Last maternal test Flashcards
1
Q
Chronic hypertension
A
high blood pressure that is known to predate conception of detected BEFORE 20 weeks gestation
2
Q
Chronic hypertension
A
high blood pressure that is known to predate conception of detected BEFORE 20 weeks gestation
3
Q
Chronic hypertension with Superimposed Preeclampsia
A
HTN with proteinuria that develops after 20th week OR HTN and proteinuria that develops before the 20th week WITH at least one:
Increase in BP, increase in liver enzymes, platelets below 100,000, RUQ pain, severe headache, pulmonary congestion or edema, renal insufficiency, sudden or sustained increase in protein excretion
4
Q
Transient gestational HTN
A
increase in blood pressure that occurs without proteinuria late in pregnancy or in the early pp period, but RETURNS TO NORMAL by 12 weeks pp
5
Q
Chronic gestational hypertension
A
increase in blood pressure without proteinuria late in pregnancy or in the early pp period, but REMAINS INCREASED after 12 wks pp
6
Q
Pre-eclampsia/Eclampsia
A
hypertension that develops after the 20th week of gestation AND proteinuria
OR
thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral or visual symptoms
7
Q
> or = 140 systolic or > or = 90 diastolic on two occasions AT LEAST 4 hours apart in a woman with previous normal BP
A
pre-eclampsia diagnostic procedure
8
Q
> or = 160 systolic or > or = 110 diastolic can be confirmed within a short interval to facilitate timely treatment
A
Pre-eclampsia diagnostic procedure
9
Q
increase in BP after 20 wks gestation
A
pre-eclampsia diagnostic procedure
10
Q
Proteinuria in pre-eclampsia
A
> or = 300 mg per 24 hour urine collection GOLD STANDARD
OR
protein/cretinine ratio > or = 0.3 mg/dL
Dipstick reading of 1+ (used only if other quantitative methods are not available)
11
Q
thrombocytopenia in patients with pre-eclampsia
A
platelet count
12
Q
Renal insufficiency in pre-eclampsia
A
protein/ creatinine ratio > or = 0.3 mg/dL
13
Q
Impaired liver function in pre-eclampsia
A
elevated blood concentrations >1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal diseases
14
Q
Eclampsia
A
presence of new-onset grand mal seizure in a woman with pre-eclampsia
15
Q
Predisposing Factors to Preeclampsia
11
A
Primiparity Previous preeclamptic pregnancy Chronic hypertension or chronic renal disease History of thrombophilia Multigestational pregnancies In vitro fertilization Family Hx of preeclampsia Type I DM or Type II DM Obesity Systemic lupus erythematosus Maternal age 40
16
Q
Changes in Normal Pregnancy
cardiac output, blood volume, peripheral vasc resistance, BP, renin, GFP, ECF, aldosterone
A
increased Cardiac output by 50% increased Blood volume by 1500ml decreased Peripheral vascular resistance decreased BP increased Renin increased GFR increased ECF Aldosterone effects blocked
17
Q
Treatment of preeclampsia without severe features:
A
Daily kick counts Ultrasound for fetal growth every 3 weeks Amniotic fluid at least assessed 1/week NST twice a week (non-reactive=BPP) Daily wt for gain Monitor BP daily Monitor lab tests: CBC, liver enzymes, serum Creatinine once a week Reg diet with no salt restrictions
18
Q
hospital care for mild preeclampsia
A
bed rest, left lateral recumbent position to increase renal perfusion and promote diuresis and lowers BP
Diet must be well balanced, moderate increase protein to replenish what is spilled in kidneys
19
Q
Assess fetal well being in hospital care for mild preeclampsia by assessing..
