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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
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
26
What will be associated with Preeclampsia:
- New onset of hypertension - After 20 weeks of gestation - resolves within 48 hours of postpartum
27
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
28
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
29
What is the etiology of preeclampsia?
-The exact mechanism is not known.
30
What do they think may be the mechanism for preeclampsia?
- Immunologic - Genetic - Placental ischemia
31
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)
32
What will be seen with upper airway edema in the preeclampsia patient:
- Upper airway edema - Laryngeal edema - Airway obstruction
33
What will be seen with cardiac in the preeclampsia patient:
- Increased CO and SVR - CVP normal or slightly increased - Plasma volume reduced
34
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
35
What will be seen in the hepatic area of preeclampsia:
- Increase LVT - Severe PIH - HELLP
36
Renal will have what changes:
- Proteinuria - Decrease in GFR and CrCl - Increase BUN - ARF with oliguria
37
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
38
How much will uterine blood decrease in preeclampsia:
50 to 70%
39
T/F: The leading cause of maternal death in PIH is abruption.
FALSE (The leading cause of maternal death in PIH is intracranial hemorrhage.)
40
What are the maternal complications of preeclampsia:
- Seizures - pulmonary edema - ARF - Proteinuria - Hepatic swelling with or without liver dysfunction - DIC
41
T/F: DIC is usually associated with placental abruption and is uncommon as a primary manifestation of preeclampsia.
TRUE
42
What are the fetal complication of preeclampsia:
- abruptio placentae - IUGR - Premature delivery - Intrauterine fetal death
43
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
44
What is the definitive cure for HELLP:
Delivery
45
Hemostasis is not problematic unless PLT < _______.
-40000 (70000 is optimal)
46
What are the goals to treat HELLP:
- Control B/P - Prevent seizure - Deliver the fetus
47
What is the drug of choice for preeclampsia:
-MgSO4 (Magnesium sulfate)
48
What drugs would be considered for treating HTN in the parturient:
- Hydralazine - Labetalol - Nitroglycerin - Nifedipine - Esmolol - Na Nitroprusside
49
What would be a concern using Na Nitroprusside for HTN in the parturient:
Risk of cyanide toxicity in the fetus
50
T/F MgSO4 has a narrow therapeutic range.
TRUE
51
What should the plasma levels be for MgSO4:
4-6 mmol/L
52
What is the correct administration for MgSO4:
- 4 gram IV bolus over 10 minutes - infusion at 1 gram/hour - titrate infusion by plasma levels
53
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)
54
How would you treat MgSO4 toxicity:
10% of Calcium Gluconate (10 cc) IV SLOWLY
55
Regional anesthesia may reduce _________ and ___ and may improve ____________ blood flow.
- Vasospasm - HTN - Uteroplacental
56
T/F: Neuraxial anesthesia in preeclamptic patient is the best option.
TRUE (IN MOST STUDIES)
57
T/F: MgSO4 does NOT blunt response to vasoconstrictors and inhibits catecholamine release after sympathetic stimulation.
FALSE (MgSO4 does blunt response.....)

Obstetrics (10 decks)

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