Lecture 14: Medical Conditions in Pregnancy Flashcards

(40 cards)

1
Q

What type of anesthesia is preferred in patient with primary pulmonary HTN?

A

Epidural anesthesia and vaginal delivery MAY be an option

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2
Q

What is the cause of neonatal thyrotoxicosis; lasts how long?

A
  • Placental transfer of thyroid stimulating antibodies
  • Transient (lasting 2-3 months)
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3
Q

When should renal function and opthalmic function be assessed in pregnant pt with preexisting diabetes?

A
  • Renal = 24-hour urine collection every trimester
  • Opthalmic = detailed eye exam in first trimester
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4
Q

Superficial thrombophlebitis is most common in pregnant pt’s with what characteristics; risk of PE?

A
  • Most common in those w/ varicose veins, obesity and little physical activity
  • Most common in calf, will NOT result in PE
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5
Q

In mother with GDM, which fetal weight warrants C-section delivery?

A

>4500 gm

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6
Q

When should coumadin be used during pregnancy for DVT’s?

A

Used for 6 weeks POST-partum, but NOT during pregnancy

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7
Q

Who is at greatest risk of developing postpartum cardiomyopathy?

A

Women w/ preeclampsia, HTN and poor nutrition

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8
Q

If patient has DVT what values should you follow if you give LMW lovenox vs. unfractionated heparin to assure therapeutic levels?

A
  • Follow aPTT values with heparin
  • Factor Xa values with lovenox
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9
Q

Triggers of thryoid storm in pregnancy can be infection, labor, C-section, and non-compliance to meds; what are signs/sx’s?

A
  • Hyperthermia
  • Tachycardia
  • Perspiration
  • High output cardiac failure
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10
Q

Which drug for hyperthryroidism is contraindicated throughout pregnancy?

A

Radioactive iodine

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11
Q

What are sx’s of PE during pregnancy?

A
  • Pleuritic chest pain
  • Shortness of air
  • Air hunger
  • Palpitations
  • Hemoptosis
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12
Q

What is the most common pulmonary disease in pregnancy?

A

Asthma

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13
Q

Intrahepatic cholestasis of pregnancy increase the risk of what complications?

A

Meconium stained amniotic fluid and fetal demise

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14
Q

How soon postpartum should a 2-hour OGTT be performed in mother who had GDM?

A

6-12 weeks post-partum to look for pre-existing disease

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15
Q

What is the most common cause of anemia during pregnancy and when do you screen these pt’s?

A
  • Iron deficiency
  • Screened at initial prenatal visit and again at 26-28 weeks
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16
Q

Which serum creatinine level worsens the prognosis of chronic kidney failure during pregnancy?

A

Serum Cr. >1.5-2

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17
Q

If pregnant patient w/ asthma has been using daily inhaled steroids or high potency oral for more than 3 weeks what is done during labor and delivery?

A

Stress dose of IV steroids to prevent adrenal crisis

18
Q

Which value of fasting glucose and 2-hour postprandial is considered good glycemic control during pregnancy?

A
  • Fasting <95 mg/dL
  • 2-hour postprandial <120 mg/dL
19
Q

What is treatment for acute fatty liver of pregnancy?

A
  • Termination of pregnancy –> need to tx the Mom
  • Supportive care —> IV fluids w/ 10% glucose; blood product replacement FFP and cryoprecipitate
20
Q

What are 6 fetal complications assoc. w/ gestational diabetes?

A
  • Macrosomia
  • Neonatal hypoglycemia
  • Hyperbilirubinemia
  • Operative delivery
  • Shoulder dystocia
  • Birth trauma
21
Q

What is asymptomatic bacteriuria more likely to cause in pregnancy?

A

Cystitis and pyelonephritis —> due to urinary stasis and glucosuria

22
Q

What are the most common cardiac arrhythmias in pregnancy; which are most worrisome?

A
  • SVT is most frequent and usually benign
  • A. fib/flutter is more worrisome for underlying cardiac disease
23
Q

What is treatment for hyperemesis gravidarum if severe (fails all conservative measures)?

A

May need nasogastric feeding or parenteral nutrition

24
Q

All pregnant pt’s with DVT or PE require a thrombophilia work-up which includes what markers?

A
  • Lupus anticoagulant
  • Anticardiolipin antibody
  • Factor V leiden
  • Protein C and Protein S
  • Antithrombin III
  • Prothrombin G20210A
25
What is the most common HA during pregnancy; treated how?
**Tension**; tx w/ **acetaminophen**
26
All pregnant patients with hx of thrombombolism will need prophylactic?
Anti-**coagulant** therapy
27
If the one hour 50 g OGTT is abnormal when testing for gestational diabetes what is done and what is abnormal?
Follow w/ **3-hour 100 g OGTT** (**fail 3 hour** w/ **2+ abnormal** values)
28
There is an increased risk for what complications if pregnant woman has pyelonephritis?
- ↑ **uterine contractions** and **preterm labor** - Can result in **adult respiratory distress syndrome**
29
What drugs used in tx of thyroid storm during pregnancy?
- **Propranolol** - **Sodium iodide** (blocks secretion of thyroid hormone) - **PTU** - **Dexamethasone** (halts peripheral conversion of T4 --\> T3)
30
What is treatment for immune idiopathic thrombocytopenia during pregnancy?
- **Begin** after **platelets \<50,000** ---\> give **prednisone** - **IV immunoglobulin** if severe - **Platelet transfusion** - **Splenectomy**
31
What 5 things used for diagnosis/evaluation of suspected PE?
- **EKG** - **CXR** - **ABG's** - **VQ scan** - **HELICAL CT**
32
What is the effect of ↑ HbA1C in the period of embryogenesis?
**Direct** link between **birth defects** and ↑ **HbA1C** = **6-fold** ↑ **congenital anomalies**
33
How should cardiac patients be delivered?
**Vaginally**
34
What is hyperemesis gravidarum?
**Persistent** N/V assoc. with **\>5% loss** of **pre-pregnancy weight + ketonuria + dehydration**
35
Due to pregnancy being a hypercoagulable state there is a 5-fold increase in venous thrombosis and the greatest risk is when?
**First 5 weeks postpartum**
36
What are the 2 classes of gestational diabetes?
- Class **A1 =** gestational DM; **diet controlled** - Class **A2 =** gestational DM; **insulin** or **oral meds controlled**
37
All anti-epileptics have teratogen risk, but what 2 are most commonly used during if pregnancy if needed?
**Dilantin** and **phenobarbital**
38
What is Mendelson's Syndrome and what complications can it cause?
- AKA **acid aspiration syndrome** - Pregnant women at \> risk due to delayed gastric emptying and ↑ intra-abdominal pressure/intra-gastric pressure - Can result in **adult respiratory distress syndrome**
39
Which pulmonary condition is a contraindication to pregnancy due to decompensation during pregnancy and a high mortality rate?
**Primary pulmonary HTN**
40
DVT's during pregnancy most commonly occur in which leg and what are the signs/sx's?
- **More** **common** in **LEFT leg** - **Pain** in the **calf** w/ **dorsiflexion (Homans sign)** - May also have **dull ache, tingling,** or **pain** w/ **walking**