A
NST, amniocentesis, DFMC, BPP
20
Q
Assess maternal well being in hospital care for mild preeclampsia by assessing
A
BP every 4 hours, headaches, visual changes, lab tests such as daily urine dipstick for protein, 24 hour protein, CBC with platelet every 2 days, serum creat, uric acid and liver function tests such as AST, ALT, LDH
21
Q
Severe preeclampsia
A
BP of 160/110 or higher on 2 occasions in at least 4 hours apart while on bedrest
might complain of HA, RUQ pain, epigastric pain, thrombocytopenia
22
Q
proteinuria in severe preeclampsia
A
greater than 5g/L in 24 hour of 3+ on 2 random urine samples 4 hours apart
23
Q
oliguira in severe preeclampsia
A
less than 500ml/24 hrs
24
Q
impaired liver function in severe preeclampsia
A
increased AST and APT
25
treatment of severe preeclampsia
bedrest.
quiet environment to reduce stimuli
delivery >34 weeks gestation
26
Medications used in treatment: seiizure prophylaxis: Mag sulfate dose...
Mag sulfate: 4-6 gm bolus is given IV over 20 minutes then continuous infusion of 2gm/hr generally advocated
27
Mag sulfate what...
a CNS depressant and needs to be maintained at a therapeutic level as determined by each lab.
28
excessive levels of mag sulfate lead to
respiratory paralysis and cardiac arrest
29
what is given to reverse mag sulf
calcium gluconate
30
Medications used in treatment: Antihypertensives
Examples and doses
given for sustained BP's of 160-110
FIRST LINE:
Labetalol: 20mg IV over 2 min, can give q10 min if needed (max of 300mg)- avoid with asthma or CHF
Hydralazine: 5mg IV over 1-2 min, can give q 20 min if needed (max of 30
NO DIURETICS AND ACE INHIBITORS SHOULD BE USED
31
Eclampsia: symtpms of impending seizure : (11)
```
Persistent occipital or frontal headaches
Blurred vision
Photophobia
Epigastric or right upper quadrant pain
Altered mental status
Hyperreflexia— 4+
Scotomata—dark spots or flashing lights
Vomiting
Neurologic hyperactivity
Pulmonary edema
Cyanosis
```
32
Safety precautions for Eclampsia
quiet environment- no phone calls, TV, lights
Padded side rails in bed
O2 ready
Suction ready
33
HELLP syndrome
Hemolysis
Elevated Liver enzymes
Low Platelets
34
HELLP is sometimes associated wtih
severe preeclampsia
35
S/S of HELLP
n&v, malaise, flu lke sx, epigastric pain with or without HTN
anyone with these s/s should have their CBC and liver enzymes drawn
36
HELLP and corticosteroids
they are usually given to foster fetal maturity but they have been found to stabilize platelet counts and hepatic enzymes and LDH levels.
37
What med is typically chosen for HELLP syndrome
Dexamethasone
38
maternal glucose crosses the placenta. true or false
true
39
CHO Metabolism in the first trimester:
increase in estrogen and progesterone which stimulates beta cells of pancreas to increase insulin production
increase use of glucose leads to decrease in serum glucose levels
increase in tissue glycogen (energy) stores
decrease in liver glycogen production
40
CHO metabolism in the 2nd and 3rd trimesters
hormone levels lead to decrease tolerance to glucose
increase insulin resistance
HPL- Human Placental Lactogen wont let insulin work
Placental insulinases- break down insulin at placental site
41
placental insulinases
breakdown insulin at placental site
42
Net result
changes in insulin needs for mother during pregnancy
43
first trimester net result
decrease need for insulin, increase insulin production, N&V, decrease food intake, increase transfer of fetus
44
2nd trimester net result
gradual increase of insulin
45
3rd trimester net results
2-4 times higher need for insulin by 36 weeks, then levels off til labor
46
after delivery net result
decrease insulin, glucose insulin balance OK by 7-10 days
47
Pregestational diabetic risks to the mother
poor control very early in pregnancy can cause miscarriage
macrosomic baby
PTL
pre-eclampsia
polyhydramnios
ketoacidosis/hypoglycemia
48
Gestational onset risks to the mother
