmonary edema, mitral valve stenosis

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8
Q

Why does mitral valve stenosis worsen with pregnancy?

A

increased cardiac output needs d/t pregnancy

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9
Q

What is the most common arrhythmia in pregnancy?

A

paroxysmal atrial tachycardia (PAT)

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10
Q

When might peripartum cardiomyopathy present?

A

Last month of pregnancy through the first 6 mo PP

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11
Q

What are the 5 proposed mechanisms for HTN dz of pregnancy?

A
  • Vascular changes
  • Hemostatic changes
  • Changes in prostanoids
  • Changes in endothelium-derived factors
  • Lipid peroxide, free radical, antioxidant release
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12
Q

What is the predominant change in preeclampsia and GHTN?

A

Maternal vasospasm

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13
Q

What are the hematological effects of HTN dz of preggo?

A

Plasma volume contraction ↑Hct = risk of hypovolemic shock in event of hemorrhage
Risk of DIC, liver involvement, third spacing of fluid (↑BP / ↓plasma oncotic pressure

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14
Q

What are the renal effects of HTN dz of preggo?

A

decreased GFR & proteinuria d/t atherosclerotic-like changes in renal vessels
↓uric acid filtration leading to ↑maternal serum levels
oliguria

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15
Q

What are the neuro effects of HTN dz of preggo?

A

hyperreflexia w/possible progression to grand mal (eclamptic) seizures

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16
Q

What are the pulmonary effects of HTN dz of preggo?

A

Edema, left heart failure, fluid overload

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17
Q

What are the fetal effects of HTN dz of preggo?

A

Decreased placental perfusion 2˚ to vasospasm leads to IUGR, oligohydramnios, placental abruption, increased incidence of perinatal mortality
Placental size & function are decreased -> progressive fetal hypoxia & malnutrition

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18
Q

What are risk factors for preeclampsia?

A 
—Primiparity
—Prior hx w/IUP
—Chronic HTN, chronic renal dz or both
—Hx thrombophilia
—Multi-fetal gestation or in vitro fertilization
—FHx 
—DM type 1 or 2; obesity
—SLE
--- > 40 y/o
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19
Q

What are the classifications of HTN dz of preggo?

A

Chronic HTN
Gestational HTN
Chronic HTN with superimposed preeclampsia
Preeclampsia- eclampsia syndrome

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20
Q

What constitutes chronic HTN?

A

Elevated BP that predates conception or before 20 weeks EGA

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21
Q

What constitutes gestational HTN?

A

New onset BP elevation > 20 weeks EGA/near term in absence of associated proteinuria
This can progress to preeclampsia 1-3 weeks after diagnosis

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22
Q

What is preeclampsia?

A

New onset HTN, new onset proteinuria > 20 weeks EGA
Alternate symptomatology w/ new onset HTN
Preeclampsia w/out severe symptoms progress to severe w/in days

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23
Q

What is eclampsia?

A

Additional presence of seizures in patient w/pre-eclampsia & w/out hx of neurologic disease

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24
Q

What is a complication of Preeclampsia- eclampsia syndrome?

A

HELLP syndrome

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25
Q

What is HELLP syndrome?

A

Hemolysis, Elevated Liver enzymes, Low Platelet count

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26
Q

How is HELLP managed?

A

-Requires cardiovascular stabilization, correction of coag abnormalities (platelet transfusion) & delivery
—Stat delivery:

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27
Q

What is preeclampsia without severe features?

A

—HTN w/proteinuria & edema > 20th week of pregnancy
—New onset HTN & TCP ( 20 weeks EGA
—New onset HTN & elevated LFTs (transaminases 2x normal) > 20 weeks EGA
—New onset HTN & serum creatinine > 1.1 mg/dL or doubling serum creatinine in absence of other renal dz > 20 weeks EGA
—New onset HTN & pulmonary edema or cerebral-visual disturbances > 20 weeks EGA

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28
Q

How is it diagnosed?

A

HTN: Persistent SBP >140-160 mm Hg or DBP > 90-110 mm Hg on 2 occasions 4 hours apart in pt w/previously normal BP
Proteinuria: 1+/dipstick or > 300 mg per 24 hr urine or protein/creatinine ratio > 0.3 mg/dL

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29
Q

Is proteinuria necessary for diagnosing preeclampsia?

A

NO

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30
Q

What is preeclampsis with severe features?

A

—HTN w/proteinuria & edema > 20th week of pregnancy??? WHY IS THIS THE SAME

  • Persistent SBP >160 mm Hg or DBP > 110 mm Hg on 2 occasions 4 hours apart in pt on bed rest
  • TCP 1.1 mg/dL or doubling serum creatinine in absence of other renal dz
  • Pulmonary edema or new onset cerebral-visual symptoms
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31
Q

What are the biomarkers for preeclampsia?

A
  • Angiogenesis proteins
  • PAPP-A
  • Placental protein 13
  • Uric acid
32
Q

How is preeclampsia managed if no severe features or only gestational HTN?

A

Monitor
—Another maternal BP w/NST visit
—Urine protein w/each visit – gestational HTN pt
—Abnormal FH:

33
Q

How is preeclampsia managed if severe gestational HTN or severe preeclampsia features are present?

