Medical Conditions in Pregnancy Flashcards
Can you palpate a DVT?
No
-but you can palpate superificial thrombophlebitis
What value for glucose is abnormal?
-130-140
Risk factors for development of GDM?
- obesity
- previous GDM
- Strong family hx of DM
- know glc intolerance
Maternal complications of GDM?
- increased risk of gestational htn
- increased risk of preeclampsia
- greater risk of cesarean delivery
- increase risk of developing diabetes later in life
Fetal complications of GDM?
- Macrosomia
- neonatal hypoglycemia
- hyperbilirubinemia
- operative delivery
- shoulder dystocia
- birth trauma
will DM increase the risk of spontaneous abortions?
-yes
When is the baby recommended for a cesarean delivery?
-if weight is greater than 4500 gm
What drops significantly after the delivery of placenta?
-insulin
Maternal hyperthyroidism, how is the diagnosis made?
-elevated free T4 and suppressed TSH
What is the treatment for maternal hyperthyroidism?
- PTU
- methimazole
When do we give methimazole?
-2nd 3rd trimester
When is PTU used?
-increased risk of liver toxicity so only used in 1st trimester
Thyroid storm
- hyperthermia
- tachycardia
- perspiration
- high output cardiac failure
tx of thyroid storm?
- B blockers: propanolol
- block secretion of thyroid hormone: Na I
- stop synth of Thyroid hormone: PTU
- Halting peripheral conversion of T4-T3: dexamethasone
- Replacing fluid losses
- bring temperature down
Hypothyroidism tx
- thyroid replacement: levothyroxine
- monitor TSH and free T3/4 levels monthly
What is neonatal thyrotoxicosis?
-transplacental transfer of thyroid stimulating antibodies
causes of neonatal ypothyroidism?
- thyroid dysgenesis
- inborn errors of thyroid function
- drug induced
What is the most common lesion for rheumatic heart disease?
-mitral stenosis
What is a contraindication to pregnancy due to decompensation during pregnancy and a high mortality rate?
- primary pulmonary hypertension
- epidural anesthesia is preferred and vaginal delivery may be an option for these patients
What is the most common cardiac arrhythmia with preggo ppl?
- supraventricular tachycardia
- usually benign
What develops within last weeks of pregnancy or within 6 months postpartum
- women with preeclamsia, htn, and poor nutrition are at risk for developing
- mortality rate is about 10%?
-postpartum cardiomyopathy
Who should all pregnant cardiac patients be co-managed with?
- a cardiologist
- fetus will need ECG
How should cardiac patients be delivered?
- vaginally
- unless there are obstetric indications
- Ab prophylaxis for endocarditis in high risk patients
What is Immune idiopathic Thrombocytopenia
- Ig’s attach to maternal platelets
- can be confused with gestational thrombocytopenia
Tx of IIT?
- begun after platelets drop 50,000
- prednisone
- IV Ig if severe
- Platelet transfusion
- Splenectomy
- neonatal thrombocytopenia can occur due to placental transfer of antiplatelet antibodies
SLE
-flared are treated with prednisone
-preterm delivery
-fetal growth restrictions
-stillbirth
-miscarriage
-
Antiphospholipid syndrome
- presence of lupus anticoagulant and or anticardiolipin antibody
- may coexist with SLE
- associated with arterial or venous thrombosis
- pregnancy complications: miscarriage, preeclampsia, fetal growth restriction
Tx of antiphospholipid syndrome?
- treat during preggo with heparin.low molecular weight heparin and low-dose aspirin
- if hx of thrombosis: full anticoagulation
Acute Renal Failure ARF
- due to preexisting renal disease or pregnancy induced
- three types: Prerenal, renal, postrenal
how do you treat ARF?
- prerenal: restore volume
- renal: treatment is directed at preventing further damage
- postrenal: remove the obstruction
What is a worsening prognosis thing for Chronic renal failure?
-serum creatinine greater than 1.5-2
What is the most common organism for asymptomatic bacteriuria?
-E. Coli
Pyelonephritis
- fever, CVA tenerness, malaise
- elevated WBC and abnormal urinalysis
- 20% of these patients have increased uterine activity and preterm labor
- can result in adult respiratory distress syndrome
Tx of pyelonephritis?
- IV hydration
- abx
- antipyretics
- tocolytics if needed
- will need suppression for remainder of preggo
What is a common GI thing for Preggo ppl?
-GERD
Mendelson’s syndrome
- acid aspiration syndrome
- preggo women at greater risk due to delayed gastric emptying and increased intraabdominal/intragastric pressure
- can result in adult resp syndrome
Tx of mendelson’s syndrome?
- supplemental O2
- maintain airway
- tx for acute respiratory failure
Inflammatory bowel disease
- they usually do well in preggo
- can increase miscarriage risk if bowel disease is active at time of conception
Tx of IBD?
-treat acute exacerbation… same as non preggo
Intrahepatic Cholestasis of pregnancy (ICP)
- cholestasis and pruritis in second half of preggo not associated with liver enzyme elevations
- itching without abdominal pain or rash
- abs reveal elevated serum bile acids
Tx of ICP
- local tx- cold baths, bicarb washes
- use of ursodeoxycholic acid
- fetal surveillance and delivery at early term
Acute fatty liver of pregnancy
- scary…
- diffuse fatty infiltration of liver resulting in hepatic failure
- jaundice….
- increased PT and PTT
- elevated bilirubin
- ammonia and uric acid
Tx of acute fatty liver of pregnancy?
- termination of pregnancy
- supportive care
- people die
- but if they survive, usually full recovery
Anemia
- physiologic decrease in HgB/hematocrit during pregnancy
- hematocrit less than 30% or a HgB concentration < 10
- most common reason is iron deficiency
Is pregnancy a hypercoagulable state?
-yes, upt o 5 fold increase in venous thrombosis and the greatest risk is the first 5 weeks postpartum
superficial thrombophlebitis
- most common in pts with varicose veins, obesity, and little physical activity
- limited to calf, will not turn into PE
- swelling and tenderness
tx of superficial thrombophlebitis
- Bed rest
- pain medication
- local heat
- no need for anticoagulants
- wear support hose
DVT
- more common in left leg than right
- pain in calf with dorsiflexion (homan’s sign)
- may also have dull ache, tingling, or pain with walking
tx of DVT
-low molecular weight or unfractionated heparin
Pulmonary embolism
- 70% of the time, DVT is instigating factor
- accentuated pulmonic valve second heart sound
Tx of PE
-anticoagulation
what do patients with a DVT or PE require?
- a thrombophilia work-up
- all patients with history of Thromboembolism will need prohpylactic anticoagulant therapy
What is the most common pulmonary disease in pregnancy?
- asthma
- tx is same is with non preggo ppl
What is the most common type of Headache and what do we treat it with?
- tension headache
- treat with acetaminophen
What kind of headache happens more in childbearing years?
- migraines
- usually improve during preggo
- neurology can be helpful in tx
Multiple sclerosis
- most common at age 30
- usually experience fewer and less evere episodes
- may exacerbate postpartum
- increased risk of lower birth rate infants
- increased risk of cesarean delivery
Does seizure frequency alter in pregnancy?
-no
What seizure med should not be used because it is more teratogenic that other antiepileptics?
-Valproate
What are the most commonly used meds for seizures?
-dilantin and phenobarbital
if a woman gets depression with preggo, when should we avoid antidepressants?
-the first trimester
why is post partum depression so common? 70-80%!!
- usually due to hormonal fluctuations
- raises concern if persists after the first 2 weeks
- younger women at greater risk
- severest form- postpartum psychosis