2X more likely to have pre-eclampsia and macrosomic baby
49
pregestational risks to baby for diabetes:
congenital defects :heart, skeletal, CNS
50
Gestational diabetes risks for baby
```
macrosomia
trauma
hypoglycemia
RDS
hypocalcemia
hyperbilirubinemia
thrombocytopenia
polycythemia
```
51
Management of pre-gestational diabetes
establish glycemic control BEFORE pregnancy
understand very close monitoring - 4-8 times a day
If type 2- oral hypoglycemic agents are teratogenic- insulin subq during pregnanacy
diet carefully balanced
52
Management of pre-gestational diabetes: Hgn A1c
Good control: 2.5-5.9 %
Fair control: 6-8%
Poor control: >8%
53
for mothers with pre-gestational diabetes, when is exercise best
after meals
54
Management of pre-gestational diabetes- INSULIN
multiple times a day, mixed longer acting and rapid acting in the morning and pm
humulin and novolin, NOT PORK OR BEEF INSULINS
humulog if NEWLY diagnosed
55
goal for insulin in pre-gestational diabetes
fasting 60-90 mg/dl
| 2 hour postprandial= 90=120
56
Management of Pre-gestational Diabetes-Delivery
Careful determination of ACTUAL due date
Amniocentesis ----Fetal lung maturity
Induce 39-40 wks-NO LATER THAN 40 WKS
If estimated fetal weight greater than 4000-4500 gms---C/S
In L&D- Watch maternal glucose levels EVERY 2 hours
57
low risk for gestational diabetes screening
less than 25 y/o
no family Hx
normal BMI
no abnormal GTT
58
high risk for gestational diabetes screening
history of diabetes,
overweight, obese
high risk group- african american, native, latina, pacific
59
Gestational diabetes screening- First pre-natal visit.
50 gm glucose load, draw serum 1 hour later
negative less than 140
positive greater than 140
screen again at 24-28wks gestation
60
if positive result of gestational diabetes screening
do 3 hour GTT (100g of glucose)
positive for GDM- 2 or more levels are met or exceeded:
Fasting
61
managment of gestational diabetes
```
keep blood sugars within levels
3 meals and 3 snacks diet
exercise
insulin- 20% will need insulin during pregnancy
blood glucose monitoring
delivery by 40 wks
prequent NST/ BPP in last 2 mo
```
62
Group B hemolytic strep
major cause of perinatal infections
found in vagina and urine
increase fetal mortality and morbidity
screen 35-37 weeks
63
IF positive for GBS
treat with penicillin: 5 milli units IV X 1; 2.5-3 milli units every 4 hours
treat with ampicillin: 2 GMS X 1; 1 GM every 4 hrs
treat with clindamycin: 900 mg q 8 hr or
erythromycin 500mg q 6 hrtil delivery IF ALLERGIC TO PENICILLIN
64
GBS: prophylactic treatment is indicated if
previous infant with GBS, GBS bacteria during pregnancy, PTL, temp in labor of greater than 100.4, membranes ruptured for more than 18 hours
65
TORCH
toxoplasmosis
rubella
cytomegalovirus
herpes
66
why are steroids given to patients with HELLP
it can stabilize the platelets
67
patients might complain of what symptoms when experiencing HELLP
flu like symptoms
68
ectopic pregnancy
egg implants outside of uterus
lots of pain and internal bleeding
surgical intervention needed
69
hydatidiform mole
no fetus, fluid filled vesicle, N&V, no FHT, 2nd trimester bleeding, d&C, not get pregnant for 1 year, choriocarinoma if HCG evelated
70
cerclage: McDonalds or Shirodkar procedure
```
10-14 weeks gestation
no intercourse, prolonged stanging, heavy lifting
bedrest
teach signs of preterm labor
take tocolytics
uterine monitoring
remove suture at 37 weeks
leave suture in for c/section
```
71
hyperemesis gravidarum
vomiting during pregnancy, 5% loss of body weight, ketosis, metabolic alkalosis
rule out gestational trophoblastic Dz by ultrasound
needs hospitalization if it doesnt respond to small frequent meals (IV fluids with Kcl to prevent hypokalemia)
B vitamin replacement
TPN temporary
72
Chronic hypertension with Superimposed Preeclampsia
HTN with proteinuria that develops after 20th week OR HTN and proteinuria that develops before the 20th week WITH at least one:
