lecture 5: medical conditions in pregnancy, wooton Flashcards by Daniel Aaron

gestational diabetes

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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risk factors for GDM

obesity
previous history of GDM
family history DM
known glucose intolerance

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maternal complications with GDM

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

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fetal complications of GDM

**macrosomia
neonatal hypoglycemia
hyperbili
shoulder dystocia
trauma

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2 classes of GDM

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

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class A2 split into classes

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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want fasting glucose at what

below 90 mg/dl

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antepartum managment of preexisting diabetes

-maternal eval

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

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antepartum managment of preexisting diabetes

-fetal eval

early dating US
fetal ECG
biochem testing (spina bifida)

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

4500

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

if diet controlled

if on meds

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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want delivery of GDM pt between what

weeks 39-40

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treatment maternal hyperthyroidism

possible fetal effects from treatment?

PTU first trimester
methimazole 2nd and 3rd trimester

-fetal goiter can develop

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treatment for thyroid storm

beta blockers
sodium iodide
PTU
dexamethasone

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treatment for hypothyroidism

levothyroxine

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postpartum cardiomyopathy

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

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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management of cardiac disease prenatal

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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immune idiotpathic thrombocytopenia treatment

what can occur

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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fetal complications of mom with SLE

what other autoimmune with it and treatment

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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renal disorders- intrarenal

preexisting disease (lupus nephritis) or hypercoaguable state

treatment prerenal

restore volume

treatment intrarenal

prevent further damage

diuretic therpay, fluid restriction, hemodialysis

treatment postrenal

remove obstruction

chronic renal failure is serum creatinine greater than

1.5 to 2–> worsens prognosis

urinary tract disorders

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

GI disorders in pregnancy

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

when does hyperemesis gravidarum occur more often

in first pregnancies and multiple pregnancies

GERD

occurs in 70% of pregnant women

mendelson's syndrome aka

acid aspiration syndrome pregnant women at greater risk due to delayed gastric emptying and increased intrabdominal pressure -can result in adult respiratory syndrome

treatment of mendelson's syndrome

supplemental oxygen maintain airway treatment for acute resp failure

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

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

actue fatty liver of pregnancy

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

treatment for acute fatty liver of pregnancy

termination of pregnancy | supportive care

hematologic disease in pregnancy

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

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

superfiial thrombophlebitis (edema and TTP can go with this)

what is pain with dorsiflexion in leg and tenderness clue for

DVT | especially if only in one leg

treatment for DVT in pregnancy what values do you follow with each what is used postpartum

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

PE what is instigating factor in 70% of cases

DVT

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

pts with DVT or PE require what

thrombophilia workup

what is the most common pulmonary disease in pregnancy

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

treatment of asthma in preg

same as in non pregnant pt

neurologic disorders in pregnancy

HA -tension is most common type, treat with acetaminophen Migraines - highest prevalence in childbearing years - most improve during pregnancy MS

seizure disorder in pregnancy: does seizure frequency alter pregnancy

treatment for seizure disorder in pregnancy

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

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

1 to 4 mg of folic acid

antiseizure med congenital malformations

cleft lip, cleft palate, cardiac anomalies

treatment for depression in pregnancy

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

what women are at greater risk for post partum depression

younger women