Lecture 14: Medical Conditions in Pregnancy Flashcards

1
Q

If the one hour 50 g OGTT is abnormal when testing for gestational diabetes what is done and what is abnormal?

A

Follow w/ 3-hour 100 g OGTT (fail 3 hour w/ 2+ abnormal values)

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2
Q

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

A
  • Macrosomia
  • Neonatal hypoglycemia
  • Hyperbilirubinemia
  • Operative delivery
  • Shoulder dystocia
  • Birth trauma
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3
Q

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

A

>4500 gm

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4
Q

What is the effect of ↑ HbA1C in the period of embryogenesis?

A

Direct link between birth defects and ↑ HbA1C = 6-foldcongenital anomalies

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5
Q

What are the 2 classes of gestational diabetes?

A
  • Class A1 = gestational DM; diet controlled
  • Class A2 = gestational DM; insulin or oral meds controlled
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6
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
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7
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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8
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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9
Q

Which drug for hyperthryroidism is contraindicated throughout pregnancy?

A

Radioactive iodine

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10
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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11
Q

What drugs used in tx of thyroid storm during pregnancy?

A
  • Propranolol
  • Sodium iodide (blocks secretion of thyroid hormone)
  • PTU
  • Dexamethasone (halts peripheral conversion of T4 –> T3)
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12
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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13
Q

Which pulmonary condition is a contraindication to pregnancy due to decompensation during pregnancy and a high mortality rate?

A

Primary pulmonary HTN

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14
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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15
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
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16
Q

Who is at greatest risk of developing postpartum cardiomyopathy?

A

Women w/ preeclampsia, HTN and poor nutrition

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17
Q

How should cardiac patients be delivered?

A

Vaginally

18
Q

What is treatment for immune idiopathic thrombocytopenia during pregnancy?

A
  • Begin after platelets <50,000 —> give prednisone
  • IV immunoglobulin if severe
  • Platelet transfusion
  • Splenectomy
19
Q

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

A

Serum Cr. >1.5-2

20
Q

What is asymptomatic bacteriuria more likely to cause in pregnancy?

A

Cystitis and pyelonephritis —> due to urinary stasis and glucosuria

21
Q

There is an increased risk for what complications if pregnant woman has pyelonephritis?

A
  • uterine contractions and preterm labor
  • Can result in adult respiratory distress syndrome
22
Q

What is hyperemesis gravidarum?

A

Persistent N/V assoc. with >5% loss of pre-pregnancy weight + ketonuria + dehydration

23
Q

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

A

May need nasogastric feeding or parenteral nutrition

24
Q

What is Mendelson’s Syndrome and what complications can it cause?

A
  • 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
25
Q

Intrahepatic cholestasis of pregnancy increase the risk of what complications?

A

Meconium stained amniotic fluid and fetal demise

26
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
27
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
28
Q

Due to pregnancy being a hypercoagulable state there is a 5-fold increase in venous thrombosis and the greatest risk is when?

A

First 5 weeks postpartum

29
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
30
Q

DVT’s during pregnancy most commonly occur in which leg and what are the signs/sx’s?

A
  • More common in LEFT leg
  • Pain in the calf w/ dorsiflexion (Homans sign)
  • May also have dull ache, tingling, or pain w/ walking
31
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
32
Q

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

A

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

33
Q

What are sx’s of PE during pregnancy?

A
  • Pleuritic chest pain
  • Shortness of air
  • Air hunger
  • Palpitations
  • Hemoptosis
34
Q

What 5 things used for diagnosis/evaluation of suspected PE?

A
  • EKG
  • CXR
  • ABG’s
  • VQ scan
  • HELICAL CT
35
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
36
Q

All pregnant patients with hx of thrombombolism will need prophylactic?

A

Anti-coagulant therapy

37
Q

What is the most common pulmonary disease in pregnancy?

A

Asthma

38
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

39
Q

What is the most common HA during pregnancy; treated how?

A

Tension; tx w/ acetaminophen

40
Q

All anti-epileptics have teratogen risk, but what 2 are most commonly used during if pregnancy if needed?

A

Dilantin and phenobarbital