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Obstetrics > Lecture 4 - Pre-Eclampsia, PIH, and Obesity > Flashcards

Lecture 4 - Pre-Eclampsia, PIH, and Obesity Flashcards

1
Q

T/F: Diabetes Mellitus is the most common medical problem of pregnancy.

A

TRUE

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2
Q

What is gestational diabetes associated with:

A
  • Advanced maternal age
  • Obesity
  • Family history of DM
  • History of stillbirth, neonatal death, fetal malformation, or macrosomia
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3
Q

What trimester(s) is gestational diabetes more prevalent in:

A
  • 2nd

- 3rd

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4
Q

What are some acute complications of gestational diabetes:

A
  • Diabetic Ketoacidosis
  • Hyperglycemic nonketotic state
  • Hypoglycemia
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5
Q

What are some chronic complication of gestational diabetes:

A
  • Macrovascular
  • Bicrovascular
  • Neuropathy
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6
Q

What can gestational diabetes lead to in the parturient:

A
  • HTN
  • polyhydramnios
  • cesarean delivery
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7
Q

Important facts of stiff joint syndrome in the parturient:

A
  • 30 to 40% in Type 1 diabetes
  • Direct laryngoscopy can be difficult in 30% of all parturients with DM
  • Preanesthestic management (Controversial)
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8
Q

What are the S/S of Stiff joint syndrome:

A
  • Type 1 Diabetes
  • non familial short stature
  • joint contractures
  • Tight Skin
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9
Q

Maternal insulin requirements _________ progressively during the 2nd and 3rd trimester and __________ at the onset of labor and continue to _________ following delivery.

A
  • increase
  • decrease
  • decrease
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10
Q

T/F: Absorption of SQ insulin is unpredictable unlike IV insulin therapy which is more flexible.

A

TRUE

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11
Q

What would be the S/S of Diabetic Autonomic neuropathy:

A
  • HTN
  • Orthostatic Hypotension
  • Painless MI
  • Decreased response to medication (Atropine and propanolol)
  • Resting tachycardia
  • Neurogenic atonic bladder
  • Hemoglobin A1c
  • Gastroporesis with delayed emptying
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12
Q

The blood glucose of a parturient should be maintained between _____ to _____ mg/dL.

A

> 100

<180

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13
Q

T/F: Incidence of CNS infection after administration of neuraxial anesthesia in the parturient. .

A

FALSE (No data rearding incidence of CNS ….)

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14
Q

Protamine sulfate ___________ in patients taking NPH or protamine zinc insulin.

A

anaphylaxis

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15
Q

T/F: There is a delayed clearance and higher serum levels following epidural lidocaine administration in diabetic groups.

A

TRUE

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16
Q

Gestational diabetes mellitus has uteroplacental blood flow index reduced by ___ to ___ % and more with poorer control.

A

30

45

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17
Q

What labs will be seen with diabetic ketoacidosis:

A
  • Plasma glucose >300
  • HCO3 < 15
  • pH < 7.30
  • Acetone positive 1:2
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18
Q

What will ketones do in the parturient:

A
  • Cross placenta

- Decrease fetal oxygenation

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19
Q

Minimal Local Anesthetic Concentration for obese women was __ % lower than non-obese women.

A

41

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20
Q

What is the most common medical issue during pregnancy.

A

HTN (Uncertain whether diabetes or HTN is greater)

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21
Q

What are the four categories of HTN in pregnancy:

A
  • Chronic Hypertension
  • Pregnancy Induced Hypertension
  • Preeclampsia eclampsia
  • Preeclampsia superimpoised on chronic HTN
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22
Q

T/F: Hypertension is the third leading cause of maternal mortality, after thromboembolism and non-obstetric injuries.

A

TRUE

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23
Q

T/F: Maternal DBP > 160 is associated with increase risk of placental abruption and fetal growth restriction.

A

FALSE (Maternal DBP > 110 is associated…)

24
Q

What category of hypertension causes the most morbidity of pregnancy:

A

Superimposed preeclampsia

25
Q

What will be associated with pregnancy induced hypertension:

A
  • 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
26
Q

What will be associated with Preeclampsia:

A
  • New onset of hypertension
  • After 20 weeks of gestation
  • resolves within 48 hours of postpartum
27
Q

How will the systems will be affected with Preeclampsia:

A
  • 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
28
Q

What are the risk factors for preeclampsia:

A
  • First pregnancy
  • Age 35
  • Prior h/o preeclampsia
  • Black race
  • chronic HTN,
  • Renal disease,Diabetes,
  • Antiphospholipid syndrome
  • Twin
  • Family History
29
Q

What is the etiology of preeclampsia?

