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OB > Concurrent disorders of pregnancy (unit 2) > Flashcards

Concurrent disorders of pregnancy (unit 2) Flashcards

1
Q

anemia during pregnancy

A
  • Hgb < 11 g/dl in 1st & 3rd trimester
  • Hgb < 10.5 in 2nd trimester
  • Hct < 33%
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2
Q

main consequence of anemia

A

•less O2 carrying capacity
•CO inc.
•inc. pressure in vessels
*can cause preeclampsia, CHF

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3
Q

causes of anemia

A
  • malnutrition
  • hemolysis
  • blood loss
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4
Q

s/sx Fe deficiency anemia

A 
•pallor
•fatigue
•lethargy
•HA
•pica
*most common anemia
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5
Q

fetal effects r/t Fe deficiency anemia

A
  • unclear b/c fetus receives adequate stores at cost to mom

* anemia has to be profound for fetal O2 supply to be impacted

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6
Q

FeSO4

A
  • Fe replacement
  • b/t meals on empty stomach
  • take w/ vit. C
  • avoid bran, tea, coffee, milk, egg yolks
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7
Q

folic acid deficiency anemia

A
  • causes slowing of DNA synthesis, resulting in many immature or decreased formation of RBCs
  • needs double in PG
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8
Q

fetal effects r/t folic acid anemia

A
  • r/o SAb, placental abruption, cleft palate/lip

* r/o neural tube defects (biggest)

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9
Q

folic acid sources

A 
•liver
•kidney/lima beans
•dark greens
•supplements (recommend 600 mcg/day in childbearing women)
*extra need in multifetal PG
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10
Q

causes of sickle cell anemia exacerbation in pregnancy

A
  • low O2 sats- greater needs
  • dehydration- morning sickness
  • infection- suppressed so doesn’t attack baby
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11
Q

maternal effects of sickle cell trait

A
  • usually do fine in PG
  • higher r/o UTI and Fe deficiency
  • r/o UPI
  • more prone to develop pyleonephritis, bone infection, heart dz
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12
Q

sickle cell crisis in PG mom

A
  • temporary cessation of bone marrow fxn
  • hemolytic crisis
  • massive erythrocyte dysfunction (-> jaundice)
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13
Q

fetal effects of sickle cell anemia

A
  • prematurity
  • death r/t crisis
  • possible SC anemia (autosomal recessive)
  • intra uterine groth restriction (IUGR)
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14
Q

sickle cell management

A
  • freq. Hgb, Fe, IBC, folate labs
  • close fetal surveillance
  • assess/prevent crisis
  • exchange transfusion
  • prophylactic transfusion controversial
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15
Q

exchange transfusion

A

•RBCs removed and replaced

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16
Q

goals of sickle cell management

A 
*adequate hydration/nutrition
•good hygiene
•adequate rest
•prompt tx of infection 
*prevent crisis
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17
Q

thalassemia

A
  • genetic disorder affecting synth of hemoglobin

* causes short life span of RBC

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18
Q

s/sx thalassemia in children

A
  • none at birth

* become anemic b/t 3 and 18 months b/c can’t make enough Hgb

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19
Q

anemia progression s/sx in thalassemia children

A
  • failure to thrive/grow
  • poor feeding/emesis
  • irritability/crying
  • pallor
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20
Q

women w/ thalassemia trait

A

•typically have uncomplicated PG when seek genetic counseling

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21
Q

women w/ thalassemia dz

A 
•infertility common
•50% of PG complicated
-stillbirth
-IUGR
-preeclampsia
-PTD
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22
Q

maternal effects of thalassemia during PG

A

•mild anemia

*DONT give Fe supp. b/c they store Fe in excess and it’s hard to excrete

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23
Q

fetal effects of thalassemia

A
  • may/may not cause morbidity

* r/o inheriting dz or having problems associated

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24
Q

asthma and pregnancy

A
  • affects 1-4% of women
  • ½ improve
  • ¼ worsen
  • ¼ stay same
  • labor can exacerbate attack
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25
Q

cystic fibrosis and pregnancy

A
  • if not advanced, tolerate PG well

* if have advanced, often have PG hypoxia and pulmonary infections

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26
Q

pregnancy and SLE

A
  • r/o exacerbation
  • s/sx of joint pain, photosensitivity, butterfly rash
  • if pass 1st trimester, 90% chance for live birth
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27
Q

fetal effects SLE

A
  • congenital heart block

* SAb in 1st trimester

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28
Q

rheumatoid arthritis and pregnancy

A

•symptoms usually greatly improved during PG

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29
Q

epilepsy and pregnancy

A 
•increased r/o IUFD & PTL
•anti-convulsant tx controversial
-dec. clotting; inc. bleeding
-compete for Fe
-teratogenic
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30
Q

what dz could epilepsy during pregnancy be confused with?

