Medical Complications of Pregnancy Flashcards
When is GDM screened for?
What is the test done?
What is a failed test? What do you do next?
What causes the increase in glucose tolerance seen in GDM?
26-28 wks.
1 hour glucose challenge test (GCT) - 50 g sugar load.
Failed test is a [glucose] > 135 after 1 hour. Perform a 3 hour glucose tolerance test (100 g sugar load).
What is a normal blood sugar during gestation while fasting and 2 hours after a meal?
Fasting: < 95
2 hours postprandial: < 120
What are 4 maternal complications from GDM?
Increased risk of gestational HTN
Preeclampsia
C-section
Increased risk of developing DM later in life (50% risk)
What are 5 fetal complications of GDM?
Macrosomia (> 4000 g)
HyperBR
Operative delivery
Shoulder dystocia
Birth trauma
When should a patient with GDM be delivered if sugars are well controlled?
What if the sugars are uncontrolled?
Well controlled: between 39-40 wks.
Poorly controlled: as early as 37 wks.
What fetal complications can occur in pregnancies complicated by diabetes? (4)
Increased risk of spontaneous abortion
Anatomical birth defects
FGR
Prematurity
What studies are done to evaluate overall maternal health during pregnancy with GDM? (4)
24-hour protein collection each trimester to assess kidney function
Ophthalmologic exam
Thyroid studies
Glycemic control
What fetal monitoring is indicated in GDM? (5)
Early US for dating and viability
Biochemical testing and/or nuchal translucency
Detailed US for fetal anatomy including echo
Growth US every 3-4 wks beginning between 28-32 wks gestation
Antepartum testing: NST, BPP and doppler studies at 32 wks
How should women with preexisting diabetes be delivered?
It depends on the glycemic control.
Vaginal delivery is preferred unless estimated fetal weight is > 4500 g.
What is the major complication (other than death) in thyroid storm?
Heart failure
What 2 medicines can treat hyperthyroidism in pregnancy? When are they used?
PTU - used in 1st trimester, but changed the methimzaole after due to risk of liver toxicity. MOA = inhibits synthesis of thyroid hormones.
Methimazole - used in 2nd and 3rd trimester (not 1st) due to risk of crossing placenta and leading to aplasia cutis (scalp defects, esophageal atresia with TE fistula and chonoanal atresia with absent nipples). MOA = same as PTU.
What are 2 fetal effects of maternal hyperthyroidism?
Fetal hypothyroidism and fetal goiter
How do you treat hypothryoidism?
Replace the thyroid hormone
How do you treat a patient’s symptoms of thyroid storm? (4)
Beta blocker
Fluid replacement
Anti-pyretics
Block thyroid hormone production
What is a good test to order if you suspect superficial thrombophlebitis?
How can you tell if its superficial thrombophlebitis vs. DVT?
LE doppler study
Painful/abnormality to palpation = superficial
Risk factors for superficial thrombophlebitis? (4)
Obesity
Inactivity
Pre-existing varicose veins
Hypercoagulable state in pregnancy
How do you manage a patient with superficial thrombophlebitis?
Reassurance
Supportive measurements
- pain meds
- heat
- support hose
Anti-coagulants are NOT necessary
How is a DVT diagnosed?
What meds should be used if pregnant?
Postpartum?
What lab should be monitored in each?
LE doppler
Heparin (aPTT values) or Lovenox (factor Xa levels) during pregnancy
Coumadin if postpartum (INR)
How long should anticoagulation be done postpartum in a patient with a DVT?
What cannot be used with it?
Does the patient need to continue this therapy forever?
3 mo postpartum
No use of OCs (no estrogen)
No, but they should get back on therapy once the patient gets pregnant again
How do you manage a patient with a PE in pregnancy?
Anticoagulation with Lovenox until 36 wks gestation and then transition to Heparin (because it is reversible if there needs to be operation, anesthesia, etc.)
How can progesterone lead to GERD?
It relaxes the LES
What is hyperemesis gravidarum?
Persistent N/V and frequently with electrolyte imbalance.
>5% pre-pregnancy weight loss
More common in first pregnancy and multiple gestation
When is N/V the worst in pregnancy?
Around weeks 8-12 wks and will improve
What is Mendelson’s syndrome?
What is a significant complication?
Chemical pneumonitis or aspiration pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.
Can progress to ARDS
What can cause hyperemesis gravidarum?
Psychological
Hormonal changes
Gastric dysrhytmias
Hyperacuity
