Medical Complications Of Pregnancy Flashcards
Risk factors for Preeclampsia
Fmhx Nullip Age >40 Multiple gestation Preeclampsia inprior pregnancy (7x) Htn abd or renal disease SLE or anti phospholipid syndrome Increased BMI Prior DM
Expectant management of PreE without severe features
Meet 2x weekly NST biweekly AFI weekly Weekly CBC, ALT, LDH, uric acid, and creatinine Fetal growth every 3 weeks Umbilical artery doppler if IUGR noted
HYPITAT RCT
Study showing benefit of early IOL in preE
Severe Features
160/110 + two occasions greater than 4 hours apart.
Progressive renal insufficiency (serum Cr >1.1mg/dL, or double baseline)
Cerebral or visual disturbance
Pulmonary edema
Transaminases 2x normal, RUQ or epigastric pain
Thrombocytopenia (<100,000/ml)
Max dose IV labetolol
300mg over 24hrs
How to order Calcium Gluconate
1g IV to be administered in case of respiratory depression. Keep at bedside.
Treating severe range pressures > 15 min apart
Hydralazine 10mg over 2 min. Wait 20 min. If high, administer second dose of the same and monitor for 20 min. No effect? Change to labetolol.
Or
Labetolol 20mg iv over 2 min. Wait 10 min. Double dose to 40mg. Wait 10 min. 80mg every 10min until controlled or 300mg. If severe range still after first 80 dose, switch to hydralazine.
Nifedipine dosing for severe range pressures
10-20mg orally q30min until 40mg. Then 10-20 every 4-6 hours. Max 180mg daily
Tests if suspecting PCOS
TSH, prolactin, serum 17-hydroxy progesterone, 24 hour free cortisol level
Metformin for PCOS
weight loss through appetite suppression. Does not improve ovulation
Clomiphene vs Letrozole
Higher success of Letrozole?
Statins in pregnancy?
NO! teratogenic
PCOS on US
> 25 or String of Pearls with central clarity
Key Features of PCOS
Hyperandrogenism - acanthosis nigricans
How many months of clomid trial
3-5 months
