Medical Complications in Pregnancy (Wootton)

Question 1

Gestational Diabetes

Answer 1

glucose intolerance identified in pregnancy; screening between 24-28 weeks; oral glucose challenge >135 is abnormal

Question 2

Fetal complications from gestational diabetes

Answer 2

macrosomia (big baby); C-section (if baby is >4500 g); shoulder dystocia

Question 3

Birth defects and HgBA1C

Answer 3

direct link between increased HgBA1C and risk of congenital anomalies

Question 4

Class A1 gestational diabetes

Answer 4

diet controlled

Question 5

Class A2 gestational diabetes

Answer 5

insulin or oral meds controlled

Question 6

Good glycemic control

Answer 6

fasting less than 95 mg/dL; two hour postprandial less than 120 mg/dL

Question 7

Thyroid storm

Answer 7

can be fatal; triggers can be infection, labor, C-section or non compliance to hyperthyroid meds; treat w beta-blockers (propranolol); stop conversion of T4 to T3 (Dexamethasone); replace fluid loss and bring temp down

Question 8

Neonatal thyrotoxicosis

Answer 8

transplacental transfer of thyroid-stimulating antibodies; mortality rate 16%

Question 9

Rheumatic Heart disease

Answer 9

look for mitral stenosis (most common)

Question 10

Primary pulmonary hypertension

Answer 10

CONTRAINDICATED to pregnancy; high mortality rate in these patients

Question 11

Postpartum cardiomyopathy

Answer 11

no underlying cardiac disease; develops within last weeks of pregnancy or w/i 6 month postpartum; mortality about 10%

Question 12

Immune Idiopathic Thrombocytopenia

Answer 12

Abs attach to maternal platelets; can be confused with gestational thrombocytopenia; begin treatment after platelets drop to 50,000

Question 13

Asymptomatic bacteriuria

Answer 13

can lead to cystitis and pyelonephritis; most common pathogen is E. coli

Question 14

Hyperemesis gravidarum

Answer 14

persistent n/v; these pts are miserable; lose >5% weight, ketonuria, and dehydration; marijuana has been seen to relieve symptoms; if severe may need NG tube

Question 15

GERD

Answer 15

occurs in almost all pregnancies; eat small meals, avoid lying down after meals, elevate head when sleeping, antiacids

Question 16

Mendelson’s Syndrome

Answer 16

acid aspiration syndrome; due to delayed gastric emptying; can result in adult respiratory syndrome

Question 17

Intrahepatic Cholestasis of pregnancy (ICP)

Answer 17

cholestasis and pruritis in second half of pregnancy; increased risk for meconium and fetal demise; itching w/o abdominal pain or rash; elevated bile acids

Question 18

Acute fatty liver of pregnancy

Answer 18

SCARY; looks like preeclampsia but pt will be jaundiced with elevated liver function enzymes; treatment is termination of pregnancy and supportive care; if survive - usually full recovery

Question 19

Anemia

Answer 19

common; <11g/dL first trimester and <10.5 g/dL second and third trimester; commonly due to iron deficiency

Question 20

Superficial thrombophlebitis

Answer 20

common for patients to present with varicose veins

Question 21

DVT

Answer 21

more common in left leg than right; pain in calf with dorsiflexion (Homans sign); diagnosis w US w doppler flow

Question 22

Can patient be at 100% O2 sat and still have a PE

Answer 22

yes; PE pleuritic chest pain, SOB, tachycardia; DVT is common instigating factor

Question 23

Headaches

Answer 23

Tension - most common; relieved with acetaminophen
Migraines usually improve during pregnancy

Question 24

Postpartum depression

Answer 24

“baby blues”; persistent after the first two weeks postpartum then a concern for postpartum depression