Medical complications of pregnancy

Question 1

What screening should be performed for gestational diabetes?

Answer 1

-screens should be done at 24-28 wks; screen consists of 50 g glucose load given to mom, followed by serum glucose measured 1 hr after administration. Normal is less than 130. If abnormal glucola, do a 3 hr glucose tolerance test: carb load for 3 days, then take a fasting BG, then give 100 mg glucose load and measure BG every hour for 3 hours. Abnormal if fasting glucose >95, 1 hr >180, 2 hr >150, and 3 hr > 140 all abnormal

Question 2

What are potential complications of gestational diabetes?

Answer 2

lung immaturity, macrosomia w/ incr risk of birth trauma or shoulder dystocia, post-natal hypoglycemia

Question 3

What are potential complications associated with pregestational maternal diabetes?

Answer 3

preeclampsia, renal insufficiency, retinopathy, diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic state
can cause heart defects, neural tube defects, sacral agenesis, renal agenesis, IUGR, macrosomia

Question 4

What is the definition of preeclampsia?

Answer 4

HTN and proteinuia/edema after 20 wks gestation. proteinuria must be 2+ on dipstick or >300 mg protein/24 hr. If urine protein-to-creatinine ratio is

Question 5

What should you do for severe preeclampsia in a patient who is far from term?

Answer 5

inpatient monitoring with goal BP

Question 6

What are complications of preeclampsia?

Answer 6

seizure, blindness, pulmonary edema, elevated liver enzymes/low platelets (HELLP), stroke, IUGR,

Question 7

What are risk factors for preeclampsia?

Answer 7

previous preeclampsia, nulliparity, SLE, HTN, 35, twins, vascular disease, obesity, DM

Question 8

What are complications of HELLP?

Answer 8

placental abruption, renal insufficiency, encephalopathy, and DIC

Question 9

If a patient has eclampsia or preeclampsia, how should she be managed after delivery?

Answer 9

continue antihypertensives and magnesium ost partum. they suggest at least 48 hrs since 25 % of seizures occur within 24 hrs postpartum

Question 10

What should you do for a pregnant patient with epilepsy?

Answer 10

OK to keep on (most) antiepileptics, but give supplemental folate and vitamin K

Question 11

What is the treatment for hyperemesis gravidum?

Answer 11

pyridoxine and dosylamine, with hydration, avoidance of large meals

Question 12

How should you manage a pregnant woman who gets a DVT?

Answer 12

initial anticoagulation with IV heparin or low molecular weight heparin (goals on pg 267).

• switch to subcutaneous LMWH before discharge
• If possible d/c anticoagulation 24-36 hrs prior to delivery. If at high risk, switch to IV unfractionated heparin until 6 hrs pritor to delivery
• Continue therapy for 6 wks after delivery