Disease Of Pregnancy Flashcards
1
Q
Def and Diff for Anemia in Pregnancy
A
Def = HgB < 10.5
Diff
- Iron Def - (microcytic) do iron trial then recheck in 3 wks - if no improvement then do iron studies and HgB electrophoresis
- Beta thalassemia minor (microcytic) - high A2 HgB; do not give iron
- HELLP - anemia + jaundice + thrombocytopenia; treatment is delivery of baby
- If also low WBCs and low platelets suspect BM problem - acute leukemia or TB of BM - biopsy
- Folate > Vit B12 def (macrocytic)
2
Q
HSV in Pregnancy
A
- Can cause neonatal encephalitis
- Consider C sect if vesicles on cervix, vagina, uterus OR just if prodromal symptoms (burning, itching, tingling)
- Acyclovir @ 36 wks for any woman who had recurrence or first episode of HSV during pregnancy - dec viral shedding
3
Q
2 Major Causes of Antepartum Bleeding (@ > 20 wks)
A
1- Placenta Previa
- Painless bleeding (often first time is mild), post-coital spotting
- US first then speculum then digital to avoid bleeding b/f US
- Not associated w/ sig coagulopathy
- C section at 34 wks
2- Placental Abruption
- Painful w/ uterine contractions
- Complications include coagulopathy, fetal to maternal hemorrhage, still birth
- US is not sensitive; blood looks like placenta
- Dx is by clinical picture, serial HgB, fetal erythrocytes in maternal blood, FHR tracings
- Deliver if > 34 wks
4
Q
Risk Factors for Placenta Previa
A
- grand multiparity
- prior c section
- prior uterine curettage
- prior placenta previa
- mult gestations
5
Q
Risk Factors for Placental Abruption
A
- cocaine or cig use
- short umbilical cord
- trauma
- uteroplacental insufficiency
- PPROM
- submucosal fibroid
- sudden uterine decompression (hydramnios)
6
Q
Appendicitis in Pregnancy
A
- nausea, vomiting, anorexia, fever, leuks, superior and lateral to normal McBurney point
- Laproscopic or laparotomy if far along in pregnancy + abx
- Mimics location of pyelonephritis
7
Q
Cholecystitis in Pregnancy
A
- inc sludge production predisposes to gallstones; if just stones then conservative but if cholecystitis, cholangitis, pancreatitis then surgery
- RUQ pain
- If just biliary colic switch to low fat diet and observe until post-partum
8
Q
Ovarian Torsion in Pregnancy
A
- Unilateral colicky sudden ab or pelvic pain w/ nausea and vomiting
- Most common around 14 wks and immediately post-partum
- Surgery - untwist to see if blood flow returns; if not then remove ovary
- Can be complication of a benign ovarian cyst
9
Q
Ectopic Pregnancy
A
- esp in 1st trimester; spotting; unilateral
- Diagnose by transvaginal US and beta hCG
- May have hemoperitoneum
10
Q
Corpus Luteum Cyst Rupture
A
- Form from normal physiology or excess progesterone
- Rupture because hemorrhage into cyst itself; esp in pregnancy because friable luteum or if bleeding disorder (VWF) or on blood thinner –> hypovolemia and syncope
- If persistent then do lap; stop bleeding and remove cyst
- If b/f 10 wks the corpus luteum makes progesterone for baby so if removed you must replace w/ progesterone
11
Q
Diff for Pruritus in Pregnancy
A
1- ICP - intrahepatic cholestasis of pregnancy; inc bile acids in blood; itching without rash; esp in third trimester; may cause fetal distress or preterm labor esp if jaundice
- Tx - cornstarch bath, antihistamine, cholestyramine or ursodeoxycholic acid
2- Herpes gestationis - IgG against BM and complement activation; diagnosed by immunofluroesence from biopsy; intense itching w/ erythema and vesicles/bullae on trunks more than abdomen; associated w/ stilbirth and growth restriction
- oral steroids
3- PUPPP - pruritic urticaria w/ papules and plaques of pregnancy (papules w/ pale halo); esp on abdomen and extremities
- Histo - normal epidermis but superficial leuk infiltrate
- No association w/ fetal problem
- Tx - topical antihistamine and topical steroids
12
Q
DVT in Pregnancy (pathophysiology, diagnosis and treatment)
A
- Pathophysiology - venous stasis from pressure on vena cava and inc estrogen so more clotting factors like fibrinogen
- Diagnosis - CT or MRI angio; no D dimer because naturally elevated in pregnancy (esp if clear CXR)
- Tx - IV heparin for 5 to 7 days then subQ for 3 months (unfractionated or LMWH); no warfarin because teratogenic; cont “full heparinization” thru 6 wks postpartum
- Goal aPTT = 1.5 to 2.5
- Same for DVT
- Main side effect is osteoporosis
13
Q
Blood Gas in Pregnancy
A
- Inc tidal volume and minute ventilation - so respiratory alkalosis; higher O2 and lower CO2 in arteries
- Higher pH (7.45)
- Lower bicarbonate because try to partially compensate for respiratory alkalosis thru inc bicarbonate excretion; this makes pregnant women more prone to metabolic acidosis (less buffer)
- Give oxygen if PaO2 < 80 in pregnant women
14
Q
Chlamydia
A
- No inc risks of preterm birth
- Chlamydia eye infection and pneumonia in neonate; not protected by erythromycin eye ointment; give baby 14 days oral erythromycin if conjunctivitis
- Also late postpartum endometritis in mom
- Tx for mom - erythromycin or amox for 7 days, azithromycin 1X (no doxy because yellow fetal teeth)
15
Q
Gonorrhea
A
- Can cause preterm birth, stillbirth, PPROM, chorioamnionitis, postpartum infection, neonatal sepsis
- Erythromycin eye cream protects baby
- More likely to become disseminated in pregnant women
- Tx for mom - IM ceftriaxone w/ treatment of Chlamydia too
