Exam 3 Abn Preggo 2

Question 1

HTN in preggos: Chronic?

Answer 1

HTN before preggo or before 20 wks

Question 2

Preeclampsia is?

Answer 2

HTN after 20 wks

+ proteinuria

Question 3

HELLP Synd is?

Answer 3

Severe preeclampsia w/:
Hemolysis
Elevated liver enz
Low platelets

Question 4

Preeclampsia risk factors? (9)

Answer 4

< 20 or > 35 yo
Nulliparity (no babies)
Many preggos
DM
Thyroid dz
Chronic HTN
Renal dz
Collagen vascular dz
FHx

Question 5

Preeclampsia presentation? (8)

Answer 5

HTN + Proteinuria
Edema
HA
N/V
Hyperreflex
Oliguria
Blurred vision
Epigastric pain

Question 6

Preeclampsia: Mild? (2)

Answer 6

SBP 140+ or DBP 90+ (2 reads)

AND 300+mg in 24hr urine

Question 7

Preeclampsia: Severe? (4)

Answer 7

ANY of:
SBP 160+ or DBP 110+ (2 reads)
Severe proteinuria
Signs of end-organ damage (olig, plum edema, RUQ pain, liver enz, severe HA)
Restricted fetal growth

Question 8

Preeclampsia labs? (6)

Answer 8

CBC for hct
Platelet count: thrombocytopenia = worse
PT/PTT
LFT
Cr
Fetal studies

Question 9

Preeclampsia mgmt? (5)

Answer 9

↓ activity
Serial CBC/CMP/Uric acid
Glucocorts < 34 wks
Labetalol
Fetal studies

Question 10

Eclampsia?

Superimposed?

Answer 10

Preeclampsia with new-onset convulsions

Pre/eclamp with pre-existing HTN

Question 11

Intrauterine Growth Restriction (IUGR) is?

Why do we care?

Answer 11

Birth weight < 10th%

Vulnerable to asphyxia, acidemia, labor intolerance
Low APGAR, many issues
As adult: HTN, CVdz, obesity, dyslipidemia

Question 12

IUGR caused by? (5)

Answer 12

Very young or very old mother
Smoking, drugs, HTN, anemia, DM, etc
Primary placental dz
Abn uterus
Multiples, genetics, infection, teratogens

Question 13

TORCH infections include?

Answer 13

Toxoplasmosis
Other
Rubella
CMV
HSV

Question 14

IUGR assessment includes? (2)

Answer 14

Fundal height

US

Question 15

IUGR mgmt? (6)

Answer 15

Watch fetus:
Non-stress test
Biophysical Profile w/ dopler 1-2 x wks
Glucocorts < 34 wks
P bed rest
Deliver when fetal death > neonate risks

Question 16

Gestational HTN is?

Answer 16

HTN after 20 wks

No proteinuria

Question 17

Gestational DM hallmark?

Risk factors? (7)

Answer 17

Insulin resistance

FHx of DM
BMI >30
>25 yo
Hx of macrosomia (big baby)
Polycystic Ovary
Hx unexplained stillbirth
Prior HTN

Question 18

Gestational DM complications? (6)

Answer 18

Preeclamp
Stillbirth
Macrosomia
C-section
Mom -> develops DMII
Baby: hypogly/Ca2+, hyperbili, resp distress

Question 19

Gestational DM screening?

Answer 19

@ 24-28 wks
1 hr Glucose test: if > 130, get 3hr
3hr: if any > 200 or 2 are elevated = GDM

Question 20

Gestational DM mgmt? (4)

Answer 20

Monitor glucose before and after each meal: goal 70-95 fasting, <120 post meal

Health diet
Exercise
P insulin

Question 21

Gestational DM: if baby >4500gms, what next?

What test should be done @ 6 wks postpartum?

Answer 21

C-section

2hr GTT on mom

Question 22

Preterm Labor is?

Answer 22

Regular contractions after 20 wks and before 37 wks

Result in cervix changes

Question 23

Preterm Labor risk factors? (5)

Answer 23

Previous pre-term
Multiples
FHx
Smoking/drugs
Dental infect

Question 24

Preterm Labor sxs? (5)

Answer 24

Cramps
Backache
Abd/pelvic pressure
Vag d/c change
Painless contractions

Question 25

Preterm Labor exam? (6)

Answer 25

r/o membrane rupture
Digital cervical exam
US for cervical length
UA C&S
B Strep cx
Non-stress test
Fetal Fibronectin: + = risk of delivery

Question 26

Preterm Labor mgmt? (3)

Answer 26

Corticosteroids 24-34 wks: speed fetal lung maturation, decrease hemorr
Stop smoking
Progesterone