Lecture 4 - Pre-Eclampsia, PIH, and Obesity Flashcards
T/F: Diabetes Mellitus is the most common medical problem of pregnancy.
TRUE
What is gestational diabetes associated with:
- Advanced maternal age
- Obesity
- Family history of DM
- History of stillbirth, neonatal death, fetal malformation, or macrosomia
What trimester(s) is gestational diabetes more prevalent in:
- 2nd
- 3rd
What are some acute complications of gestational diabetes:
- Diabetic Ketoacidosis
- Hyperglycemic nonketotic state
- Hypoglycemia
What are some chronic complication of gestational diabetes:
- Macrovascular
- Bicrovascular
- Neuropathy
What can gestational diabetes lead to in the parturient:
- HTN
- polyhydramnios
- cesarean delivery
Important facts of stiff joint syndrome in the parturient:
- 30 to 40% in Type 1 diabetes
- Direct laryngoscopy can be difficult in 30% of all parturients with DM
- Preanesthestic management (Controversial)
What are the S/S of Stiff joint syndrome:
- Type 1 Diabetes
- non familial short stature
- joint contractures
- Tight Skin
Maternal insulin requirements _________ progressively during the 2nd and 3rd trimester and __________ at the onset of labor and continue to _________ following delivery.
- increase
- decrease
- decrease
T/F: Absorption of SQ insulin is unpredictable unlike IV insulin therapy which is more flexible.
TRUE
What would be the S/S of Diabetic Autonomic neuropathy:
- HTN
- Orthostatic Hypotension
- Painless MI
- Decreased response to medication (Atropine and propanolol)
- Resting tachycardia
- Neurogenic atonic bladder
- Hemoglobin A1c
- Gastroporesis with delayed emptying
The blood glucose of a parturient should be maintained between _____ to _____ mg/dL.
> 100
<180
T/F: Incidence of CNS infection after administration of neuraxial anesthesia in the parturient. .
FALSE (No data rearding incidence of CNS ….)
Protamine sulfate ___________ in patients taking NPH or protamine zinc insulin.
anaphylaxis
T/F: There is a delayed clearance and higher serum levels following epidural lidocaine administration in diabetic groups.
TRUE
Gestational diabetes mellitus has uteroplacental blood flow index reduced by ___ to ___ % and more with poorer control.
30
45
What labs will be seen with diabetic ketoacidosis:
- Plasma glucose >300
- HCO3 < 15
- pH < 7.30
- Acetone positive 1:2
What will ketones do in the parturient:
- Cross placenta
- Decrease fetal oxygenation
Minimal Local Anesthetic Concentration for obese women was __ % lower than non-obese women.
41
What is the most common medical issue during pregnancy.
HTN (Uncertain whether diabetes or HTN is greater)
What are the four categories of HTN in pregnancy:
- Chronic Hypertension
- Pregnancy Induced Hypertension
- Preeclampsia eclampsia
- Preeclampsia superimpoised on chronic HTN
T/F: Hypertension is the third leading cause of maternal mortality, after thromboembolism and non-obstetric injuries.
TRUE
T/F: Maternal DBP > 160 is associated with increase risk of placental abruption and fetal growth restriction.
FALSE (Maternal DBP > 110 is associated…)
What category of hypertension causes the most morbidity of pregnancy:
Superimposed preeclampsia
What will be associated with pregnancy induced hypertension:
- Sustained BP increase to SBP > 140 or DBP > 90
- Usually mild and later in pregnancy
- NO renal or other systemic involvement
- Resolves 12 weeks postpartum
- May evolve to preeclampsia
What will be associated with Preeclampsia:
- New onset of hypertension
- After 20 weeks of gestation
- resolves within 48 hours of postpartum
How will the systems will be affected with Preeclampsia:
- Proteinuria > 300mg/24 hr
- Oliguria or Serum plasma creatinine ratio> 0.09 mmoL/L
- Headache with hyperreflexia, eclampsia, clonus or visual disturbances or right abdominal pain
- Thrombocytopenia,
- Increase LDH
- Hemolysis
- DIC
What are the risk factors for preeclampsia:
- First pregnancy
- Age 35
- Prior h/o preeclampsia
- Black race
- chronic HTN,
- Renal disease,Diabetes,
- Antiphospholipid syndrome
- Twin
- Family History
What is the etiology of preeclampsia?