A

•eclampsia

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31
Q

multiple sclerosis and pregnancy

A

•medications contraindicated in PG and BF, so may have bowel, bladder, ambulation, and fatigue issues

32
Q

4 cardinal signs of diabetes

A
  • polyuria
  • polydipsia
  • polyphagia
  • weight loss
33
Q

diabetes in 1st trimester

A

•usually not an issue b/c insulin needs are lower

34
Q

diabetes in 2nd/3rd trimester

A
  • insulin needs increase

* pancreas can’t respond sufficiently, so have hyperglycemia

35
Q

pre-existing diabetes and PG

A
  • difficult to control insulin
  • N/V
  • inc. energy needs
  • vascular disorders can worsen
36
Q

pre-existing diabetes increases risk of…

A
  • ABs
  • congenital anomalies
  • macrosomia (lots of sugar)
  • shoulder dystocia (macrosomic)
  • PIH
  • C/S
  • over dissension of uterus
  • IUGR
  • UPI (uterus is peripheral vascular site)
37
Q

why does pre-existing diabetes increase r/o IUGR

A

•vasoconstriction @ uterus

38
Q

influence of diabetes on newborn

A
  • cardiac anomalies
  • hypoglycemia (rebound)
  • resp. distress syndrome (late surfactant development)
  • birth trauma (macrosomia)
  • hypocalcemia
  • hyperbilirubinemia (r/t birth trauma)
39
Q

screening for diabetes

A
  • urine dip (prot, ket, WBC, sugar)
  • Hgb A1c (2.5-5.9%)
  • GCT (24-28 wk)
  • OGTT (if GCT abnormal)
40
Q

GDM diagnosis criteria

A
  • must have 2/4 abnormal to be GDM
    1. fasting- 95
    2. 1 hr- 180
    3. 2 hr- 155
    4. 3 hr- 140
41
Q

diabetes management

A
  • 2200-2400 cal diet
  • exercise
  • SBGM 4-6x/day
  • insulin admin/control
  • monitor fetal status
42
Q

why risk of macrosomia

A

•hyperinsulinemia

43
Q

fetal lung maturity in DM mom

A
  • surfactant development later
  • inc. risk of respiratory distress
  • ideal to have vag birth (squeeze lungs)
44
Q

hyperemesis gravidarum

A 
•excessive N/V past 12 wks
•leads to:
-5% wt loss
-electrolyte imbalance
-dehydration
-ketosis
45
Q

hyperemesis gravidarum risk factors

A
  • < 20 y/o
  • obesity
  • first PG
  • multifetal
  • gestation trophoblastic dz
  • psych d/o
  • hyperthyroidism
  • vit. B deficiency
  • high stress
46
Q

hyperemesis gravidarum effect on fetus

A
  • IUGR

* preterm birth

47
Q

mitral valve prolapse PG implications

A

•give abx before delivery

48
Q

rheumatic heart dz

A
  • occurs when strep throat proceeds into heart dz, causing scarring on heart and stenosis
  • mitral valve stenosis inc. pressure in R atrium -> pulmonary HTN/edema -> HF
49
Q

cardiomyopathy

A

•heart dz that begins last weeks of PG-20 wk PP
•s/sx same as HF
•tx: anticoag; antiarrhythmias, anti-infect; diuretics
*reoccurrence in subsequent PG, so contraindicated