Increase in BP, increase in liver enzymes, platelets below 100,000, RUQ pain, severe headache, pulmonary congestion or edema, renal insufficiency, sudden or sustained increase in protein excretion
73
Transient gestational HTN
increase in blood pressure that occurs without proteinuria late in pregnancy or in the early pp period, but RETURNS TO NORMAL by 12 weeks pp
74
Chronic gestational hypertension
increase in blood pressure without proteinuria late in pregnancy or in the early pp period, but REMAINS INCREASED after 12 wks pp
75
Pre-eclampsia/Eclampsia
hypertension that develops after the 20th week of gestation AND proteinuria
OR
thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral or visual symptoms
76
> or = 140 systolic or > or = 90 diastolic on two occasions AT LEAST 4 hours apart in a woman with previous normal BP
pre-eclampsia diagnostic procedure
77
> or = 160 systolic or > or = 110 diastolic can be confirmed within a short interval to facilitate timely treatment
Pre-eclampsia diagnostic procedure
78
increase in BP after 20 wks gestation
pre-eclampsia diagnostic procedure
79
Proteinuria in pre-eclampsia
> or = 300 mg per 24 hour urine collection GOLD STANDARD
OR
protein/cretinine ratio > or = 0.3 mg/dL
Dipstick reading of 1+ (used only if other quantitative methods are not available)
80
thrombocytopenia in patients with pre-eclampsia
platelet count
81
Renal insufficiency in pre-eclampsia
protein/ creatinine ratio > or = 0.3 mg/dL
82
Impaired liver function in pre-eclampsia
elevated blood concentrations >1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal diseases
83
Eclampsia
presence of new-onset grand mal seizure in a woman with pre-eclampsia
84
Predisposing Factors to Preeclampsia
| 11
```
Primiparity
Previous preeclamptic pregnancy
Chronic hypertension or chronic renal disease
History of thrombophilia
Multigestational pregnancies
In vitro fertilization
Family Hx of preeclampsia
Type I DM or Type II DM
Obesity
Systemic lupus erythematosus
Maternal age 40
```
85
Changes in Normal Pregnancy
| cardiac output, blood volume, peripheral vasc resistance, BP, renin, GFP, ECF, aldosterone
```
increased Cardiac output by 50%
increased Blood volume by 1500ml
decreased Peripheral vascular resistance
decreased BP
increased Renin
increased GFR
increased ECF
Aldosterone effects blocked
```
86
Treatment of preeclampsia without severe features:
```
Daily kick counts
Ultrasound for fetal growth every 3 weeks
Amniotic fluid at least assessed 1/week
NST twice a week (non-reactive=BPP)
Daily wt for gain
Monitor BP daily
Monitor lab tests: CBC, liver enzymes, serum
Creatinine once a week
Reg diet with no salt restrictions
```
87
hospital care for mild preeclampsia
bed rest, left lateral recumbent position to increase renal perfusion and promote diuresis and lowers BP
Diet must be well balanced, moderate increase protein to replenish what is spilled in kidneys
88
Assess fetal well being in hospital care for mild preeclampsia by assessing..
NST, amniocentesis, DFMC, BPP
89
Assess maternal well being in hospital care for mild preeclampsia by assessing
BP every 4 hours, headaches, visual changes, lab tests such as daily urine dipstick for protein, 24 hour protein, CBC with platelet every 2 days, serum creat, uric acid and liver function tests such as AST, ALT, LDH
90
Severe preeclampsia
BP of 160/110 or higher on 2 occasions in at least 4 hours apart while on bedrest
might complain of HA, RUQ pain, epigastric pain, thrombocytopenia
91
proteinuria in severe preeclampsia
>5g/L in 24 hour of 3+ on>2 random urine samples e4 hours apart
92
oliguira in severe preeclampsia
less than 500ml/24hr
93
impaired liver function in severe preeclampsia
increased AST and APT
94
treatment of severe preeclampsia
bedrest.
quiet environment to reduce stimuli
delivery >34 weeks gestation
95
Medications used in treatment: seiizure prophylaxis: Mag sulfate dose...