-The exact mechanism is not known.
What do they think may be the mechanism for preeclampsia?
- Immunologic
- Genetic
- Placental ischemia
What are the symptom of Preeclampsia:
- Visual disturbances
- Headache
- Epigastric pain
- Rapidly increasing or nondependent edema (may be a signal of developing preeclampsia
- Rapid weight gain (result from edema due to capillary leak as well as renal Na and fluid retention)
What will be seen with upper airway edema in the preeclampsia patient:
- Upper airway edema
- Laryngeal edema
- Airway obstruction
What will be seen with cardiac in the preeclampsia patient:
- Increased CO and SVR
- CVP normal or slightly increased
- Plasma volume reduced
What will be seen with pulmonary in the preeclampsia patient:
- Decrease oncotic/collid pressure
- capillary/endothelial damage (Leak)
- Vasoconstriction
- Increase in PWP and CVP
- Occurs in 3 % of preeclamptic patients
What will be seen in the hepatic area of preeclampsia:
- Increase LVT
- Severe PIH
- HELLP
Renal will have what changes:
- Proteinuria
- Decrease in GFR and CrCl
- Increase BUN
- ARF with oliguria
Uterine will be affected in what way with preeclampsia:
- Activity increased
- Hyperactive/hypersensitive to oxytocin
- Preterm labor - frequent
- Uterine/placental blood flow
- increase incidence of abruption
How much will uterine blood decrease in preeclampsia:
50 to 70%
T/F: The leading cause of maternal death in PIH is abruption.
FALSE (The leading cause of maternal death in PIH is intracranial hemorrhage.)
What are the maternal complications of preeclampsia:
- Seizures
- pulmonary edema
- ARF
- Proteinuria
- Hepatic swelling with or without liver dysfunction
- DIC
T/F: DIC is usually associated with placental abruption and is uncommon as a primary manifestation of preeclampsia.
TRUE
What are the fetal complication of preeclampsia:
- abruptio placentae
- IUGR
- Premature delivery
- Intrauterine fetal death
Important facts about HELLP Syndrome:
- Malaise (90%)
- Epigastric pain (90%)
- N/V (50%)
- Multi-system failure
- Rate of fall in PLT count is important
- PLT count normal within 72 hours of delivery
- Thrombocytopenia may persist for longer periods
What is the definitive cure for HELLP:
Delivery
Hemostasis is not problematic unless PLT < _______.
-40000 (70000 is optimal)
What are the goals to treat HELLP:
- Control B/P
- Prevent seizure
- Deliver the fetus
What is the drug of choice for preeclampsia:
-MgSO4 (Magnesium sulfate)
What drugs would be considered for treating HTN in the parturient:
- Hydralazine
- Labetalol
- Nitroglycerin
- Nifedipine
- Esmolol
- Na Nitroprusside
What would be a concern using Na Nitroprusside for HTN in the parturient:
Risk of cyanide toxicity in the fetus
T/F MgSO4 has a narrow therapeutic range.
TRUE
What should the plasma levels be for MgSO4:
4-6 mmol/L
What is the correct administration for MgSO4:
- 4 gram IV bolus over 10 minutes
- infusion at 1 gram/hour
- titrate infusion by plasma levels
What will be seen with MgSO4 toxicity:
- 5 to 10 meq/L (Prolonged PR,Wide QRs)
- 11 to 14 meq/L (Depressed tendon reflexes)
- 15 to 24 meq/L (SA, AV node block, resp. paralysis)
- > 25 meq/L (Cardiac arrest)
How would you treat MgSO4 toxicity:
10% of Calcium Gluconate (10 cc) IV SLOWLY
Regional anesthesia may reduce _________ and ___ and may improve ____________ blood flow.
- Vasospasm
- HTN
- Uteroplacental
T/F: Neuraxial anesthesia in preeclamptic patient is the best option.
TRUE (IN MOST STUDIES)
T/F: MgSO4 does NOT blunt response to vasoconstrictors and inhibits catecholamine release after sympathetic stimulation.
FALSE (MgSO4 does blunt response…..)