50
Q

class I heart dz

A
  • uncompromised
  • no limitation of physical activity
  • 1% mortality
  • Ex: MVP
51
Q

class II heart dz

A
  • slight limitation of physical activity d/t fatigue, dyspnea, palpitation, angina
  • mortality 5-15%
52
Q

class III heart dz

A
  • moderated/marked limitation of physical activity
  • symptoms w/ less than ordinary activity
  • mortality 25-50%
53
Q

class IV heart dz

A
  • inability to carry on any physical activity w/o discomfort
  • cardiac insufficiency even at rest
  • CANNOT sustain PG
54
Q

s/sx heart dz

A
  • frequent cough
  • dyspnea
  • edema
  • murmor
  • palpitation
  • rales
55
Q

management of heart dz

A
  • high iron/protein intake
  • avoid excessive wt gain
  • freq. rest
  • prophylactic abx
56
Q

Bell’s Palsy

A 
•sudden unilateral neuropathy of 7th CN (facial)
•paralysis/weakness on one side of face
•inc. risk during PG
•tx: steroids 
*spontaneously resolves w/ time
57
Q

TORCH

A 
•Toxoplasmosis
•Other: gonorrhea, syphilis, varicella zoster, hep B, HIV
•Ruebella
•Cytomegalovirus (CMV)
•Herpes Simplex Virus
*infections during PG
58
Q

toxoplasmosis

A
  • protozoan transmitted through undercooked meat & contact with infected cat feces
  • crosses placental barrier
  • often subclinical (no s/sx)
  • IgG/IgM confirm
59
Q

toxoplasmosis in infant

A
  • may be asymptomatic
  • VLBW
  • enlarged spleen/liver
  • jaundice
  • anemia
60
Q

varicella-zoster virus

A

•chicken pox
•herpes thru resp. contact
•may cause PTL, encephalitis, pneumonia
*fetal effects uncommon after 20 wk b/c placental immunity protects

61
Q

congenital varicella syndrome

A
  • fetal effects if varicella in 1st 20 wks
  • limb hypoplasia
  • cutaneous scars
  • microcephaly
62
Q

hepatitis B transmission

A
  • blood, saliva, vag secretions, seme, breast milk

* crosses placental barrier

63
Q

hep B s/sx

A
  • emesis
  • abd pain
  • jaundice
  • fever
  • rash
  • painful joints
64
Q

HIV and PG

A
  • infant has 20-30% r/o contracting form mom w/o tx

* prevention is only tx

65
Q

zidovudine

A
  • PO medication given to HIV+ mom @ 14 wks to prevent vertical transmission
  • IV during labor
  • elixir for newborn up to 6 wk
66
Q

preventing HIV transmission to newborn

A
  • zidovudine
  • DONT BF
  • elective C/S @ 38 wk
  • DONT want ROM
67
Q

rubella

A
  • crosses placental barrier
  • greatest risk in 1st trimester (SAb)
  • can cause fetal deafness, retardation, IUGR, cardiac comp, microcephaly
68
Q

cytomegalovirus (CMV)

A
  • herpes family
  • can cause fetal deafness, retardation, seizure, blindness, dental d/o
  • tx infant w/ Gancyclovir
69
Q

herpes virus

A
  • vertical transmission as fetus descends or during birth
  • C/S if active lesions
  • if contracted in 1st 20 wks, SAB, IUGR, PTL
  • tx: mom w/ acyclovir
70
Q

parvovirus B19 (fifths dz)

A
  • transplacental and respiratory secretions (daycare)
  • maternal effects of “slapped face”, arthralgia, malaise, SAb
  • fetal effect: hydrops (U/S)
71
Q

fetal hydrops

A
  • immature erythrocytes replace hemolyzed erythrocytes
  • placenta and fetal face become edematous
  • can lead to uterine rupture
72
Q

group beta strep neo/infant effects

A

•spesis
•pneumonia
•meningitis***
*crucial to screen mom @ 36 wks (vag swab)

73
Q

GBS abx tx if…

A
  • hx of infant w/ GBS
  • GBS during current PG
  • preterm birth
  • maternal fever during labor
  • ROM > 18 hrs
74
Q

tuberculosis

A

•rare perinatal (infant has to aspirate amniotic fld)
•s/sx of FFT, lethargy, resp. distress, fever, large spleen/nodes/liver
•tx w/ Rafampin, INH and B6
*antiviral drugs contraindicated

75
Q

why fetus at risk later in PG when exposed to external trauma

A
  • less amniotic:fetal ratio

* less cushion

76
Q

most important for trauma during PG

A

•left lateral position

OB (17 decks)

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