Medical Disorders in Pregnancy

Question 1

Pulmonary - Asthma

goal

Answer 1

• Ultimate goal of asthma therapy in pregnancy is maintaining adequate oxygenation of the fetus by preventing hypoxic epidosdes in mother
  > animal dander
  > house dust mites
  > pollens
  > molds
  > tobacco smoke
  > food additives
  > certain drugs
• Affects 4-8% of all pregnancies

Question 2

Pulmonary - Asthma

care considerations

Answer 2

• Pulse ox during labor
• Epidural anesthesia
  > dcr incident of hyperventilation
• Fentanyl & Stadol are safer choices for systemic analgesia
• At incrd risk for pp hemorrhage
  > due to affected clotting factors
  > avoid carboprost (Hemabatel), ergonovine, methylergonovine (Methergine), Terbutaline: can cause bronchoconstriction
• Asthma meds should be continued through pregnancy and postpartum

Question 3

Integumentary - Disorders Induced by Pregnancy

normal changes

Answer 3

• Melasma (chloasma)
• Vascular “spiders”
• Palmar erythema
  > red hands
• Striae Gravidarum
  > stretch marks
• Pruritic utricarial papules & plaques of pregnancy (PUPPs)
  > lesions that itch/spread all over body
  > resolves before/after birth

Question 4

Integumentary - Disorders Aggravated by Pregnancy

Answer 4

• Acne vulgaris
  > in 1st tri
• Intrahepatic Cholestasis
  > generalized pruritus (ithcing) in 3rd tri
  > commonly affects palms & soles
  > no skin lesions; bile salts under skin
  > elevated liver function tests, jaundice, & dark urine
  > high chance of stillbirth