Medical Conditions in Pregnancy (Wootton) Flashcards
Screening for Gestational Diabetes is done between weeks __1__.
50 gm one hour oral load glucose challenge test are considered abnormal if values are greater than a range of __2__.
1) 24-28
2) 130-140
What are some maternal complications associated with Gestational Diabetes?
1) Increased risk of gestational hypertension
2) Increased risk of preeclampsia
3) Greater risk of cesarean delivery
4) Increase risk of developing diabetes later in life
What are some fetal complications associated with Gestational Diabetes?
1) Macrosomia
2) Neonatal hypoglycemia
3) Hyperbilirubinemia
There is a direct link between birth defects and increasing ____ levels in the period of embryogenesis, sixfold increase risk of congenital anomalies.
Glycosylated hemoglobin levels (HgBA1C)
There are 2 classes of gestational diabetes:
Class A1: gestational diabetes is __1__ controlled.
Class A2: gestational diabetes is __2__ controlled .
1) Diet
2) Insulin or oral meds
In the management of diabetes, good glycemic control is determined by fasting levels less than __1__ mg/dL.
Along with two hour postprandial levels less than __2__ mg/dL.
1) 95 mg/dL
2) 120 mg/dL
Delivery options depends on estimated fetal weight and glycemic control, at what estimated fetal weight is C-section chosen?
Greater than 4500 gm
Maternal hyperthyroidism diagnosis is made by elevated__1__ and suppressed __2__.
1) Free T4
2) TSH
In the treatment of maternal hyperthyroidism, what is contraindicated?
Radioactive iodine
In the treatment of maternal hyperthyroidism, __1__ is used in 2nd and 3rd trimester (can cause aplasia cutis and choanal atresia in 1st trimester).
__2__ increases risk of liver toxicity so only used in 1st trimester.
1) Methimazole
2) Propylthiouracil (PTU)
____ can occur due to infection, labor, cesarean delivery and noncompliance with medication with signs/symptoms of hyperthermia, tachycardia, perspiration, and high output cardiac failure.
Thyroid storm
What beta blocker is used to treat thyroid storm?
What is used to block the secretion of thyroid hormones?
What is used to stop synthesis of thyroid hormones?
What is used to halt peripheral conversion of T4 to T3?
1) Propranolol
2) Sodium iodide
3) PTU
4) Dexamethasone
If ____ is treated appropriately anticipate normal pregnancy outcome. However if untreated it can increase the risk of spontaneous abortion, preeclampsia, abruption, low birth weight infants, stillbirth, or lower intelligence levels.
Hypothyroidism
You want to treat Hypothyroidism with thyroid replacement such as?
Levothyroxine
What is due to transplacental transfer of thyroid
stimulating antibodies and is transient (lasting 2-3 months)?
Neonatal thyrotoxicosis
Neonatal hypothyroidism due to thyroid dysgenesis, inborn errors of thyroid function, or drug induced can result in generalized ____.
Developmental retardation
__1__ disease has a high risk of developing heart failure, subacute bacterial endocarditis and thromboembolic disease.
__2__ is the most common lesion is.
1) Rheumatic heart disease
2) Mitral stenosis
Atrial and ventricular septal defects, primary pulmonary hypertension, tetralogy of Fallot, and transposition of the great vessels are all examples of?
Congenital heart disease
Primary pulmonary hypertension is a contraindication
to pregnancy due to decompensation during pregnancy and a high mortality rate, __1__ anesthesia is preferred and __2__ delivery may be an option for these patients.
1) Epidural
2) Vaginal
What are the most frequent cardiac arrhythmias seen and are usually benign?
What arrhythmia is more worrisome for underlying cardiac disease?
1) Supraventricular tachycardia
2) Atrial fibrillation/flutter
__1__ develops typically within last weeks of pregnancy or within 6 months postpartum and women with preeclampsia, hypertension, and poor nutrition are at risk for developing.
The mortality rate is about __2__ percent.
1) Postpartum cardiomyopathy
2) 10%
All pregnant cardiac patients should be on a __1__ diet.
Encourage rest in the __2__ position.
1) Low sodium
2) Left lateral
What condition is characterized by immunoglobulins attaching to maternal platelets?
Immune Idiopathic Thrombocytopenia
What steroid is given for Immune Idiopathic Thrombocytopenia treatment?
Prednisone
Preterm delivery, fetal growth restrictions, stillbirth, and miscarriage are all fetal complications of what autoimmune disorder?
SLE
Treat the SLE flares with?
Prednisone
There is a 10% risk for neonatal lupus-passive transfer of __1__ or __1__.
anti-Ro/SSA or anti-La/SSB
The presence of lupus anticoagulant and or anticardiolipin antibody is diagnostic of?
