fun prego complications

Question 1

what is morning sickness?

Answer 1

N +/- V up til 16 wks

Question 2

what is hyperemesis gravidarum?

Answer 2

severe, excessive form of am sickness associated with weight loss and electrolyte imbalance

Question 3

when does HEG develop

Answer 3

during 1st and 2cd trimester, persists > 16 wks gestation

Question 4

what are rf for HEG?

Answer 4

primigravida, previous hyperemesis in past prego, multiple gestations, molar prego

Question 5

what is the pP of HEG

Answer 5

vomiting center oversensitivity to prego hormones

Question 6

what are s/sx of HEG

Answer 6

severe N/V, weight loss 5%of preg weight, acidosis from starvation, metabolic hypochloremic alkalosis

Question 7

how do you tx HEG?

Answer 7

fluids, electrolyte replacement, vitamins

**diet: high protein foods, small frequent meals, avoiding spicy/fatty foods

Question 8

what is the first line antiemtic for hEG?

Answer 8

pyridoxine (vit B6 +/- doxylamine,

can also use methazine, dimenhydrinate

Question 9

what is the Rhesus factor?

Answer 9

maternal antibodies that bind to fetal RBC

Question 10

what is neonatal hemolytic dz?

Answer 10

if the mom is Rh- and the fetus is rh +

Question 11

pp of rh alloimmunization

Answer 11

occurs if rh neg mom carries rh + fetus w/ exposure to fetal blood mixing (C-section, abruption, palcenta previa, amniocenstesis, vag delivery)
-this mixing causes maternal immunization (mathernal anti-rh antibodies

-during subsequent pregos, if mom crries another rh + fetus, antibodies may cross the placenta and attack the fetal RBC= hemolysis of fetal RBC

Question 12

what pregos are at risk for this?

Answer 12

rh neg mom with rh+/unknown father

Question 13

what are s/sx of of rh alloimmunization?

Answer 13

if newborn is Rh+; hemolytic anemia, jaundice, kernicterus, hepatosplenomegaly, chf

fetal hydrops

Question 14

what is kernicterus?

Answer 14

brain damage that is caused by excessive jaundice (bilirubin goes to brain)

Question 15

what are fetal hydrops?

Answer 15

fluid accumulation in 2 spaces–> pericardial effusion, ascites, pleural effusion, subq edema

Question 16

dx of rh alloimm?

Answer 16

prego women: get ABO, rh, indirect erythrocyte antibody screen (1:8-1:32 is associated with fetal hemolysis) indirect coobs

Question 17

fetal monitoringg in rh allo?

Answer 17

in 2cd trimester: if present, check amniotic fluid (increased bilirubin)
-US of middle cerebral artery (increased flow secondary to decreased viscosity of blood in anemia)

-percutaneous umbilical blood sampling (decreased hematocrit

Question 18

how to tx rh alloimmunization?

Answer 18

mom: prevention w/ 300 mg Rhogam (pooled anti-d IgG binds to fetal RBC to prevent maternal mixing)

Question 19

what are the indications for rhogam?

Answer 19

given if Rh -, Ab negative in 3 indications:

1. 28 wks gestation
2. w/in 72 hrs of delivery of an Rh positive baby
3. after any potential mixing of blood (spontaneous abortion, vaginal bleeding,etc)

Question 20

how to treat erythroblastosis fetalis?

Answer 20

umbilical vein transfusions guided by US

*mod- severe anemia tx w/ antigen-negative RBC

Question 21

gestational Dm?

Answer 21

glucose intolerance or DM only present during prego: usually subsides postpartum

Question 22

what are RF for Gest. DM?

Answer 22

fmhx, pmhx of gest. dm, spontaneous abortion, hx of infant >4000g at birth, multiple gestation, obesity, > 25 yso, Aa, hispanic, asian/pacific islander, native american

Question 23

PP of gestational dm?

Answer 23

cuased by placental release of growth hormone, corticotropin releasing hormone, and human placental lactogen (HPL) –> antagonizes insulin –> works similar to growth hormone as a counterregulatory hormone increasing glucose availability for the growing fetus

Question 24

dx of gest. dm?

Answer 24

screening: 50 g oral glucose challenge test at 24-28 wks gestation

if greather than 140 after 1 hour, then perform 3 hour oral GTT

Question 25

how is gest dm confirmed?

Answer 25

3 hr 100 g oral glucose tolerance tests

performed in AM after an o/n fast
fasting> 95
1 hr> 180
2hr > 155
3 hr > 140

Question 26

how is gest dm managed?

Answer 26

daily fingersticks o/n and after each meal

Question 27

what is the medical tx for gest dm?

Answer 27

insulin bc it doesn’t cross the placenta

can also use glyburide (higher risk of eclampsia)
or metformin

Question 28

what type of insulin is used for gest dm?

Answer 28

NPH/regular insulin 2/3 in am, 1/3 in PM

0.8IU/kg first trimester, 1.0 IU/kg 2cd trimester, 1.2 IU.kg in 3rd

Question 29

when is labor induced in gest dm?

Answer 29

@ 38 wks if uncontrolled/macrosomia (c-section may be method of choice)

@40 wks if controlled

Question 30

what are fetal complications of gest dm?

Answer 30

fetal dmise, congenital malformation, premature labor, neonate hypoglycemia from abrupt removal of maternal glucose, hyperglycemia, shoulder dystocia, macrosomia, birth trauma, neonatal hypocalcemia, hyperbilirubinemia

Question 31

what er maternal complicatios of gest dm?

Answer 31

preeclampsia, abruptio placentae, >50% chance of developing DM after prego, > 50% change os recurrence,

*mother should be screened at 6 wks postpartum for DM and yearly afterwad