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