Medical and Surgical Complications of Pregnancy Flashcards
Pt has Neisseria but is allergic to penicillin. What is the best option for tx?
Azithromycin
(20% chance of reacting poorly to ceftriaxone)
22 yo pregnant woman just dx with toxoplasmosis. Which of the following risk factors is most likely to have contributed to her dx?
a. Eating raw meat
b. Eating raw fish
c. Owning a dog
d. Having viral infections in early pregnancy
a. Eating raw meat
or in contact with infected cat feces
How to manage pregnant pts with PMHx significant for clots?
Place on low-dose unfractionated heparin therapy or LMWH therapy throughout pregnancy and puerperium
Pregnancy itself is a hypercoagulable state
A 20 yo G1 at 18 weeks of gestation is hospitalized for IV abx for tx of acute pyelo. +SOB and found to have tachypnea and decrease O2 sat. CXR reveals pulmonary infiltrates consistent with pulmonary edema. What is the most likely cause of this complication?
a. Acute renal failure
b. Allergic rxn
c. Bacteremia
d. Endotoxin release
e. IV hydration
d. Endotoxin release
Can cause alveolar injury and lead to pulmonary edema and ARDS.
Insulin requirement during pregnancy?
Expect her insulin req to increase throughout pregnancy
Pregnancy is characterized by both inc. insulin resistance and dec. sensitivity to insulin. The increased insulin resistance is largely due to placental hormones such as human placental lactogen, progesterone, and cortisol.
Most common birth defect associated with diabetes?
VSD
Which of the following diabetic complications is most likely to be permanently worsened by pregnancy?
a. CAD
b. Gastroparesis
c. Nephropathy
d. Neuropathy
e. Proliferative retinopathy
e. Proliferative retinopathy
25 yo G2P0 at 30 weeks’ gestation presents with complaint of intense itching that is. worse on the palms and soles of her feet, and is worse at night. Her physical exam does not. show any evidence of rash, but she has obvious excoriations from scratching on her abdomen.
Which of the following tests would be most likely to confirm suspected dx?
a. Skin biopsy demonstrating evidence of bile acids in dermis
b. Elevated serum liver fxn enzymes
c. Elevated total serum bile acids
d. Liver biopsy demonstrating cholestasis w/o inflammation
c. Elevated total serum bile acids
Hallmark of intrahepatic cholestasis of pregnancy = elevated serum bile acids
Liver biopsy not needed to confim dx.
Tx for intrahepatic cholestasis?
Oral ursodeoxycholic acid –> relieve pruritis, lower hepatic enzyme levels, decrease acid concentrations….
primarily works by increasing bile flow
23 yo G3P2002 with PMHx of genital herpes visits at 34 weeks’ gestation. Concerned about possibility of having an outbreak and infect baby.
How to manage?
Suppressive antiviral therapy can be started at 36 weeks to help prevent outbreak from occurring at time of delivery
How will a patient with acute fatty liver of pregnancy px?
Tx?
Rare complication of pregnancy
Several-day or -week hx of malaise, anorexia, nauesea, emesis, jaundice
Indications of liver failure are present, manifested by elevated PT/PTT, bilirubin, and ammonia levels
+marked hypoglycemia
Low fibrinogen and platelet levels occur 2/2 consumptive coagulopathy
Tx: immediate delivery
A 23 yo G1P0 presents for routine OB visit at 28 weeks’ gestation. Lab findings drawn at her prenatal visit 2 weeks ago reveal 1-hour glucose test of 128 mg/dL, hemoglobin of 10.8 g/dl, and a platelet count of 80,000/microL. All other lab findings were normal. During present visit, her BP is 120/70 and urine dip is negative. No complaints. +hx of epistaxis on occasion but no other bleeding. Next step in treatment for her thrombocytopenia?
a. No tx necessary
b. Stop prenatal vitamins
c. Oral corticosteroids
d. IVIG
e. Splenectomy
a. No tx necessary
Pt has gestational thrombocytopenia. Asymptomatic pregnant women with platelet counts above 50,000 do not need to be treated
20 yo G1 patient delivers a live-born infant with cutaneous lesions, limb defects, cerebral cortical atrophy, and chorioretinitis. Her pregnancy was complicated by pneumonia at 18 weeks.
Varicella
Maternal infection during first half of pregnancy = cutaneous and bony defects, chorioretinitis, cerebral cortical atrophy, and hydronephrosis. 10% will develop pneumonitis
A 23 yo G1 with hx of flulike illness, fever, myalgias, and lymphadenopathy during her early thrid trimester delivers a growth-restricted infant with seizures, intracranial calcifications, hepatosplenomegaly, jaundice, and anemia.
Toxoplasmosis gondii
A 32 yo G5 delivers a stillborn fetus at 34 weeks. Placenta is noted to be much larger than normal. Fetus appeared hydropic and had petechiae over much of the skin.
Syphilis
Transplacental infection can occur with stage of syphilis but the highest incidence of congenital infection occurs in women with primary or secondary disease.
Fetal and neonatal effects: hepatosplenomegaly, edema, ascites, hydrops, petechiae, osteochondritis, rhinitis, pneumonia, myocarditis, nephrosis.
Placenta is enlarged
