Medical Complications Of Pregnancy (5)

Question 1

Risks for dev GESTATIONAL diabetes? How do you screen? How do you treat? What’s normal fasting and post-meal?

Answer 1

Obesity, FH of diabetes, PCOS (known glucose intolerance)

Glucose challenge test at 26-28w when human placental lactogen is maxed (>135 is abnormal): if failed, move on to glucose tolerance text (GTT, 3h, must be fasting)

Start w/ diet (main stay), Glyburide or Metformin (insulin if none of this works)

Normal is fasting below 90, 2h after eating 120,

Question 2

What maternal complications arise in GESTATIONAL diabetes? Fetal complications? When should a mom w/ gestational diabetes deliver?

Answer 2

Complications are unusual (gestational HTN/pre-eclampsia, delivering larger kids > birth trauma, inc risk of DM later in life)

Fetal macrosomia (> 4000g, large kids > birth trauma, hyperbilirubinemia, shoulder dystocia)

Normal (39-40w, rarely less than 37w)

Question 3

What is and what does human placental lactogen (hPL) do?

Answer 3

Placental hormone

Increases glucose intolerance

Question 4

A diabetic previous to pregnancy (so a person w/ T1 or T2 DM) has a risk of what during pregnancy? Fetal complications? What studies do moms w/ DM get? How is the fetus monitored? How should the babies be delivered?

Answer 4

Same things during non-preg (HTN, renal complications/nephropathy, eye complications/retinopathy), preg can exacerbate renal dx, DKA

Growth restriction (vasculature to placenta restricted d/t dmg caused by DM), SIDS, cardiac malfunctions, prematurity

24h urine (preeclampsia), EKG, eye exam, thyroid studies (grouped auto-I dxs)

Gross scans (UlSo), biochemical testing, antepartum testing (28-32w)

Vaginally if possible (diabetics have poor wound healing, cesarean section can be dangerous)

Question 5

What does antepartum mean?

Answer 5

Not long before birth

Question 6

Delivery time in diabetics can depend on what?

Answer 6

Glycemic control (uterus is more hostile than outside world)

Child size (>4500g babies are considered for non-vaginal delivery)

Question 7

Pt presents w/ racing heart, fever, and temp of 102 degrees. H/o overactive thyroid and they’ve been w/o meds for 6w. Diagnosis?

Answer 7

Thyroid storm

Question 8

Does thyroid hormone cross the placenta?

Answer 8

Yes, too much can > goiter and complicate delivery

Question 9

What’s the tx for thyroid storm? Hypothyroidism?

Answer 9

B-blockers + fluid replacement + antipyretics + PTU (first trimester, longer use > liver toxicity) OR Methimazole (2nd semester onward, DONT use in first trimester)

Replace it (Levothyroxine)

Question 10

Why isn’t Methimazole used in the first trimester?

Answer 10

Crosses placenta and inc risk of aplasia cutis (scalp defects, esophageal atresia w/ tracheoesophageal fistulas, abnormal nipples)

Question 11

Fetal effects of hypothyroidism?

Answer 11

Cretinism (severely stunted growth)
Lower IQ
Low birth-wt
Spontaneous abortion
Preeclampsia

Question 12

What are the risk factors for a DVT?

Answer 12

Obesity
Physical inactivity
Pre-existing varicose veins
Hypercoagulable state in pregnancy

Question 13

What medications are used to manage a DVT? For how long? What’s contraindicated? Is prophylaxis for future pregnancies a thing?

Answer 13

Heparin (aPPT values)
Lovenox (Factor Xa levels)
Coumadin (INR)

3 months post-partum

Estrogen

YES

Question 14

What are the presentations of a PE?

Answer 14

Tachypnea and Tachycardia
Low grade fever
Pleural friction rub
Chest splinting
Pulmonary rales

Question 15

What’s involved in a thrombophilia workup?

Answer 15

Lupus anticoagulant (LAC)
actor V leiden
Protein C and S
Anti-thrombin III
Prothrombin gene mutation
Anticardiolipin antibody (ACA)