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Repro II Final DF > lecture 5: medical conditions in pregnancy, wooton > Flashcards

lecture 5: medical conditions in pregnancy, wooton Flashcards

1
Q

gestational diabetes

A

glucose intolerance during preg

screening done btwn 24-28 weeks
50 gm one hour oral load glucose, value above 130 abnormal

if abnormal follow by 3 hour 100 gm oral load glucose tolerance tesst

fail 3 hour with 2 or more abnormal values

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2
Q

risk factors for GDM

A

obesity
previous history of GDM
family history DM
known glucose intolerance

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3
Q

maternal complications with GDM

A

increased risk gestational HTN
increased risk preeclampsia
greater risk of C section delivery
increase risk developing diabetes later in life

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4
Q

fetal complications of GDM

A 
**macrosomia
neonatal hypoglycemia
hyperbili
shoulder dystocia
trauma
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5
Q

2 classes of GDM

A 
class A1: GD, diet controlled
class A2: gestational diabetes, insulin or oral meds controlled
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6
Q

class A2 split into classes

A 
B- at 20 or older with duration less than 10 yrs
C age 10-19 or duration of 10-19 yrs
D before age 10 or more than 20 yrs
F- diabetic nephropathy
R- reitnopathy
RF both
H ischemic heart disease
T piror kidney transplant
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7
Q

want fasting glucose at what

A

below 90 mg/dl

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8
Q

antepartum managment of preexisting diabetes

-maternal eval

A

renal, 24 hr collections every trimester
cardiac: EKG
ophthalamic (first trimester)
daily fingerstick and HgBA1c

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9
Q

antepartum managment of preexisting diabetes

-fetal eval

A

early dating US
fetal ECG
biochem testing (spina bifida)

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10
Q

ultrasound, if weight is greater than ____ gms then recommend C section

A

4500

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11
Q

intrapartum (onset to end of third stage of labor) management of GDM

if diet controlled

if on meds

A

if diet controlled
freq monitoring BG, no treatment

if on meds
hourly glucose monitoring, insulin drip

continusous fetal monitoring in labor

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12
Q

want delivery of GDM pt between what

A

weeks 39-40

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13
Q

treatment maternal hyperthyroidism

possible fetal effects from treatment?

A

PTU first trimester
methimazole 2nd and 3rd trimester

-fetal goiter can develop

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14
Q

treatment for thyroid storm

A

beta blockers
sodium iodide
PTU
dexamethasone

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15
Q

treatment for hypothyroidism

A

levothyroxine

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16
Q

postpartum cardiomyopathy

diseae before?
when develop?
who is at risk?
mortality?

A

no underlying cardiac disease
develops at end of pregnancy or within 6 months postpartum
women with preeclampsia, HTN, and poor nutrition are at risk
mortality is 10%!!

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17
Q

management of cardiac disease prenatal

A

ALL pregnant cardiac pts should be comanaged with a cardiologist

should be delivered vaginally unless obstetric indications

antibiotic prophylaxis for endocarditis in high risk pts (prostethic valves, heart disease, previous endocarditis)

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18
Q

immune idiotpathic thrombocytopenia treatment

what can occur

A

platelts under 50,000
prednisone or IVIG if severe
platelet transufion
splenectomy

-neonatal thrombocytopenia can occur due to placental transfer of antiplatelet antibodies

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19
Q

fetal complications of mom with SLE

what other autoimmune with it and treatment

A

preterm delivery
fetal growth restrictions
stillbirth
miscarriage

can also have antiphospholipid syndrome
-treat with heparin/ LMW heparin and low dose aspirin

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20
Q

renal disorders- intrarenal

A

preexisting disease (lupus nephritis) or hypercoaguable state

21
Q

treatment prerenal

A

restore volume

22
Q

treatment intrarenal

A

prevent further damage

diuretic therpay, fluid restriction, hemodialysis

23
Q

treatment postrenal

A

remove obstruction

24
Q

chronic renal failure is serum creatinine greater than

A

1.5 to 2–> worsens prognosis

25
Q

urinary tract disorders

A

asymptomatic bacteriuria. more likely to lead to cystitis and pyelonephritis
most common is E coli

26
Q

GI disorders in pregnancy

A

nausea and vomiting

hyperemesis gravidarum, persistent nausea and vomiting associated with over 5% loss of prepregnancy weight, ketonuria, dehyration

27
Q

when does hyperemesis gravidarum occur more often

A

in first pregnancies and multiple pregnancies

28
Q

GERD

A

occurs in 70% of pregnant women

29
Q

mendelson’s syndrome aka

A

acid aspiration syndrome

pregnant women at greater risk due to delayed gastric emptying and increased intrabdominal pressure

-can result in adult respiratory syndrome

30
Q

treatment of mendelson’s syndrome

A

supplemental oxygen
maintain airway
treatment for acute resp failure

31
Q

what is intrahepatic cholestasis of pregnancy
associated with what
result for mom and fetus
treatment

A

cholestasis and pruritis in second half of pregnancy not associated with liver enzyme elevations

associated with OCs and multiple gestations
benign for mom
increase risk of fetal demise

treatment is cold baths, bicarb wash, ursodeoxycholic acid, fetal surveilance at delivery

32
Q

actue fatty liver of pregnancy

A

jaundice, nausea and vomiting, ab pain, increase in PT and PTT

33
Q

treatment for acute fatty liver of pregnancy

A

termination of pregnancy

supportive care

34
Q

hematologic disease in pregnancy

A

anemia
hematocrit less than 30%
most common reason is iron deficiency

35
Q

if you feel a palpable cord then what is it in the leg

A

superfiial thrombophlebitis (edema and TTP can go with this)

36
Q

what is pain with dorsiflexion in leg and tenderness clue for

A

DVT

especially if only in one leg

37
Q

treatment for DVT in pregnancy

what values do you follow with each

what is used postpartum

A

anticoagulation therapy
LMW (lovenox) or unfractioned heparin (for PE or DVT)
follow PTT values with heparin and factor Xa values with lovenox

coumadin used for 6 weeks postpartum but not during pregnancy, monitor INR

38
Q

PE what is instigating factor in 70% of cases

A

DVT

39
Q

signs: tachypnea, tachycardia, low grade fever, pleural friction rub, chest splint, pulmonary rales, accentuated pulmonic valve second heart sound

what is this

A

PE

40
Q

pts with DVT or PE require what

A

thrombophilia workup

41
Q

what is the most common pulmonary disease in pregnancy

A

asthma

variable course in pregnancy, 1/3, worse, same, better

42
Q

treatment of asthma in preg

A

same as in non pregnant pt

43
Q

neurologic disorders in pregnancy

A

HA
-tension is most common type, treat with acetaminophen

Migraines

  • highest prevalence in childbearing years
  • most improve during pregnancy

MS

44
Q

seizure disorder in pregnancy: does seizure frequency alter pregnancy

A

no

45
Q

treatment for seizure disorder in pregnancy

A

if seizure free for at least 2 yrs may be able to discontinue meds prior to conception

don’t give valproate

most common is dilantin and phenobarbital

46
Q

women on antiepileptics should be on anywhere from ___ to ___ mg of ____

A

1 to 4 mg of folic acid

47
Q

antiseizure med congenital malformations

A

cleft lip, cleft palate, cardiac anomalies

48
Q

treatment for depression in pregnancy

A

counseling
antidepressants
-avoid in first trimester
-if used in 3rd trimester, greater risk of neonatal withdrawal

49
Q

what women are at greater risk for post partum depression

A

younger women

Repro II Final DF (8 decks)

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