Medical Complications in Pregnancy Flashcards
Screening for gestational diabetes is done between 24-28 weeks. How is the diagnosis reached?
50g 1 hr oral glucose challenge test resulting in abnormal result of >130-140 mg/dL
This would be followed by a 3 hr 100g oral glucose tolerance test (failed with 2 or more abnormal values)
Maternal complications with gestational diabetes
Increased risk of gestational HTN
Increased risk of preeclampsia
Greater risk of C section delivery [fetal weight >4500g is indication for C section]
Increased risk of developing diabetes later in life
Fetal complications of gestational diabetes
Macrosomia Neonatal hypoglycemia Hyperbilirubinemia Operative delivery Shoulder dystocia Birth trauma
Maternal complications with pregestational diabetes
Worsening nephropathy and retinopathy
Increased risk of preeclampsia
Greater risk of DKA
Fetal complications with pregestational diabetes
Direct link between birth defects and increasing HbA1c during embryogenesis, and a six-fold increase risk of congenital anomalies
Increased risk of spontaneous abortion, anatomic birth defects (sacral agenesis and cardiac), fetal growth restriction and prematurity
2 classes of gestational diabetes
Class A1 GDM = diet controlled
Class A2 GDM = insulin or oral meds controlled
Classification of pregestational diabetes
Class B = onset at age 20+ with duration <10 yrs
Class C = onset at age 10-19 or duration of 10-19 yrs
Class D = onset before age 10 or duration >20yrs
Class F = diabetic nephropathy
Class R = proliferative retinopathy
Class H = ischemic heart disease
Class T = prior kidney transplant
When a pregnant mom has preexisting diabetes, her delivery options depend on ______ and _____
Estimated fetal weight; glycemic control
Postpartum management of GDM
Insulin requirements drop significantly after delivery of placenta
GDM typically does not require further tx, but should get 2 hour glucose tolerance test 6-12 wks postpartum to look for preexisting disease
Fetal effects of maternal hyperthyroidism
Medications cross placenta and fetal hypothyroidism and fetal goiter can develop
Increased risk of prematurity, IUGR, preeclampsia, and stillbirth
Untreated hypothyroidism in pregnancy increases risk of what complications?
Spontaneous abortion Preeclampsia Abruption Low birth weight infants Stillbirth Lower intelligence levels (cretinism)
What is neonatal thyrotoxicosis?
Result of transplacental transfer of thyroid stimulating antibodies
Transient condition usually lasting 2-3 months with a mortality rate of ~16%
Effects of neonatal hypothyroidism
Generalized developmental retardation
May be the result of thyroid dysgenesis, inborn errors of thyroid function, or drug induced
Most common lesion associated with rheumatic heart disease and potential complications
Mitral stenosis
High risk of developing heart failure, subacute bacterial endocarditis and thromboembolic disease
What condition is a contraindication to pregnancy due to decompensation during pregnancy and a high mortality rate?
Primary pulmonary HTN
[if pt does become pregnant, epidural anesthesia is preferred and vaginal delivery may be an option]
Cardiac arrhythmias associated with pregnancy
Supraventricular tachycardia
Afib/flutter — worrisome for underlying cardiac dz, increased risk of PE
Postpartum cardiomyopathy typically develops within the last weeks of pregnancy or within 6 months postpartum and is not associated with underlying cardiac disease. Women with what conditions are at increased risk of postpartum cardiomyopathy?
Preeclampsia, HTN, poor nutrition
Management of antepartum cardiac disease
All pregnant cardiac pts should be co-managed with a cardiologist
Need EKG and echo, avoid excess weight and edema, avoid strenuous activity, prevent anemia, avoid infection, anticoagulation may be necessary, fetus will also need echo at 22-26 wks
How should cardiac pts deliver?
Vaginally, although pushing may need to be avoided in second-stage
Other considerations: strict fluid management, antibiotic prophylaxis for endocarditis in high risk pts, monitor for acute cardiac decompensation in CHF pts (medical emergency!)
Condition in which immunoglobulins attach to maternal platelets
How does this condition affect the fetus?