Mag sulfate: 4-6 gm bolus is given IV over 20 minutes then continuous infusion of 2gm/hr generally advocated
96
Mag sulfate what...
a CNS depressant and needs to be maintained at a therapeutic level as determined by each lab.
97
excessive levels of mag sulfate lead to
respiratory paralysis and cardiac arrest
98
what is given to reverse mag sulf
calcium gluconate
99
Medications used in treatment: Antihypertensives
Examples and doses
given for sustained BP's of 160-110
FIRST LINE:
Labetalol: 20mg IV over 2 min, can give q10 min if needed (max of 300mg)- avoid with asthma or CHF
Hydralazine: 5mg IV over 1-2 min, can give q 20 min if needed (max of 30
NO DIURETICS AND ACE INHIBITORS SHOULD BE USED
100
Eclampsia: symptoms of impending seizure : (11)
```
Persistent occipital or frontal headaches
Blurred vision
Photophobia
Epigastric or right upper quadrant pain
Altered mental status
Hyperreflexia— 4+
Scotomata—dark spots or flashing lights
Vomiting
Neurologic hyperactivity
Pulmonary edema
Cyanosis
```
101
Safety precautions for Eclampsia
quiet environment- no phone calls, TV, lights
Padded side rails in bed
O2 ready
Suction ready
102
HELLP syndrome
Hemolysis
Elevated Liver enzymes
Low Platelets
103
HELLP is sometimes associated wtih
severe preeclampsia
104
S/S of HELLP
n&v, malaise, flu lke sx, epigastric pain with or without HTN
anyone with these s/s should have their CBC and liver enzymes drawn
105
HELLP and corticosteroids
they are usually given to foster fetal maturity but they have been found to stabilize platelet counts and hepatic enzymes and LDH levels.
106
What med is typically chosen for HELLP syndrome
Dexamethasone
107
maternal glucose crosses the placenta. true or false
true
108
CHO Metabolism in the first trimester:
increase in estrogen and progesterone which stimulates beta cells of pancreas to increase insulin production
increase use of glucose leads to decrease in serum glucose levels
increase in tissue glycogen (energy) stores
decrease in liver glycogen production
109
CHO metabolism in the 2nd and 3rd trimesters
hormone levels lead to decrease tolerance to glucose
increase insulin resistance
HPL- Human Placental Lactogen wont let insulin work
Placental insulinases- break down insulin at placental site
110
placental insulinases
breakdown insulin at placental site
111
Net result
changes in insulin needs for mother during pregnancy
112
first trimester net result
decrease need for insulin, increase insulin production, N&V, decrease food intake, increase transfer of fetus
113
2nd trimester net result
gradual increase of insulin
114
3rd trimester net results
2-4 times higher need for insulin by 36 weeks, then levels off til labor
115
after delivery net result
decrease insulin, glucose insulin balance OK by 7-10 days
116
Pregestational diabetic risks to the mother
poor control very early in pregnancy can cause miscarriage
macrosomic baby
PTL
pre-eclampsia
polyhydramnios
ketoacidosis/hypoglycemia
117
Gestational onset risks to the mother
2X more likely to have pre-eclampsia and macrosomic baby
118
pregestational risks to baby for diabetes:
congenital defects :heart, skeletal, CNS
119
Gestational diabetes risks for baby
```
macrosomia
trauma
hypoglycemia
RDS
hypocalcemia
hyperbilirubinemia
thrombocytopenia
polycythemia
```
120
Management of pre-gestational diabetes
establish glycemic control BEFORE pregnancy
understand very close monitoring - 4-8 times a day
If type 2- oral hypoglycemic agents are teratogenic- insulin subq during pregnanacy
