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CK OB > Medical Cx of Pregancy > Flashcards

Medical Cx of Pregancy Flashcards

1
Q

Adverse consequences of hypoxic heart disease include

A

miscarriage, fetal death, preterm

delivery, and increased perinatal morbidity and mortality

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2
Q

The most common acquired lesion in pregnancy is

A

rheumatic heart disease

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3
Q

The most common rheumatic heart disease is _____

A

mitral stenosis

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4
Q

The most common congenital lesions are

A

atrial (ASDs) and ventricular septal defects (VSDs).

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5
Q

The most common cyanotic congenital heart disease

in pregnancy is ________

A

tetralogy of Fallot.

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6
Q

Diseases with high Maternal MR

A

High maternal mortality (25–50% risk of death): pulmonary hypertension,
Eisenmenger’s syndrome, Marfan syndrome with aortic root >40 mm diameter, and
peripartum cardiomyopathy

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7
Q

What condition

This condition is characterized by pulmonary hypertension and a bidirectional intra-cardiac shunt.

The normal decrease in systemic vascular resistance (SVR) in pregnancy places the patient at risk for having the pulmonary vascular resistance (PVR) exceed the SVR

A

Eisenmenger syndrome

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8
Q

What condition

This is an autosomal dominant connective tissue disorder. In pregnancy, if the aortic root diameter is >40 mm, the risk of aortic dissection is high, placing the patient at a 50% mortality
risk.

A

Marfans

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9
Q

In this condition, the patient has no underlying heart disease, but develops idiopathic biventricular
cardiac decompensation between the last few weeks of pregnancy and the first few months postpartum

A

Peripartum cardiomyopathy

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10
Q

New York Heart Association (NYHA) functional classifications of heart disease in pregnancy

A
  • Class I—no signs or symptoms of cardiac decompensation with physical activity
  • Class II—no symptoms at rest, but minor limitations with activity
  • Class III—no symptoms at rest, but marked limitations with activity
  • Class IV—symptoms present at rest, increasing with any physical activity
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11
Q

General Principles in Pregnancy Management of Rheumatic Mitral Heart Disease

A
  • Minimize tachycardia.

* Minimize excessive intravascular volume.

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12
Q

Intrapartal Mx of RHD

A

Aim for vaginal delivery, left lateral rest, monitor intravascular volume, administer oxygen, reassurance, sedation, SBE prophylaxis, epidural, no pushing, elective
forceps to shorten the second stage of labor, possible arterial line and pulmonary artery catheter (if Class III or IV status).

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13
Q

Postpartum Mx of RHD

A

Watch closely for postpartum intravascular overload caused by sudden emptying of uterine venous sinuses after placental delivery

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14
Q

Increased thyroid blood flow leads to ______

Increased glomerular filtration rate (GFR) in pregnancy enhances ________

A

thyromegaly.

iodine excretion, lowering plasma iodine concentrations.

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15
Q

_____ causes an increase in liver-produced thyroid binding globulin (TBG), thus increasing total T3 and T4.However, free T3 and T4 remain unchanged

A

Estrogen

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16
Q

Fetal thyroid function begins as early as _____

A

12 weeks with minimal transfer of T3 or T4 across the placenta.

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17
Q

Cx of uncontrolled hyperthyroidism

A

it is associated with increased spontaneous abortions, prematurity, intrauterine growth retardation (IUGR), and perinatal morbidity and mortality.

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18
Q

_______ is a life-threatening hypermetabolic state presenting with pyrexia, tachycardia, and severe dehydration

A

Thyroid storm

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19
Q

This is the most common kind of hyperthyroidism in pregnancy.

A

Graves disease

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20
Q

It is mediated by autoimmune production of ________ that drives thyroid hormone production independent of thyrotropin (TSH).

A

thyrotropin-receptor antibodies

TSHR-Ab

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21
Q

TSHRAb can cross the placenta, potentially causing ________

A

fetal hyperthyroidism.

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22
Q

Dx of Graves

A

The diagnosis is confirmed by elevated free T4 and TSHR-Ab, as well as low TSH
in the presence of clinical features described above.