A

Magnesium sulfate - prevent seizures

Antihypertensive meds

34
Q

When should baby be delivered with preeclampsia?

A

> 37.0 weeks EGA or suspect abruption

> 34.0 wks EGA plus progressive labor &/or ROM, of US fetal wt

35
Q

How long should you monitor PP to make sure symptoms resolve?

A

Monitor closely 24- 48 hrs PP

36
Q

How can you screen for opioid addiction?

A

CRAFT: Car, Relax, Alone, Forget, Family/Friends, Trouble

37
Q

What might be some signs that your preggo mom has an opioid addiction?

A 
—Seek PN late in pregnancy
—High non-compliance w/appointments
—Poor wt gain
—Seem intoxicated or sedated
--- Track marks, skin abscesses
38
Q

What do you need to watch for with withdrawal syndrome?

A

Fetus @ risk: IUGR, preterm labor, placental abruption, death

39
Q

What labs do you want to run if suspect opioid addiction?

A

basic panel (CBC, STD/HIV include Hep C w/Hep B w/ IVDU or high risk exposure, urine drug screen

40
Q

When is detox recommend?

A

during 2nd trimester to avoid risk miscarriage or after 32 weeks EGA to limit preterm labor risk

41
Q

How can withdrawal be managed?

A

Methadone/ buprenorphine…. This will not just be you, lots of people will be involved in care

42
Q

When should you monitor fetus when giving methadone? Why?

A

NSTs or BPPs: 4-6 hours s/p methadone dose

Methadone decreases baseline FHR, variability, breathing movements & tone

43
Q

What is NAS?

A

neonatal abstinence syndrome

44
Q

What are s/s of NAS?

A

CNS/ANS hyperactivity, poor feeding/uncoordinated sucking reflex, irritability, high pitch cry

45
Q

When do symptoms of NAS become apparent?

A

w/in 72 hrs after delivery & last days to weeks

46
Q

Whats with methadone and bup in breast milk?

A

Methadone minimally excreted in breast milk

Buprenorphine maintenance may be safe but research literature is too sparse

47
Q

What is the most common cause of jaundice in pregnancy?

A

Acute viral hepatitis

48
Q

Which antibodies cross the placenta? What does this mean?

A

anti-HAV IgG antibodies

risk for vertical or puerperium transmission

49
Q

Where might a preggo woman pick up hep A?

A

Travel

50
Q

What will be their diagnostic lab finding for acute hep A?

A

anti-HAV IgM positive (serum or feces)

51
Q

How is hep A tx in preggos?

A

supportive & outpatient ……

inpatient only if: severe dz w/coagulopathy, encephalopathy, extreme malaise or hepatic necrosis

52
Q

What would indicate hepatic necrosis?

A

high fever, acute abd’l pain, vomiting, altered MS

53
Q

Can you immunize against hep A while pregnant?

A

Inactivated form is ok

54
Q

Does hep A affect ability to breast feed?

A

No, it is not contraindicated for breastfeeding

55
Q

What is the most common form of chronic hep?

A

B

56
Q

Does hep B cross the placenta?

A

No

57
Q

What does hep B put your pt at risk for?

A

chronic hepatic insufficiency or hepatocellular CA

58
Q

How is it transferred to baby?

A

Perinatal infection – mom to baby during delivery

59
Q

What lab values indicate what type of infection?

A

—anti-HBc antibodies – acute infection

—HBsAg, HBeAg &/or HBV DNA positive = infection

60
Q

How is hep B managed?

A

Neonate: IZ, HBIG postexposure prophylaxis

61
Q

Can you immunize against hep B while preggo or breast feeding?

A

Yes

62
Q

What are risk factors for hep c?

A

alcoholism, IVDU, HIV

63
Q

What is hep C a major cause of?

A

chronic hepatitis, cirrhosis & HCC

64
Q

How is hep c transmitted to baby?

A

—Vertical or perinatal: viral load & HIV status dependent

65
Q

Is c section recommended for hep c positive moms?

A

Not unless HIV co-infected

66
Q

Can you tx hep c while pregnant?

A

Interferon CI and ribavirin category X

67
Q

Is there prophylaxis for hep C?

A

No pre/post exposure prophylaxis yet

68
Q

What does hep D use for transmission?

A

Uses HBsAg for transmission

Co-infection or super-infection w/chronic HBV

69
Q

What lab findings will there be with hep D positive?

A

anti-HDAg positive, HDV DNA

70
Q

How do you tx hep D?

A

No effective meds, immunize against hep B

71
Q

What happens with hep E infection in preggo?

A

severe w/fulminant hepatitis

20% mortality w/acute infection 3rd trimester

72
Q

What will the lab findings be with hep E?

A

IgM antibodies Hep E (anti-HEV antibodies)

73
Q

Is there any tx for hep E?

A

No immunoglobulin available… monitor for renal failure, fulminant hep, premature labor and delivery and eclampsia

74
Q

Is hep E contraindicated in breastfeeding?

A

No

75
Q

What other infections does hep G commonly happen with?

A

Hep C and HIV

76
Q

What will be lab findings in hep G?

A

RNA-PCR amplification; anti-HGVE2 antibodies

77
Q

Should all pregnant women be screened for hep G?

A

Not recommended

OB (11 decks)

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