diet carefully balanced
121
Management of pre-gestational diabetes: Hgn A1c
Good control: 2.5-5.9 %
Fair control: 6-8%
Poor control: >8%
122
for mothers with pre-gestational diabetes, when is exercise best
after meals
123
Management of pre-gestational diabetes- INSULIN
multiple times a day, mixed longer acting and rapid acting in the morning and pm
humulin and novolin, NOT PORK OR BEEF INSULINS
humulog if NEWLY diagnosed
124
goal for insulin in pre-gestational diabetes
fasting 60-90 mg/dl
| 2 hour postprandial= 90=120
125
Management of Pre-gestational Diabetes-Delivery
Careful determination of ACTUAL due date
Amniocentesis ----Fetal lung maturity
Induce 39-40 wks-NO LATER THAN 40 WKS
If estimated fetal weight greater than 4000-4500 gms---C/S
In L&D- Watch maternal glucose levels EVERY 2 hours
126
low risk for gestational diabetes screening
less than 25 y/o
no family Hx
normal BMI
no abnormal GTT
127
high risk for gestational diabetes screening
history of diabetes,
overweight, obese
high risk group- african american, native, latina, pacific
128
Gestational diabetes screening- First pre-natal visit.
50 gm glucose load, draw serum 1 hour later
negative less than 140
positive greater than 140
screen again at 24-28wks gestation
129
if positive result of gestational diabetes screening
do 3 hour GTT (100g of glucose)
positive for GDM- 2 or more levels are met or exceeded:
Fasting
130
managment of gestational diabetes
```
keep blood sugars within levels
3 meals and 3 snacks diet
exercise
insulin- 20% will need insulin during pregnancy
blood glucose monitoring
delivery by 40 wks
prequent NST/ BPP in last 2 mo
```
131
Group B hemolytic strep
major cause of perinatal infections
found in vagina and urine
increase fetal mortality and morbidity
screen 35-37 weeks
132
IF positive for GBS
treat with penicillin: 5 milli units IV X 1; 2.5-3 milli units every 4 hours
treat with ampicillin: 2 GMS X 1; 1 GM every 4 hrs
treat with clindamycin: 900 mg q 8 hr or
erythromycin 500mg q 6 hrtil delivery IF ALLERGIC TO PENICILLIN
133
GBS: prophylactic treatment is indicated if
previous infant with GBS, GBS bacteria during pregnancy, PTL, temp in labor of greater than 100.4, membranes ruptured for more than 18 hours
134
TORCH
toxoplasmosis
rubella
cytomegalovirus
herpes
135
why are steroids given to patients with HELLP
it can stabilize the platelets
136
patients might complain of what symptoms when experiencing HELLP
flu like symptoms
137
ectopic pregnancy
egg implants outside of uterus
lots of pain and internal bleeding
surgical intervention needed
138
hydatidiform mole
no fetus, fluid filled vesicle, N&V, no FHT, 2nd trimester bleeding, d&C, not get pregnant for 1 year, choriocarinoma if HCG evelated
139
cerclage: McDonalds or Shirodkar procedure
```
10-14 weeks gestation
no intercourse, prolonged stanging, heavy lifting
bedrest
teach signs of preterm labor
take tocolytics
uterine monitoring
remove suture at 37 weeks
leave suture in for c/section
```
140
hyperemesis gravidarum
vomiting during pregnancy, 5% loss of body weight, ketosis, metabolic alkalosis
rule out gestational trophoblastic Dz by ultrasound
needs hospitalization if it doesnt respond to small frequent meals (IV fluids with Kcl to prevent hypokalemia)
B vitamin replacement
TPN temporary
141
antihypertensives should be given if..
diastolic is greater than 105-110
142
Cerlage or McDonalds procedure
done for incompetent cervix.
10-14 weeks
sutures taken out at 37 weeks if giving vaginal birth
no intercourse, heavy lifting, etc.