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23
Q

Graves

____is an FDA pregnancy category D so
should not be used in the first trimester, though it is acceptable in the second and third.

A

Methimazole

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24
Q

Graves

_______ has a risk of liver failure (rare) so it should be used only in the first trimester.

A

PTU

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25
Q

Graves

_______ is primarily indicated when antithyroid medical therapy fails and is ideally performed in the second trimester.

A

Subtotal thyroidectomy

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26
Q

Graves in Pregnancy

______ is contraindicated because it can cross the placenta, destroying the fetal thyroid.

A

Thyroid ablation with radioactive iodine (I131)

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27
Q

This condition is most commonly a primary thyroid defect and often results in anovulation
and infertility

A

Hypothyroidism

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28
Q

Management of Hypothy.

A

Increase supplemental thyroid hormone by 30% in pregnancy

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29
Q

MCC of Hypothy

A

Hashimoto’s thyroiditis

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30
Q

Cx of Hypothy

A

Anovulation, spontaneous

abortion

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31
Q

Sz rates during pregnancy

A

Up to 25% of these women will experience deterioration of seizure control during pregnancy, with 75% seeing no change.

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32
Q

T or F,

The more severe the disorder, the more likely it will worsen

A

T

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33
Q

Seizure medication clearance may be

_________

A

enhanced by higher hepatic microsomal activity, resulting in lower blood levels.

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34
Q

Effect of anticonvulsants on fetus and infant

A

Congenital malformation rate is increased from 3% to >10%.

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35
Q

Maternal phenytoin use is associated with neonatal deficiency of ________

A

vitamin K-dependent clotting factors: II, VII, IX, and X.

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36
Q

Sz DO in pregnancy

Ensure ________before conception and during embryogenesis to minimize neural tube defects.

A

extra folic acid supplementation

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37
Q

What screening to do during pregnancy

A

Anomaly screening. Offer triple-marker screen and second trimester sonography to
identify neural tube defects (NTDs) or other anomalies

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38
Q

Dx

A pregnant woman is unable to maintain fasting (FBS) or postchallenge glucose
values in the normal pregnant range before or after a standard 100-g glucose challenge.

A

DM

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39
Q

Prevalence of glucose intolerance in pregnancy is_______

A

2–3%.

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40
Q

Pathophysio of DM in pregnancy

A

Pathophysiology involves the diabetogenic

effect of human placental lactogen (hPL), placental insulinase, cortisol, and progesterone.

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41
Q

______ is juvenile onset, ketosis prone, insulin-dependent diabetes caused by pancreatic islet cell deficiency

A

Type 1 DM

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42
Q

______is adult onset, ketosis resistant, non–insulin-dependent diabetes caused by
insulin resistance

A

Type 2 DM

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43
Q

DM

Screening is performed on all pregnant women 24–28 weeks’ gestation when the
_______

A

anti-insulin effect of hPL is maximal

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44
Q

DM screening in pts with high risk

On patients with risk factors it is performed on the _______

A

first prenatal visit then repeated at 24–28 weeks if initially negative.

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45
Q

_______ of

patients with GDM can maintain glucose control with diet therapy

A

Eighty percent

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46
Q

DM

Home blood glucose monitoring. Patient checks her own blood glucose values at least
four times a day with target values of FBS _____ and 1 h after meal of ______

A

<90 mg/dL

<140 mg/dL

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47
Q

Total insulin units in pregnancy

A

actual body weight in kilograms × 0.8 (first trimester), 1.0 (second trimester), or 1.2 (third trimester)

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48
Q

How Insulin is given during pregnancy?

A

Insulin is divided with two thirds of total daily dose in morning (split into 2/3 NPH and
1/3 regular) and one third of total daily dose in evening (split into 1/2 NPH and 1/2 regular

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49
Q

T or F

Insulin is a large molecule and does not cross the placenta

A

t

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50
Q

_______ appears to cross the placenta minimally, if at all, and is being used for
patients with GDM who cannot be controlled by diet alone.