A

-The exact mechanism is not known.

30
Q

What do they think may be the mechanism for preeclampsia?

A
  • Immunologic
  • Genetic
  • Placental ischemia
31
Q

What are the symptom of Preeclampsia:

A
  • 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)
32
Q

What will be seen with upper airway edema in the preeclampsia patient:

A
  • Upper airway edema
  • Laryngeal edema
  • Airway obstruction
33
Q

What will be seen with cardiac in the preeclampsia patient:

A
  • Increased CO and SVR
  • CVP normal or slightly increased
  • Plasma volume reduced
34
Q

What will be seen with pulmonary in the preeclampsia patient:

A
  • Decrease oncotic/collid pressure
  • capillary/endothelial damage (Leak)
  • Vasoconstriction
  • Increase in PWP and CVP
  • Occurs in 3 % of preeclamptic patients
35
Q

What will be seen in the hepatic area of preeclampsia:

A
  • Increase LVT
  • Severe PIH
  • HELLP
36
Q

Renal will have what changes:

A
  • Proteinuria
  • Decrease in GFR and CrCl
  • Increase BUN
  • ARF with oliguria
37
Q

Uterine will be affected in what way with preeclampsia:

A
  • Activity increased
  • Hyperactive/hypersensitive to oxytocin
  • Preterm labor - frequent
  • Uterine/placental blood flow
  • increase incidence of abruption
38
Q

How much will uterine blood decrease in preeclampsia:

A

50 to 70%

39
Q

T/F: The leading cause of maternal death in PIH is abruption.

A

FALSE (The leading cause of maternal death in PIH is intracranial hemorrhage.)

40
Q

What are the maternal complications of preeclampsia:

A
  • Seizures
  • pulmonary edema
  • ARF
  • Proteinuria
  • Hepatic swelling with or without liver dysfunction
  • DIC
41
Q

T/F: DIC is usually associated with placental abruption and is uncommon as a primary manifestation of preeclampsia.

A

TRUE

42
Q

What are the fetal complication of preeclampsia:

A
  • abruptio placentae
  • IUGR
  • Premature delivery
  • Intrauterine fetal death
43
Q

Important facts about HELLP Syndrome:

A
  • 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
44
Q

What is the definitive cure for HELLP:

A

Delivery

45
Q

Hemostasis is not problematic unless PLT < _______.

A

-40000 (70000 is optimal)

46
Q

What are the goals to treat HELLP:

A
  • Control B/P
  • Prevent seizure
  • Deliver the fetus
47
Q

What is the drug of choice for preeclampsia:

A

-MgSO4 (Magnesium sulfate)

48
Q

What drugs would be considered for treating HTN in the parturient:

A
  • Hydralazine
  • Labetalol
  • Nitroglycerin
  • Nifedipine
  • Esmolol
  • Na Nitroprusside
49
Q

What would be a concern using Na Nitroprusside for HTN in the parturient:

A

Risk of cyanide toxicity in the fetus

50
Q

T/F MgSO4 has a narrow therapeutic range.

A

TRUE

51
Q

What should the plasma levels be for MgSO4:

A

4-6 mmol/L

52
Q

What is the correct administration for MgSO4:

A
  • 4 gram IV bolus over 10 minutes
  • infusion at 1 gram/hour
  • titrate infusion by plasma levels
53
Q

What will be seen with MgSO4 toxicity:

A
  • 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)
54
Q

How would you treat MgSO4 toxicity:

A

10% of Calcium Gluconate (10 cc) IV SLOWLY

55
Q

Regional anesthesia may reduce _________ and ___ and may improve ____________ blood flow.

A
  • Vasospasm
  • HTN
  • Uteroplacental
56
Q

T/F: Neuraxial anesthesia in preeclamptic patient is the best option.

A

TRUE (IN MOST STUDIES)

57
Q

T/F: MgSO4 does NOT blunt response to vasoconstrictors and inhibits catecholamine release after sympathetic stimulation.

A

FALSE (MgSO4 does blunt response…..)

Obstetrics (10 decks)

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