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RNC-OB > Disease Processes > Flashcards

Disease Processes Flashcards

1
Q

Gestational htn- diagnosed for the first time at ____ , most often after ____ weeks

A

20, 37

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2
Q

Mild htn: ___/___

A

140-159/90-109

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3
Q

Severe htn: ___/___

A

> 160/>110

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4
Q

Outcome risks with severe ghtn

A

Abruption
SGA
preterm delivery

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5
Q

Mild ghtn pts need weekly assessments of ___

A

Proteinuria
Liver enzymes
Platelets
BP (2x/wk, 1 in office)

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6
Q

Do you give mild ghtn pts oral hypertensives?

A

Nope, no salt or activity restrictions either

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7
Q

When do you deliver mild ghtn pts ?

A

EGA 37 or >

spontaneous labor or srom 34 or >

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8
Q

What meds are used for severe ghtn?

A

IV labetolol or IV hydralazine

Oral antihypertensives to maintain BP

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9
Q

Preeclampsia definition

A 
Ghtn PLUS proteinuria 
OR
without proteinuria but with:
Thrombocytopenia (platelets 1.1 or doubling)
Impaired liver function (2x normal labs)
Pulmonary edema
Cerebral/visual symptoms
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10
Q

Proteinuria definition

A

> or = 300 (24-hr urine)
Protein/creatinine ratio > or = .3
Dipstick 1+

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11
Q

Risk factors for preeclampsia

A 
Nulliparity (or new male partner)
Htn
Renal disease
Diabetes
Collagen vascular disease
Thyroid disease
Abnormal placental size or function
40
Hx or family hx of preeclampsia
Inc BMI
Af-American
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12
Q

Hypertension definition

A

Sbp >= 140 OR dbp >= 90

2 measurements, 4 hours apart

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13
Q

Signs of worsening preeclampsia

A 
Increase in subjective symptoms
Oliguria
Sudden wt gain or inc facial edema
Hemoconcentration (hgb >12) *fluid leaking
Inc creatinine >.8
Inc uric acid >5
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14
Q

Meds for eclampsia

A

4g mag slow IV push

Do NOT give diazepam

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15
Q

What to do during/after eclamptic seizure

A 
Prevent injury
Administer 02
Auscultate lungs
Assess/correct acidemia (blood gasses)
Allow fetus to recover before rushing to delivery
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16
Q

What is HELLP syndrome?

A

Hemolysis
Elevated liver enzymes
Low platelets

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17
Q

What is hemolysis (HELLP)

A

Schistocytes on blood smear
Bilirubin >1.2
LDH >600

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18
Q

What are elevated liver enzymes (HELLP)

A

Inc ALT, AST, LDH

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19
Q

What is the cluster of s/s to warrant lab eval for HELLP (htn/proteinuria may be absent)

A 
N/v/d
Malaise
Flank/shoulder pain
Jaundice
Unusual bleeding
Generalized edema
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20
Q

What additional management is needed with mild preeclampsia than mild ghtn?

A

Twice weekly BPP and growth scan

Add umbilical artery Doppler velocimetry if iugr

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21
Q

Indications for delivery with mild preeclampsia

A

Same as mild ghtn
EGA >= 37 wks
Spontaneous labor/srom >=34wks

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22
Q

Management for severe preeclampsia or HELLP

A

4-6g loading dose mag
2-3g/hr maintenance dose mag
Antihypertensives for severe BP

continue intraop mag for c/s
Neuraxial techniques for analgesia/anesthesia

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23
Q

Indications for delivery with severe preeclampsia or HELLP

A

If mom/fetus unstable deliver after stabilization

^even if previable

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24
Q

When do you delay delivery 48hrs after steroids with severe preeclampsia /HELLP

A

PPROM
Spontaneous labor
IUFGR
severe oligo (AFI

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25
Q

When do you NOT delay delivery after steroids for

A 
Uncontrollable sever htn
Eclampsia
Pulmonary edema
Abruption
DIC
fetal compromise
IUFD
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26
Q

When are mag levels drawn?

A

Creatinine >1.2 or UOP

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27
Q

When do you DC mag for mag toxicity

A

Absent DTR’s

Respirations

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28
Q

HTN that presents before the 20th week is considered ___

A

Chronic htn

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29
Q

What meds are used to treat chronic htn?

A

Labetolol, nifedipine, methyldopa

Low dose ASA in third tri for very high risk

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30
Q

What is the goal BP for chronic htn?

A

120/80-160/105

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31
Q

At what gestational age do you deliver chronic htn pts with no other issues?

A

38 wks

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32
Q

What is a side effect of hydralazine to watch out for?

A

Rebound tachycardia

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33
Q

When should you be cautious with labetolol?