A

Glyburide

51
Q

Oral hypoglycemic agents. These were contraindicated in the past because of concern that

A

they would cross the placenta and cause fetal or neonatal hypoglycemia

52
Q

What to monitor in anterpartum for DM

A

Hemoglobin A1C
Renal status
Retinal status.
Home blood glucose monitoring

53
Q

Preconception Anomaly Prevention

  1. Anomaly risk. This risk can be minimized by ______
  2. Folate supplementation._______a day, should be started 3 months prior to
    conception
  3. Euglycemia for 3 mos
A

lifestyle modification

Folic acid, 4 mg

54
Q

Anomalies are mediated through hyperglycemia and are highest with poor glycemic control during______

A

embryogenesis

55
Q

Most common fetal anomalies with overt DM are ___________

A

NTD and congenital heart disease.

56
Q

An uncommon anomaly, but one highly specific for overt DM, is________

A

caudal regression syndrome.

57
Q

DM Dx

Obtain a ________ at 16–18 weeks to assess for NTD as well as a______ at 18–20 weeks to look for structural anomalies

A

quadruple-marker screen

targeted ultrasound

58
Q

If the glycosylated hemoglobin is elevated, order a ________ at 22–24 weeks to assess for congenital heart disease.

A

fetal echocardiogram

59
Q

Monthly sonograms will assess fetal _________ (most commonly

seen) or _____(seen with longstanding DM and vascular disease).

A

macrosomia

IUGR

60
Q

DM

Fetal surveillance. Start weekly _______ and ________ at 32 weeks if
taking insulin, macrosomia, previous stillbirth, or hypertension.

A

NSTs and amniotic fluid index (AFIs)

61
Q

Start NSTs and AFIs at

_________ if small vessel disease is present or there is poor glycemic control

A

26 weeks

62
Q

_______ is often delayed in fetuses of diabetic mothers, yet

prolonging the pregnancy may increase the risk of stillbirth

A

Fetal maturity

63
Q

The target delivery gestational age is ______ but may be necessary earlier in the presence of fetal jeopardy and poor maternal glycemic
contro

A

40 weeks,

64
Q 
The cesarean section rate in diabetic pregnancies approaches 50%
because of 
1
2
3
A

fetal macrosomia, arrest of labor, and concern regarding shoulder dystocia.

65
Q

IN GDM

Maintain maternal blood glucose levels between 80 and 100 mg/dL
using _______

A

5% dextrose in water and an insulin drip.

66
Q

Neonatal Cx of GDM

• ____ caused by persistent hyperinsulinemia from excessive prenatal transplacental
glucose.

  • _____ caused by failure to increase parathyroid hormone synthesis after birth.
  • _____ caused by elevated erythropoietin from relative intrauterine hypoxia.

• ______ caused by liver immaturity and breakdown of excessive neonatal
red blood cells (RBCs).

• ___ caused by delayed pulmonary surfactant production

A

Hypoglycemia

Hypocalcemia

Polycythemia

Hyperbilirubinemia

Respiratory distress syndrome

67
Q

Definition of anemia during pregnancy

A

A hemoglobin concentration of <10 g/dL during pregnancy or the puerperium

68
Q

Dx of IDA

A

RBCs are microcytic and hypochromic. Hemoglobin <10 g/dL, MCV <80, RDW
>15

69
Q

A pregnant woman needs 800 mg of elemental iron, of which 500
mg goes to ______ and 300 mg goes to the ________

A

expand the RBC mass

fetal-placental unit

70
Q

RF for IDA

A

Chronic bleeding, poor nutrition, and frequent pregnancies.

71
Q

Fetal effects of IDA

A

Increased IUGR and Preterm birth.

72
Q

Tx of IDA

Treatment._______
Prevention. _______

A

FeSO4 325 mg po tid.

Elemental iron 30 mg per day.

73
Q

This is a nutritional anemia resulting in decreased hemoglobin production.

A

Folate Deficiency Anemia

74
Q

This is a nutritional anemia resulting in decreased hemoglobin production.

A

Folate Deficiency Anemia (FDA)

75
Q

Folate stores in the body are usually enough for _____. Falling hemoglobin
values do not occur until complete depletion of folate stores.

