Medical/Surgical Complications in Pregnancy Flashcards
What complications are of most concern for planned pregnancy with history of T1DM?
In women with insulin-dependent diabetes, the rates of spontaneous abortion and major congenital malformations are both increased; risk related to metabolic control in first trimester; increased risk for fetal growth restriction, although fetal macrosomia may occur; also risk for polyhydramnios, congenital malformations, preterm birth, hypertensive complications
Why are ACE inhibitors contraindicated in pregnancy?
angiotensin converting enzymes, such as lisinopril, beyond the first trimester have been associated with oligohydramnios, fetal growth restriction neonatal renal failure, hypotension, pulmonary hypoplasia, joint contractures and death
What treatment should be given to women with HIV to reduce risk of transmission to newborn?
antiretroviral therapy should be offered regardless of CD4 or viral load. transmission rate can be reduced from 24 to 2% with HAART(highly active antiretroviral therapy) protocol antepartum and continuing through delivery with IV zidovudine in labor and zidovudine treatment for the neonate; C section can reduce transmission in women with viral loads >1000 copies
What is the most common cause of sepsis in pregnancy?
Pyelonephritis
How do you manage asthma in pregnancy?
asthma worsens in 40% of pregnant patients; indication for moving to next line of treatment in addition to albuterol includes need to use beta agonist more than twice a week. Appropriate choice would be inhaled corticosteroids or cromolyn and theophylline in refractory patients. SubQ terbutaline and systemic corticosteroids in acute cases
How do you treat maternal thyroid storm?
Acute treatment my include thioamides(PTU), propranolol, sodium iodide and dexamethasone. Oxygen, digitalis and antipyretics may also be indicated; maternal mortality with thyroid storm exceeds 25%
What thyroid treatment is contraindicated in pregnancy?
Radioactive iodine(I-131) concentrates in fetal thyroid can cause congenital hypothyroidism
Why is doxycycline contraindicated in pregnancy?
it can complicate tooth formation and cause permanent discoloration
How do you treat syphilis in pregnancy with a penicillin allergy?
Transmission rates for primary and secondary disease are 50-80%; women with penicillin allergy can be skin tested to confirm risk of IgE mediated anaphylaxis; if skin test reactive penicillin desensitization is recommended and is followed by IM benzathine penicillin G treatment; erythromycin has 11% failure rate
How do you screen for gestational diabetes?
performed between 24-28 weeks in women who dont have risk factors for T2DM or gestational diabetes; women with risk for T2DM or glucose intolerance can be screened at first visit. Two steps: 50g oral glucose challenge followed by diagnostic 100g oral glucose tolerance test if initial results exceed predetermined plasma glucose concentration. 75g 2 hour OGTT can be used as a one step approach and is screening/diagnostic
How is bacterial vaginosis treated in pregnancy?
oral metronidazole(500mg BID for 7 days) or clindamycin. Treatment should not be delayed because treatment can reduce incidence of preterm delivery.
What are the risks for pregnant pt with pulmonary hypertension?
25-50% risk of death during pregnancy; women are at greatest risk when there is diminished venous return and right ventricular filling; similar mortality rates in aortic coarctation with valve involvement and Marfan syndrome with aortic involvement
What signs and symptoms can be seen in mitral valve prolapse?
systolic ejection murmur with a click; most women are asymptomatic and are diagnosed by routine physical exam or incidental finding on echo; small percentage have anxiety, palpitations, atypical chest pain, and syncope
How should you treat women with mitral valve prolapse?
for when who are symptomatic, beta blocking drugs are given to decrease sympathetic tone, relieve chest pain and palpitations and reduce risk of arrhythmias
What are signs and symptoms of pneumonia?
cough, dyspnea, sputum production, and pleuritic chest pain, fever; mild upper respiratory symptoms and malaise usually precede these symptoms and mild leukocytosis is usually present; diagnosis with chest xray