A

When pt is asthmatic and requires rescue inhaler. (Won’t work)

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34
Q

When should you be cautious with nifedipine use?

A

When used together with mag sulfate

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35
Q

In postpartum period when would you treat a BP with antihypertensives ? What BP ?

A

SBP >150 or DBP>100

*2 readings, 4 hrs apart

> 160/110 treat as hypertensive emergency

36
Q

If somebody has any htn disorder how long should BP be monitored after delivery?

A

For 72 hrs after delivery, and at office at 7-10 days

37
Q

First half of pregnancy is ___ , while second half is ___

Anabolic- fat storage
Catabolic- fat breakdown

A

Anabolic

Catabolic

38
Q

Insulin infusion is started for type 1 diabetics if blood glucose is higher than ___

A

120

39
Q

Cardiac output in pregnancy rises to ___% of normal by ___wks

A

150, 24-28

40
Q

What are the three periods of high risk for cardiac decompensation?

A

When fluid volume peaks at end of 2nd tri
During work of labor
With fluid shifts that occur postpartum

41
Q

What are the NYHA functional classes?

A

1- asymptomatic
2- symptoms with normal activity
3- symptoms with less than normal activity
4- symptoms at rest

42
Q

What should you know about coarctation of aorta?

A

Aorta narrows
Associated with intracranial aneurysms
Epidural ideal, shorten second stage

43
Q

What should you know about rheumatic heart disease?

A

Eradicate pathogen, reduce inflammation

Long acting pnc, NSAIDs or corticosteroids

44
Q

What types of valvular defects are there?

A

Stenosis and regurgitation

45
Q

Which type of valvular defect tends to be worse in pregnancy?

A

Stenotic- >60% have worsening NYHA class

Can also have CHF, PTL, IUFGR, stillbirth

46
Q

What are complications of mitral stenosis?

A

Pulmonary edema, RV failure, arrhythmias, PE

47
Q

How do you treat mitral stenosis?

A

Preventing/controlling tachycardia is ESSENTIAL

Pain management, beta blockers

48
Q

What happens in aortic stenosis?

A

Stenosis between LV and aorta (to circulation)

Created fixed stroke volume, dec CO, hypotensive tachycardia

49
Q

How do you manage aortic stenosis?

A

Prevent hypotension and tachycardia!

Generous hydration, cautious epidural use
Shorten second stage
Active management of PPH

50
Q

What do you need to know about mitral valve prolapse?

A

Most common
Mostly asymptomatic
Some experience chest pain, dyspnea, weakness, palpitations
Low risk during pregnancy

51
Q

What do you need to know about mechanical heart valves?

A

Anticoagulation very difficult (no warfarin)

Advised to have valve repair/replacement

52
Q

What do you need to know about dysthymias and treatment?

A 
SVT common
Treatment unaltered by pregnancy
Vagal maneuvers 
IV adenosine (causes fetal bradycardia)
Frequent episodes- beta blockers, calcium channel blockers, digoxin
53
Q

What do you need to know about marfans syndrome?

A

Aortic root diameter critical
Surgical replacement if root diameter >5.5cm
High risk if root diameter >4.5cm- csection
Treat htn aggressively- beta blockers

54
Q

What do left-to-right shunts cause? (Seen with ASD, VSD, PDA)

A

Pulmonary htn

55
Q

What do you need to know about pulmonary htn?

A

Causes right sided heart failure, ⬇️ 02 to body
Tx with vasodilators- prostacyclin infusion
Avoid hypotension

56
Q

What do you need to know about eisenmengers syndrome?

A

L–>R shunt, pulm htn, R–>L shunt, deoxygenated blood to circulation
Maternal mortality mostly postpartum
Repair of breech before pulm htn
After pulm htn only tx heart lung transplant
Maintain preload!

57
Q

What do you need to know about peripartum cardiomyopathy?

A

Pulm edema and CHF
usually in 3rd tri or postpartum

Tx with Anticoagulation for high risk of thromboembolism
Reduce preload (Na/fluid reduction, diuretics, nitrates)
Afterload reduction (hydralazine, ACE inhibitors PP)
Digoxin

58
Q

What do you need to know about endocarditis?

A

Routine antibiotic prophylaxis not recommended

Cyanotic congenital heart defects considered high risk and should receive prophylaxis for vaginal delivery

59
Q

What do you need to know about ischemic heart disease?

A

Mostly seen in pregnancy in women who have had type 1 diabetes for over 10 years

Delay delivery for 2 weeks after MI

vaginal delivery preferred

60
Q

When do you test for GBS and how?

A

35-37 weeks with vaginal-rectal culture

61
Q

What antibiotics are used for GBS?