A

90 days

76
Q

RF for FDA

A

Chronic hemolytic anemias (e.g., sickle cell disease), anticonvulsant use (phenytoin,
phenobarbital), and frequent pregnancies

77
Q

SSx of FDA

A

Findings may vary from none to general malaise, palpitations, and ankle edema.

78
Q

Fetal Cx of FDA

A

Increased IUGR ,Preterm birth and NTD.

79
Q

This is an inherited autosomal recessive disease resulting in normal production of abnormal globin chains

A

Sickle cell anemia

80
Q

Sickle cell anemia

These are peripheral blood tests used to detect the presence or absence of
______ They do not differentiate between disease and trait

A

hemoglobin S.

81
Q

A_______ will differentiate between SA trait (<40% hemoglobin S) or SS disease (>40% hemoglobin S).

A

hemoglobin electrophoresis

82
Q

____ and _____ descent is the only significant risk factor for sickle
cell anemi

A

African and Mediterranean

83
Q

With Sickle cell trait , the patient may have increased _______

A

urinary tract infections (UTIs) but pregnancy

outcome is not changed.

84
Q

With sickle cell disease the pregnancy may be complicated by increased

A

spontaneous abortions, IUGR, fetal deaths, and preterm delivery.

85
Q

_______ is stimulated by estrogen in genetically predisposed women in the second half of pregnancy. Risk is increased with twins

A

Intrahepatic cholestasis

86
Q

Intrahepatic Cholestasis of Pregnancy

The most significant symptom is ____

A

intractable pruritus on the palms and soles of the feet, worse at night, without specific skin findings.

87
Q

Intrahepatic Cholestasis of Pregnancy

Laboratory tests show a mild elevation of bilirubin but diagnostic findings are _____

A

serum bile acids increased 10- to 100-fold.

88
Q

Intrahepatic Cholestasis of Pregnancy

  • _____ can be helpful in mild cases.
  • _____has been used to decrease enterohepatic circulation.
A

Oral antihistamines

Cholestyramine

89
Q

Intrahepatic Cholestasis of Pregnancy

  • _____ can be helpful in mild cases.
  • _____has been used to decrease enterohepatic circulation.
A

Oral antihistamines

Cholestyramine

90
Q

Intrahepatic Cholestasis of Pregnancy

____ is the treatment of choice. Antenatal fetal testing should be initiated
at 34 weeks. Symptoms disappear after delivery.

A

Ursodeoxycholic acid

91
Q

Maternal mortality rate is 20%. It is thought to
be caused by a disordered metabolism of fatty acids by mitochondria in the fetus, caused by deficiency in the long-chain 3-hydroxyacyl-coenzyme A dehydrogenase (LCHAD) enzyme.

A

Acute Fatty Liver

92
Q

Acute Fatty Liver SSx

A

• Symptom onset is gradual, with nonspecific flulike symptoms including nausea,
vomiting, anorexia, and epigastric pain.

• Jaundice and fever may occur in as many as 70% of patients.

93
Q

What are the unique Sx of Acute Fatty Liver

A

Hypoglycemia and increased serum ammonia are unique laboratory abnormalities.

94
Q

UTI

The most common organisms are

A

gram-negative enteric bacteria with Escherichia coli the most frequent.

95
Q

If not treated, 30% of cases will develop acute pyelonephritis

A

Asymptomatic Bacteriuria

96
Q

Dx of Asymptomatic Bacteriuria

A

Made with a positive urine culture showing >100K colony-forming units (CFU) of
a single organism

97
Q

Urgency, frequency, and burning are common.

If not treated, 30% of cases will develop acute pyelonephritis.

A

Acute Cystitis

98
Q

Dx of Acute Cystitis

A

Made with a positive urine culture showing >100 K CFU of a single organism.

99
Q

This is a UTI involving the upper urinary tract with systemic findings. This is one of the most common serious medical complications of pregnancy.