Immune idiopathic thrombocytopenia
Neonatal thrombocytopenia can occur d/t placental transfer of antiplatelet antibodies
Maternal effects of SLE during pregnancy
Symptoms may improve, worsen, or stay the same
Fetal complications of SLE in pregnancy
Preterm delivery
Fetal growth restriction
Stillbirth
Miscarriage
10% risk for neonatal lupus-passive transfer of antibodies
Pregnancy complications with antiphospholipid syndrome
Increased risk of miscarriage
Risk for developing preeclampsia
Fetal growth restriction
Tx for renal disorders in pregnancy
Pre-renal: restore volume, monitor electrolytes
Renal: diuretic therapy, fluid restriction, hemodialysis
Postrenal: remove obstruction, left lateral position, urethral catheter, possible surgical intervention
Pregnancy after a renal transplant is not recommended due to risk of losing graft function or experiencing rejection. If mom does get pregnant, what are some fetal complications?
Steroid induced adrenal and hepatic insufficiency
Prematurity
Intrauterine growth restriction
Asymptomatic bacteriuria complications in pregnancy
More likely to lead to cystitis and pyelonephritis in pregnant women
Pyelonephritis complications in pregnancy
20% will have increased uterine activity and preterm labor
Can result in adult respiratory distress syndrome
Signs/symptoms of hyperemesis gravidarum
Persistent nausea and vomiting associated with >5% loss of pre-pregnancy weight, ketonuria, and dehydration
Risk factors for hyperemesis gravidarum
First pregnancy, multiple pregnancies, and trophoblastic disease
What effect does pregnancy tend to have on peptic ulcer disease?
Pregnancy may improve PUD
What is Mendelson’s syndrome?
Acid-aspiration syndrome [pregnant women at greater risk d/t delayed gastric emptying and increased intraabdominal pressure]
Can result in adult respiratory syndrome
How does IBD (Crohn’s and UC) change during pregnancy
Pts usually do well during pregnancy, although UC may be a little more active
Can increase miscarriage risk if bowel disease is active at the time of conception
Intrahepatic cholestasis of pregnancy (ICP) is characterized by cholestasis and pruritis in the second half of pregnancy; risk factors include oral contraceptives and multiple gestations. What are maternal and fetal risks associated with ICP?
Benign course for maternal consequences
Increased risk of meconium stained amniotic fluid and fetal demise; fetal surveillance is important, and early term delivery may occur
Acute fatty liver of pregnancy is characterized by diffuse fatty infiltration of the liver resulting in hepatic failure. What are some associated symptoms and lab findings?
Sxs: abd pain, N/V, jaundice, irritability, polydipsia/pseudodiabetes insipidus, HTN/proteinuria
Labs: increase PT and PTT, elevated bilirubin, ammonia, and uric acid, and elevation of liver transaminases
Tx for acute fatty liver of pregnancy
Termination of pregnancy and supportive care with IV fluids, glucose, FFP, and cryoprecipitate
What causes anemia in pregnancy?
Physiologic decrease in HgB/hematocrit during pregnancy (dilutional anemia); also iron-deficiency
Screening occurs at 26-28 weeks and iron supplementation may be initiated
Pregnancy is a hypercoagulable state with up to 5x risk of venous thrombosis. When is the risk the highest? what conditions is mom at increased risk for?
First 5 weeks postpartum
Increased risk for superficial vein thrombosis, deep vein thrombosis, and PE
Pts with a DVT or PE require a ______ workup
Thrombophilia (includes lupus anticoagulant, anticardiolipin Ab, factor V leiden, Protein C and S, antithrombin III, and prothrombin G20210A)
Most common pulmonary disease in pregnancy and its maternal/fetal effects
Asthma
When severe, associated with miscarriage, preeclampsia, intrauterine fetal demise, intrauterine fetal growth restriction, and preterm delivery
How does multiple sclerosis change during pregnancy
What are fetal risks?
Usually experience fewer and less severe episodes during pregnancy, but may exacerbate postpartum
Increased risk of lower birth weight infants
Increased risk of cesarean delivery
T/F: typically, seizure frequency increases during pregnancy
False — seizure frequency does not typically change in pregnancy
Complications of seizures during pregnancy
Preeclampsia Placental abruption Hyperemesis Premature labor Intrauterine fetal demise
Increased risk of congenital malformations — cleft lip, cleft palate, and cardiac anomalies
70-80% of women experience the “baby blues” post partum, usually due to hormonal fluctuations. If this persists after ______ postpartum, then there is concern for postpartum depression
2 wks
