lecture 5: medical conditions in pregnancy, wooton Flashcards
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
risk factors for GDM
obesity
previous history of GDM
family history DM
known glucose intolerance
maternal complications with GDM
increased risk gestational HTN
increased risk preeclampsia
greater risk of C section delivery
increase risk developing diabetes later in life
fetal complications of GDM
**macrosomia neonatal hypoglycemia hyperbili shoulder dystocia trauma
2 classes of GDM
class A1: GD, diet controlled class A2: gestational diabetes, insulin or oral meds controlled
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
want fasting glucose at what
below 90 mg/dl
antepartum managment of preexisting diabetes
-maternal eval
renal, 24 hr collections every trimester
cardiac: EKG
ophthalamic (first trimester)
daily fingerstick and HgBA1c
antepartum managment of preexisting diabetes
-fetal eval
early dating US
fetal ECG
biochem testing (spina bifida)
ultrasound, if weight is greater than ____ gms then recommend C section
4500
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
want delivery of GDM pt between what
weeks 39-40
treatment maternal hyperthyroidism
possible fetal effects from treatment?
PTU first trimester
methimazole 2nd and 3rd trimester
-fetal goiter can develop
treatment for thyroid storm
beta blockers
sodium iodide
PTU
dexamethasone
treatment for hypothyroidism
levothyroxine
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%!!
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)
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
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
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
PE
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
no
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