A

Acute Pyelonephritis

100
Q

Acute Pyelonephritis Cx

A

Confirmed with a positive urine culture showing >100 K CFU of a single organism

101
Q

The thrombophilias are a group of disorders that promote blood clotting,
because of either ______ or ______

A

an excess of clotting factors or a deficiency of anticlotting proteins that
limit clot formation

102
Q

More than half of pregnant women who develop a pulmonary embolus or other VTE
have an underlying_______

A

thrombophilia

103
Q

Inherited thrombophilias to test for:

A 
Factor V Leiden (FVL) mutation, prothrombin
gene mutation (PGM) G2021 OA, protein C deficiency (PCD), protein S deficiency
(PSD), antithrombin deficiency (ATD)
104
Q

One or more of the following 3 antiphospholipid antibodies must be positive on ≥2 occasions at least 12 weeks apart.
1
2
3

A

– Lupus anticoagulant
– Anticardiolipin antibody (lgG & IgM)
– Anti-b2-glycoprotein 1 (lgG & IgM)

105
Q

VTE

Disadvantage of Unfractionated heparin (

A

cannot use orally, short half-life, needs monitoring with aPTT levels, heparin-induced osteopenia, heparin-induced thrombocytopenia (HIT)

106
Q

VTE

• Low molecular weight heparin (LMWH) can be used antepartum & postpartum
– Advantages: _________

A

longer half-life, less need for monitoring with antifactor Xa levels

107
Q

Advantages and disadv of Warfarin

A

– Advantages: oral administration, long half-life, inexpensive, OK for breast feeding
– Disadvantages: crosses placenta, needs monitoring with INR

108
Q

Mx of VTE

Use_______ from first trimester to 36 weeks; then at 36 weeks transition to
______ until delivery

A

LMWH

UFH

109
Q

Whom to give Prophylactic or intermediate-dose for VTE

A
  • Low-risk thrombophilia with single VTE episode

* High-risk thrombophilia without VTE episode

110
Q

Whom to give Therapeutic dose for VTE

A
  • High-risk thrombophilia with single VTE episode

* Any thrombophilia with VTE in current pregnancy

111
Q

MX of VTE Intrapartum

A

• Discontinue UFH during immediate peripartum interval to decrease risk of hemorrhage
and permit regional anesthesia
• Protamine sulfate can be used to reverse UFH effect

112
Q

VTE risk increased _______in the first week postpartum

A

20-fold

113
Q

VTE Tx

Resume anticoagulation______ after vaginal delivery and ____ after cesarean section

A

6 hours

12 hours

114
Q

Clinical Criteria for Diagnosis / Indications for Laboratory testing for APAS

A

• Vascular thrombosis: 1 or more clinical thrombotic episodes (arterial, venous, or
small vessel)

• Pregnancy morbidity (unexplained): fetal demise: 1 or more at ≥10 weeks; consecutive
miscarriages: 3 or more at <10 weeks

115
Q

Laboratory criteria: 1 or more of the following 3 anti-phospholipid antibodies must be positive on ≥2 occasions at least 12 weeks apart.

A
  • Lupus anticoagulant
  • Anticardiolipin antibody (lgG & IgM)
  • Anti-132-glycoprotein I (lgG & IgM)
116
Q

Antepartum anticoagulation in APAS

A
  • APS without a thrombotic event: no heparin or only prophylactic heparin
  • APS with a thrombotic event: prophylactic heparin
117
Q

The mediating factor is frequently endothelial injury from traumatic delivery or cesarean
section.

A

THROMBOEMBOLISM

118
Q

THROMBOEMBOLISM

Enhanced blood coagulability in pregnancy is due to increased factors________

A

II, VII, VIII, IX, and X.

119
Q

Symptoms include localized pain and sensitivity. Signs include erythema,
tenderness, and swelling. Diagnosis is one of exclusion after ruling out DVT

A

Superficial Thrombophlebitis

120
Q

T or F

Superficial thrombophlebitis does not predispose to thromboembolism but may mimic moresevere disease

A

T

121
Q

DVT Tx

A

Treatment is full anticoagulation with IV heparin to increase PTT by 1.5 to 2.5 times the control value

122
Q

DVT

No ______ is used antepartum because of teratogenicity concerns with the fetus. Thrombophilia workup should be performed.

A

warfarin

123
Q

____ is a potentially fatal result of DVT in which emboli travel through the venous system to
the lungs

A

PE

124
Q

_______ is the

most definitive diagnostic method for DVT

A

Pulmonary angiography

CK OB (15 decks)

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