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R2F > Medical Conditions in Pregnancy > Flashcards

Medical Conditions in Pregnancy Flashcards

1
Q

Gestational Diabetes- screening

A
  • 50 gm 1 hr oral load glucose challenge (>130-140 abnormal)

- if abnormal- 3 hr 100 gm oral load gluc tolerance test

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2
Q

risk factors for GDM

A
  • obesity
  • prev hx of GDM
  • strong FH of DM
  • known glucose intolerance
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3
Q

GDM- maternal complications

A
  • gestational HTN
  • preeclampsia
  • C-delivery
  • developing diabetes later in life
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4
Q

GDM- fetal comlications

A
  • macrosomia!! (> 4000 gms)
  • hypoglycemia
  • hyperbilirubinemia
  • operative delivery
  • shoulder dystocia!!!
  • birth trauma
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5
Q

GDM pt- should deliver when?

A

b/w 39-40 wks

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6
Q

Pregestational diabetes- maternal complications

A
  • worsening nephropathy and retinopathy
  • preeclampsia
  • DKA
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7
Q

Pregestational diabetes- fetal complications

A
  • spontaneous abortions
  • anatomic birth defects (birth defects assoc with inc HgBA1C in period of embryogenesis)
  • fetal growth restriction
  • prematurity
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8
Q

diabetes- management

A

diet, oral hypoglycemic medications (glyburide), insulin, exercise
-good glycemic control- fasting < 90, 2 hr postprandial < 120

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9
Q

Pregestational diabetes- maternal evaluation

A
  • renal- 24 h urine collections
  • cardiac- EKG
  • eye exam in 1st trimester
  • glycemic control
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10
Q

Pregestational diabetes- fetal evaluation

A
  • US
  • fetal echocardiogram
  • congenital malformations- biochemical testing
  • fetal growth US every 2-4 wks
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11
Q

postpartum management of diabetes

A
  • insulin dep pts need 2/3 of pregnancy dose of insulin
  • GDM freq dont need further tx
  • GDM- need fasting blood gluc or 2 hr glucose tolerance 6-12 wks postpartum
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12
Q

maternal hyperthyroidism- tx

A
  • PTU- 1st trimester

- methimazole- 2-3 trimester

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13
Q

maternal hyperthyroidism- fetal effects

A

-meds can cross placenta- fetal hypothyroidism and fetal goiter can develop

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14
Q

thyroid storm

A
  • triggers- infection, labor, c-delivery

- hyperthermia, tachycardia, perspiration, high output cardiac failure, maternal mortality of 25%

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15
Q

thyroid storm- tx

A
  • B-blockers- propranolol
  • sodium iodide
  • PTU
  • dexamethasone
  • replace fluid losses
  • bring T down
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16
Q

Hypothyroidism- if untreated, inc risk of?

A
  • sp abortion
  • preeclampsia
  • abruption
  • low birth weight infants
  • stillbirth
  • lower intelligence levels
17
Q

hypothyroidism- tx

A

-thyroid replacement

18
Q

neonatal thyrotoxicosis

A
  • due to transplacental transfer of thyroid stim ab’s
  • transient
  • mortality rate 16%
19
Q

neonatal hypothyroidism

A
  • causes developmental retardation

- caused by- thyroid dysgenesis, inborn errors of thyroid fxn, drug induced

20
Q

Rheumatic HD

A
  • mitral stenosis!!!

- high risk of HF, subacute bacterial endocarditis, thromboembolic dz

21
Q

Cardiac arrhthmias

A

SVT!

-benign and assoc with overly strenuous exercise

22
Q

postpartum cardiomyopathy

A
  • develops within last wks of pregnancy or 6 months postpartum
  • at risk- women with preeclampsia, HTN, poor nutrition
  • mortality rate 10%
23
Q

all pregnant cardiac pts should be?

A

comanaged with a cardiologist!!!

24
Q

Immune Idiopathic Thrombocytopenia

A
  • Igs attached to maternal platelets

- tx- when plts < 50,000- prednisone, IVIG, plt transfusion, splenectomy

25
Q

SLE

A
  • flares tx with prednisone

- fetal complications- preterm delivery, fetal growth restrictions, stillbirth, miscarriage

26
Q

N/V of pregnancy

A

(50-80% of women complain of during first 8-12 wks)

27
Q

Hyperemesis gravidarum

A

(1-2%)

  • persistent N/V assoc with > 5% loss of prepregnancy wt, ketonuria, dehydration
  • cause unknown
28
Q

GERD

A

70% of pregnant women)

-small meals, avoid lying down after meals, elevate head when sleeping, antacids, H2 blockers/PPIs

29
Q

Superficial thrombophlebitis

A
  • palpable cord in calf- superficial!
  • swelling, tenderness
  • tx- bed rest, pain med, local heat wear support hose; dont need anticoagulants!!
30
Q

DVT

A

-left leg- pain in calf with dorsiflexion (50% asx)
-US with doppler flow
-tx- anticoag tx- LMW (lovenox) or unfractionated heparin
-follow aPTT values (heparin), factor Xa values (lovenox)
have to avoid estrogen for contraception

31
Q

PE- sx’s

A
  • pleuritic chest pain, shortness of air, air hunger, palpitations, hemoptysis
  • tachypnea, tachycardia, low grade fever, pleural friction
32
Q

PE- evaluation, tx

A
  • EKG, chest Xray, ABG, VQ, CT
  • anticoag
  • *require a thrombophilia work-up!!!
33
Q

asthma

A

(3-9%)

-assoc with inc miscarriage, preeclampsia, intrauterine fetal demise, fetal growth restriction, preterm delivery

34
Q

postpartum depression

A

(10-15 %)

-> first 2 wks postpartum

R2F (18 decks)

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