Medical Complications

Question 1

diabetes

Answer 1

Preexisting diabetes, pregnancy leads to worsening

No diabetes at all leading to gestational diabetes

Question 2

HTN

Answer 2

140/90 or greater

Question 3

HTN triad

Answer 3

Elevated BP, excessive weight gain, albuminemia

Question 4

Pre-eclampsia

Answer 4

new onset of HTN and either proteinuria or end organ dysfunction after 20 weeks gestation in previously normotensive pt

Question 5

patho of preeclampsia

Answer 5

Spiral arteries from myometrium become thickened, wider, and spiraled in preparation for the placenta
Something goes wrong with spiral arteries, so body releases enzymes to make endothelium of spiral arteries behave normally. This has systemic effect leading to increased BP

Question 6

HELLP syndrome

Answer 6

hemolysis
elevated
liver enzymes
low
plateltes

schistocytes-broken up RBCs seen

Question 7

preeclampsia dx

Answer 7

systolic bp >140 or diastolic >90 on two occasions at least 4 hours apart after 20 weeks gestation
if systolic>160 or diastolic >110, confirmed in minutes
proteinuria >0.3 grams in 24 hours

Question 8

eclampsia

Answer 8

development of grand mal seizures in a pt with preeclampsia, in the absence of any neuro conditions

Question 9

Pre-eclampsia is a disease of the…

Answer 9

placenta, once removed the pre-eclampsia goes away….treatment is delivery of baby and placenta

Question 10

seizure prophylaxis meds

HTN meds

Answer 10

magnesium sulfate

labetolol, hydralazine

Question 11

EJ inpregnancy

Answer 11

normal is 55%, can drop down to below 45%

Question 12

ABG O2 should be what in 3rd trimester?

Answer 12

ABG O2 of pregnant woman in 3rd trimester should be at least 100 but could be up to 108

Question 13

normal ABG values during pregnancy

Answer 13

pH:7.45-7.53 from resting hyperventilation
P02: 100-108
pC02: 25-30
HCO3: 16-22

Question 14

a pulse ox of 90% indicates…

80%…

Answer 14

P02 of 60

Po2 of 40

Question 15

is d-dimer a good test for PE i pregnancy?

Answer 15

no, levels will be increased regardless

Question 16

tx of bronchial asthma

Answer 16

albuterol,
ipatropium
systemic prednisone

Question 17

what if pt have a VP shunt?

Answer 17

in 3rd trimester, increased abdominal pressure results in cessation of drainage and increased ICP

Question 18

what do you think of if there is abdominal pain in the 3rd trimester

Answer 18

abruption of placenta or appendicits

Question 19

MC general surgical problem during pregnancy

Answer 19

appendicits, may have pain in RLQ or RUQ

Question 20

what % of blood volume can be lost before symptoms occur?

Answer 20

35%

15% blood loss shows no significant symtoms

Question 21

supine hypotensive syndrome

Answer 21

Fetus weight causes pressure on inferior vena cava/aorta causes hypotension, lift pt on right side up….pt should always be evaluated on her left side (right hip elevated)

Question 22

what test should you quickly do on a pregnant pt that comes into the ER?

Answer 22

finger stick for hypoglycemia

Question 23

alkalotic pH of vagina may indicate

Answer 23

PROM

Question 24

MCC of trauma during pregnancy

2nd MCC

Answer 24

IPV

MVA

Question 25

GI consideration in trauma

Answer 25

insert an NG tube, stomach emptying is delayed