A

PNC or ampicillin preferred
Cefazolin if allergy and low risk anaphylaxis
Clinda/vanco if allergy and high risk

62
Q

What hgb levels diagnose anemia in pregnancy?

A

H

63
Q

What causes gestational thrombocytopenia and what platelet count is considered mild to moderate?

A

Dilution and inc platelet destruction
Mild to moderate 50-149k

*spontaneously resolves after delivery

64
Q

What is immune thrombocytopenic purpura? (ITP) and what is the treatment

A 
Antiplatelet antibodies (autoimmune)
Tx with steroids
65
Q

What is thrombocytopenic purpura (TTP) and what is the treatment?

A

Extensive microscopic clots form- 90% mortality untreated

Tx with plasma exchange

66
Q

What are risks of sickle cell?

A

Preterm delivery

Preeclampsia

67
Q

What are risks of thalassemia?

A

Hydrops fetalis

IUFGR

68
Q

When are Rh-D negative mothers given rhogam?

A

28 wks, after delivery, and other situations where fetal-maternal hemorrhage can occur

69
Q

What are thrombophilias (lead to increased thrombosis)?

A 
Factor V Leiden
Protein c deficiency
Protein s deficiency
Prothrombin g20210a mutation
Antithrombin III deficiency
70
Q

What drug is used as anticoagulant for VTE prophylaxis in pregnancy?

A

Heparin- unfractionated (UH), or LMWH
doesn’t cross placenta
Switch from LMWH to UH in last mo of pregnancy
Stopped when pt goes into labor

71
Q

What is DIC

A

Dysregulated coagulation cascade that results in uncontrollable bleeding

72
Q

What are common causes of DIC?

A

Abruption
Preeclampsia
Sepsis
Anaphylactoid syndrome

73
Q

What diagnoses DIC?

A 
Abnormal bleeding
Prolonged PT/aPTT
Thrombocytopenia
Fibrinogen reduced
High levels of fibrin split products (d-dimer)
Shistocytes on blood smear
74
Q

What is the treatment for DIC?

A

Identify/reverse cause

Platelets/FFP can be given to prevent death but can worsen process

75
Q

What do you need to know about renal function in pregnancy ?

A

Renal volume inc 30%
Renal blood flow inc 60-80% in first tri
Dec to 50% inc at term
GFR inc 40-50%
Serum creatinine decreases
Angiotensinogen, angiotensin II, renin, and aldosterone all elevated
Mild proteinuria

76
Q

What do you need to remember about pyelonephritis and PTL?

A

Use great caution with tocolytics and steroids in acute phase

Withholding is appropriate in pts with respiratory or hemodynamic instability

77
Q

What happens to thyroid hormones in pregnancy?

A

Demand for thyroid hormones inc in pregnancy
Fetal CNS development depends on good T4
Fetus cannot produce T4 until 18wks
T4 converts to T3 (more metabolically active)

78
Q

What do low/high levels of TSH mean?

A

Low levels - hyperthyroidism

High levels - hypothyroidism

79
Q

What is treatment for hypothyroidism in pregnancy?

A

Synthroid (levothyroxine) synthetic T4

Dosage inc in pregnancy

80
Q

What do you need to know about hyperthyroidism in pregnancy?

A

Rare- most caused by Graves’ disease
Often masked due to normal inc in thyroid function
Associated with PTL, IUFGR, low birth weight, neonatal thyroid dysfunction

81
Q

What do you need to know about Graves’ disease?

A

Autoimmune disorder
Fetal hyper turns into neonatal hypo
Tx with propylthiouracil or methimazole
^1st tri ^2nd tri
Goal is T4 upper limits/slightly over normal

82
Q

What are signs/symptoms of a thyroid crisis?

A

Altered mental status, temp >41c, htn, diarrhea

ICU admit, aggressive tx

83
Q

What do you need to know about postpartum thyroiditis?

A

Transient thyroid dysfunction in 1st year PP
symptoms mimic pp depression
If over one year consider chronic

84
Q

What do you need to know about systemic lupus erythematosus?

A

Autoantibodies cause inflammation/tissue damage

High risk for preeclampsia
Avoid NSAIDs
Associated with SAB, IUFD, IUFGR, PTL
Complete heart block most common neonatal cardiac complication

85
Q

What do you need to know about antiphospholipid syndrome?

A

Autoantibodies
Promotes thrombosis/clot formation
High occurrence of fetal death, preeclampsia, IUFGR
tx with heparin, low dose ASA

86
Q

What do you need to know about appendicitis?

A

Most common non ob surgical emergency
Ultrasound 1st, if inconclusive then MRI
surgery required
Maternal/fetal mortality inc in cases of perforation

RNC-OB (9 decks)

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