Medical Complications in Pregnancy Flashcards
What is Hyperemesis Gravidarum?
Persistent nausea and vomiting during pregnancy that does NOT resolve after the 1st trimester
When does “morning sickness” resolve with pregnancy?
Before the end of the 1st trimester
– Hyperemesis Gravidarum will NOT
With what 3 conditions is Hyperemesis Gravidarum common?
Molar pregnancies
Multiple gestations
1st pregnancies
What lab finding may be seen with Hyperemesis Gravidarum?
HIGH b-hCG
What test should be done if you suspect Hyperemesis Gravidarum?
Ultrasound to rule out molar pregnancies and multiple gestations
What are some treatment options for Hyperemesis Gravidarum? (4)
- Doxylamine-Pyridoxine (B6)
- Ondansetron
- Promethazine
- Metoclopramide
If Hyperemesis Gravidarum is severe enough, low food intake and weight loss will be present with what metabolic/urine abnormalities?
Ketonuria – low glucose from not eating
Hypochloremic Hypokalemic Metabolic Alkalosis
When do you screen for Gestational DM?
24 weeks
When screening for Gestational DM at 24 weeks, what is done? What is an abnormal result?
1 hour 50g glucose challenge
** Abnormal = glucose > 140
If the initial Gestational DM screening comes back abnormal, then what is done?
3 hour 100g glucose challenge
To diagnose Gestational DM, what must the glucose levels be above at 1, 2, and 3 hours with the 100g challenge?
1 hour = > 180
2 hour = > 160
3 hour = > 140
Gestational DM may be able to be managed with dietary modifications but if not, what medication should be used?
Insulin
Is the mother at an increased risk for Type 2 DM if she has Gestational DM?
YES
If HTN is present before pregnancy or before 20 weeks, what is it considered throughout pregnancy?
Chronic hypertension
When does Gestational HTN develop and resolve?
Develops after 20 weeks gestation
Resolves after 12 weeks postpartum
What are the 4 antihypertensive medications used during pregnancy?
Methyldopa
Hydralazine
Nifedipine
Labetolol
What are the 4 antihypertensive medications used during pregnancy?
Methyldopa
Hydralazine
Nifedipine
Labetolol
What is needed to diagnose Gestational HTN?
2 blood pressure elevations more than 4 hours apart
When does Preeclampsia develop?
After 20 weeks gestation
What is present with Preeclampsia?
New onset HTN + Proteinuria
How much proteinuria is too much?
> 300mg in 24 hours
What symptoms can develop if Preeclampsia is more severe?
Edema
Headache and blurry vision
RUQ pain
Pulmonary Edema
What is the treatment for Preeclampsia?
Deliver no later than 37 weeks!
- BP control
- Magnesium to prevent seizures
What is the treatment for Preeclampsia?
Deliver no later than 37 weeks!
- BP control
- Magnesium to prevent seizures
What is HELLP syndrome?
Hemolytic anemia
Elevated Liver enzymes
Low Platelets
What is Eclampsia?
Women with Preeclampsia then develop a grand mal seizure
What is the management of Eclampsia?
Magnesium +/- Diazepam
- BP control
- Deliver once STABLE
Asymptomatic Bacteriuria is common in pregnancy. How will it present?
Asymptomatic but (+) urine culture at initial OB visit
If a patient is pregnant and gets a UTI, what are the treatment options?
Cephalexin
Amoxicillin/Clavulanate
Nitrofurantoin AFTER 1st TRIMESTER
If a patient is pregnant and gets Pyelonephritis, what is the treatment?
Admission + IV 3rd Gen Cephalosporin
What defines an Antepartum hemorrhage?
Bleeding AFTER 20 weeks gestation
3 common causes of bleeding after 20 weeks gestation?
Placental Abruption
Placenta Previa
Vasa Previa
What often causes Placental Abruption? (3)
Trauma
Cocaine
HTN
How will a Placental Abruption present?
PAINFUL bleeding + fetal distress
Placental Abruption is a clinical diagnosis. What is the treatment?
Stabilize and Deliver soon
Painful vaginal bleeding after 20 weeks with fetal distress is likely?
Placental Abruption
What is Placenta Previa?
Abnormally low placental implantation near or covering the cervical os
How will Placenta Previa present?
PainLESS bleeding that often ceases after a few hours
Painless vaginal bleeding after 20 weeks that stops after a few hours is likely?
Placenta Previa
How is Placenta Previa confirmed?
US
Should you preform a vaginal exam with Placenta Previa?
NO
What is Vasa Previa?
Uncovered umbilical cord vessels pass over the cervical os
How will Vasa Previa present usually?
Painless vaginal bleeding + rupture of membranes
Is it possible to see fetal bradycardia/demise with Vasa Previa?
YES
How will Vasa Previa often present?
Painless vaginal bleeding after 20 weeks with rupture of membranes
If a patient is at high-risk for developing Gestational DM, when do you screen them?
1st trimester
If a patient developed GDM during the pregnancy, what should be performed at the 6 week postpartum visit?
2 hour 75g glucose challenge test
What level of urine protein:Cr ratio can diagnose the proteinuria associated with Preeclampsia?
> 0.3
What 24 hour urine protein level can diagnose the proteinuria associated with Preeclampsia?
> 300mg in 24 hours
What BP level is diagnostic if Preeclampsia with severe features?
> 160 OR > 110
If preeclampsia WITH severe features is present, when should delivery occur?
After 34 weeks
If a patient experienced Preeclampsia in a prior pregnancy, what should they be taking during subsequent prenancies?
Low-dose Aspirin for prophylaxis
What is the delivery method for Placenta/Vasa Previa?
C-section
If Placenta Previa or Vasa Previa is present, what should be given in the 3rd trimester and how should they deliver?
Steroids –> C-section
If placenta accreta/increta/percreta spectrum is present, what is the treatment?
C-section with Hysterectomy!
