Medical Conditions in Pregnancy Flashcards
gestational DM screening
24-28 weeks
50 mg one hour oral glucose challenge
> 130 is abnormal
risk factors for gestational DM
obesity previous gestational DM fam hx of DM known glucose intolerance advanced age
maternal complications of GDM
gestational HTN
preeclampsia
C-section delivery
DM later in life
fetal complications of GDM
macrosomia neonatal hypoglycemia hyperbilirubinemia operative delivery shoulder dystocia birth trauma stillbirth
GDM management
blood glucose monitoring
diabetic teaching
diet control vs medication tx
increase exercise
maternal evaluation for GDM
urine every trimester
EKG
eye exam in 1st trimester
daily glycemic monitoring
fetal evaluation for GDM
early dating US
fetal EKG
biochemical testing for congenital malformations
fetal US every 3-4 weeks starting at 28 weeks
fetal testing every week starting at 32 weeks
maternal hyperthyroidism
dx made by elevated T4 and suppressed TSH
tx for maternal hyperthyroidism
propylthiouracil in 1st trimester
methimazole in 2nd and 3rd trimester
fetal effects of maternal hyperthyroidism
fetal hypothyroidism goiter prematurity growth restriction stillbirth
thyroid storm triggers
infection
noncompliance with meds
*labor
*C-section
thyroid storm sx
hyperthermia
tachycardia
perspiration
high output cardiac failure
thyroid storm tx
beta-blockers propylthiouracil dexamethasone IVFs antipyretics
risks of untreated maternal hypothyroidism
spontaneous abortion preeclampsia abruption low birth weight stillbirth cretinism
maternal hypothyroidism management
levothyroxine
monthly TSH and T3/T4 monitoring
neonatal thyrotoxicosis
due to transplacental transfer of thyroid-stimulating Abs
16% mortality rate
neonatal hypothyroidism causes
thyroid dysgenesis
inborn errors of thyroid function
drug-induced
postpartum cardiomyopathy
develops within the last weeks of pregnancy or within 6 months of postpartum
risk factors for developing postpartum cardiomyopathy
preeclampsia
HTN
poor nutrition
pregnancy with underlying cardiac dz management
co-management with cardiologist avoid excess weight gain and edema avoid strenuous activity prevent anemia avoid infection anticoagulation prn maternal and fetal EKGs maternal ECHO
immune idiopathic thrombocytopenia
immunoglobulins attach to maternal platelets
tx: prednisone IVIg platelet transfusion splenectomy
SLE flare tx while pregnant
prednisone
fetal complications of SLE
preterm delivery
fetal growth restrictions
stillbirth
miscarriage
antiphospholipid syndrome tx during pregnancy
heparin and low-dose ASA
full coagulation if hx of thrombosis
acute renal failure management
labs - urine, creatinine, etc
cardiovascular studies
urologic studies
acute renal failure tx
pre-renal: fluid replacement
renal: diuretic or hemodialysis
post-renal: remove obstruction
is it recommended to get pregnant post-renal transplant?
nah
causes of asymptomatic bacteriuria
urinary stasis and glucosuria
tx: abx
pyelonephritis risks
may cause increased uterine activity and preterm labor
pyelonephritis tx
IVFs
abx
antipyretics
tocolytics prn
tx for nausea and vomiting of pregnancy
Vit B6
doxylamine
promethazine
hyperemesis gravidarum
persistent N/V associated with >5% loss of pre-pregnancy weight, ketonuria, and dehydration
unknown cause
hyperemesis gravidarum tx
OP management as tolerated
may need hospitalization for IVFs, glucose, vitamins, etc.
if severe - nasogastric feeding or parental nutrition
GERD tx
small meals avoid lying down after meals elevate head when sleeping antacids H2 blockers/PPIs
peptic ulcer tx
avoid caffeine, alcohol, tobacco and spicy foods
antacids, H2 blockers/PPIs
abx for H. pylori
Mendelson’s syndrome
acid aspiration syndrome
due to delayed gastric emptying and increased pressure
Mendelson’s syndrome prevention
decrease acid in stomach
do not feed in labor
Mendelson’s syndrome tx
O2
maintain airway
watch for ARDS
intrahepatic cholestasis of pregnancy (ICP)
cholestasis and pruritis in second half of pregnancy
benign course for mom
increased risk of meconium and fetal demise
ICP tx
cold baths and bicarbonate washes
ursodeoxycholic acid
fetal surveillance
possible early fetal delivery
acute fatty liver of pregnancy
hepatic failure due to an unknown cause
acute fatty liver of pregnancy tx
pregnancy termination
supportive care
anemia of pregnancy
secondary to iron deficiency
hgb < 11 in 1st trimester
hgb < 10.5 in 2nd and 3rd trimester
anemia tx
iron supplementation
why are pregnant women at increased risk for DVT and PE?
pregnancy is a hypercoagulable state
5 fold increased risk for DVT
when are pregnant women at the greatest risk for DVT?
first 5 weeks postpartum
DVT tx
lovenox or heparin
no coumadin during pregnancy!!
most common pulmonary dz of pregnancy
asthma
tx same as non-pregnant
which antiepileptics should absolutely not be used in pregnancy?
valproic acid, phenytoin or phenobarbital
*technically all anti-epileptics are teratogenic BUT these 3 are the worst
risk factors for postpartum depression
personal or fam hx of depression
hx of abuse
drug abuse
hx of personality disorder
depression tx during pregnancy
avoid antidepressants during 1st trimester if possible
Lol I’m fucked
incidence of postpartum blues
70-80%
due to hormone fluctuations
incidence of postpartum depression
10-15%
