Lecture 14: Medical Conditions in Pregnancy Flashcards
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)
What are 6 fetal complications assoc. w/ gestational diabetes?
- Macrosomia
- Neonatal hypoglycemia
- Hyperbilirubinemia
- Operative delivery
- Shoulder dystocia
- Birth trauma
In mother with GDM, which fetal weight warrants C-section delivery?
>4500 gm
What is the effect of ↑ HbA1C in the period of embryogenesis?
Direct link between birth defects and ↑ HbA1C = 6-fold ↑ congenital anomalies
What are the 2 classes of gestational diabetes?
- Class A1 = gestational DM; diet controlled
- Class A2 = gestational DM; insulin or oral meds controlled
Which value of fasting glucose and 2-hour postprandial is considered good glycemic control during pregnancy?
- Fasting <95 mg/dL
- 2-hour postprandial <120 mg/dL
When should renal function and opthalmic function be assessed in pregnant pt with preexisting diabetes?
- Renal = 24-hour urine collection every trimester
- Opthalmic = detailed eye exam in first trimester
How soon postpartum should a 2-hour OGTT be performed in mother who had GDM?
6-12 weeks post-partum to look for pre-existing disease
Which drug for hyperthryroidism is contraindicated throughout pregnancy?
Radioactive iodine
Triggers of thryoid storm in pregnancy can be infection, labor, C-section, and non-compliance to meds; what are signs/sx’s?
- Hyperthermia
- Tachycardia
- Perspiration
- High output cardiac failure
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)
What is the cause of neonatal thyrotoxicosis; lasts how long?
- Placental transfer of thyroid stimulating antibodies
- Transient (lasting 2-3 months)
Which pulmonary condition is a contraindication to pregnancy due to decompensation during pregnancy and a high mortality rate?
Primary pulmonary HTN
What type of anesthesia is preferred in patient with primary pulmonary HTN?
Epidural anesthesia and vaginal delivery MAY be an option
What are the most common cardiac arrhythmias in pregnancy; which are most worrisome?
- SVT is most frequent and usually benign
- A. fib/flutter is more worrisome for underlying cardiac disease
Who is at greatest risk of developing postpartum cardiomyopathy?
Women w/ preeclampsia, HTN and poor nutrition
How should cardiac patients be delivered?
Vaginally
What is treatment for immune idiopathic thrombocytopenia during pregnancy?
- Begin after platelets <50,000 —> give prednisone
- IV immunoglobulin if severe
- Platelet transfusion
- Splenectomy
Which serum creatinine level worsens the prognosis of chronic kidney failure during pregnancy?
Serum Cr. >1.5-2
What is asymptomatic bacteriuria more likely to cause in pregnancy?
Cystitis and pyelonephritis —> due to urinary stasis and glucosuria
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
What is hyperemesis gravidarum?
Persistent N/V assoc. with >5% loss of pre-pregnancy weight + ketonuria + dehydration
What is treatment for hyperemesis gravidarum if severe (fails all conservative measures)?
May need nasogastric feeding or parenteral nutrition
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
Intrahepatic cholestasis of pregnancy increase the risk of what complications?
Meconium stained amniotic fluid and fetal demise
What is treatment for acute fatty liver of pregnancy?
- Termination of pregnancy –> need to tx the Mom
- Supportive care —> IV fluids w/ 10% glucose; blood product replacement FFP and cryoprecipitate
What is the most common cause of anemia during pregnancy and when do you screen these pt’s?
- Iron deficiency
- Screened at initial prenatal visit and again at 26-28 weeks
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
Superficial thrombophlebitis is most common in pregnant pt’s with what characteristics; risk of PE?
- Most common in those w/ varicose veins, obesity and little physical activity
- Most common in calf, will NOT result in PE
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
If patient has DVT what values should you follow if you give LMW lovenox vs. unfractionated heparin to assure therapeutic levels?
- Follow aPTT values with heparin
- Factor Xa values with lovenox
When should coumadin be used during pregnancy for DVT’s?
Used for 6 weeks POST-partum, but NOT during pregnancy
What are sx’s of PE during pregnancy?
- Pleuritic chest pain
- Shortness of air
- Air hunger
- Palpitations
- Hemoptosis
What 5 things used for diagnosis/evaluation of suspected PE?
- EKG
- CXR
- ABG’s
- VQ scan
- HELICAL CT
All pregnant pt’s with DVT or PE require a thrombophilia work-up which includes what markers?
- Lupus anticoagulant
- Anticardiolipin antibody
- Factor V leiden
- Protein C and Protein S
- Antithrombin III
- Prothrombin G20210A
All pregnant patients with hx of thrombombolism will need prophylactic?
Anti-coagulant therapy
What is the most common pulmonary disease in pregnancy?
Asthma
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?
Stress dose of IV steroids to prevent adrenal crisis
What is the most common HA during pregnancy; treated how?
Tension; tx w/ acetaminophen
All anti-epileptics have teratogen risk, but what 2 are most commonly used during if pregnancy if needed?
Dilantin and phenobarbital