Antiphospholipid Syndrome
With antiphospholipid syndrome there is an increased risk of developing?
Preeclampsia
Treated antiphospholipid syndrome during pregnancy with __1__ and __2__.
1) Heparin/low molecular weight heparin
2) Low-dose aspirin
Acute Renal Failure is due to preexisting renal disease or pregnancy induced and there are three types of it.
Which type is seen with acute blood or fluid loss?
Which type is there usually a preexisting disease (lupus nephritis) or hypercoagulable state?
Which type is there rare, urologic obstructive lesions such as kidney stones?
1) Pre-renal
2) Renal
3) Post-renal
Using different mechanics to remove the obstruction such as a urethral catheter is the treatment for which type of Acute Renal Failure?
Treatment such as diuretic therapy and hemodialysis is directed at preventing further damage for which type of Acute Renal Failure?
Volume restoration is the treatment for which type of Acute Renal Failure?
1) Post-renal
2) Renal
3) Pre-renal
Chronic Renal Failure with serum ____ greater the 1.5 to 2 worsens the prognosis.
Creatinine
__1__ is more e likely to lead to cystitis and pyelonephritis in pregnant women.
__2__ is the most common cause.
1) Asymptomatic bacteriuria
2) E. coli
Fever, costovertebral tenderness, malaise, elevated WBC is the presentation of __1__.
20% of these patients have increased __2__ activity and can result in __3__.
1) Pyelonephritis
2) Uterine
3) Preterm labor
What do 50-80% of women complain of during the first 8-12 weeks of pregnancy and is treated with vitamin B6, doxylamine, and promethazine?
Nausea and vomiting
Persistent nausea and vomiting associated with >5% loss of pre-pregnancy weight, ketonuria, and dehydration is characteristic of?
Hyperemesis gravidarum
What GI condition occurs in 70% of pregnant women and treatment involves small meals, avoiding lying down after meals, elevate head when sleeping, antacids, and H2 blockers?
Reflux Esophagitis (GERD)
What GI condition may pregnancy actually improve the condition of?
Antibiotic therapy is targeted at?
1) Peptic ulcer
2) H. pylori
Pregnant women with ____ syndrome are at greater risk due to delayed gastric emptying and increased intraabdominal/intragastric pressure which can result in adult respiratory syndrome.
Mendelson’s Syndrome aka acid aspiration syndrome
There can be increase ____ risk if Inflammatory Bowel Diseases (Crohn’s disease and ulcerative colitis) is active at the time of conception.
Miscarriage
Cholestasis and pruritis in second half of pregnancy along with an increased risk of meconium stained amniotic fluid and fetal demise is characteristic of?
Intrahepatic Cholestasis of pregnancy
With Intrahepatic Cholestasis of pregnancy what is a common presentation?
Labs reveal what serum levels to be elevated?
1) Itching without abdominal pain or rash
2) Bile acids
__1__ is an obstetric emergency characterized by maternal liver dysfunction and/or failure that can lead to maternal and fetal complications, including death.
__2__ must be done in order to save the mothers life.
1) Acute fatty liver of pregnancy
2) Termination of pregnancy
The most common reason for anemia in pregnancy is?
Iron deficiency
Because pregnancy is a hypercoagulable state there is up to 5 fold increase in ____ and the greatest risk is the first 5 weeks postpartum.
Venous thrombosis
What thromboembolic disorder is most common in patients with varicose veins, obesity and little physical activity and are most common in calf, will not result in pulmonary emboli?
Superficial thrombophlebitis
What thromboembolic disorder presents with pain the calf with dorsiflexion and is more common in the left leg than the right and it has incidence of 1 in 2000 patients antepartum and 1 in 700 postpartum?
Deep venous thrombosis (DVT)
____ therapy for DVT is used for 6 weeks postpartum but not during pregnancy due to risk of fetal hemorrhage or teratogenesis.
Coumadin
What complication of DVT can lead to maternal mortality?
Pulmonary Embolism
What is the most common pulmonary disease in pregnancy?
Asthma
What is the most common type of headache for pregnant women?
Treat with?
1) Tension type
2) Acetaminophen
What neurologic disorder most often improve during pregnancy?
Migraines
The episodes of Multiple sclerosis are __1__ during pregnancy.
They may __2__ postpartum.
1) Fewer and less severe
2) Exacerbate
__1__ should not be used during pregnancy as it is more teratogenic than other antiepileptics.
Most commonly used medications are __2__ and __2__.
1) Valproate
2) Lamotrigine and levetiracetam
Women on anti-epileptics should be on 0.4 mg of ____ per day before and during pregnancy.
Folic acid
The use of antidepressants should try to be avoided in the ___ trimester.
First
The diagnosis of baby blues is changed to postpartum depression after ___ weeks.
Two weeks
