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OS Reproductive > MFM Pathophysiology Lectures > Flashcards

MFM Pathophysiology Lectures Flashcards

1
Q

What is the definition of peripartum cardiomyopathy (the non-Nichols version…)?

A

HF in last month of pregnancy or within 5 months post-delivery with absence of other causes

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2
Q

What are some potential viral causes of peripartum cardiomyopathy?

A

Parovirus
HHV 6
EBV
CMV

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3
Q

What are the risk factors for peripartum cardiomyopathy?

A 
Chronic HTN
Preeclampsia
Obesity
Advanced maternal age, or the very young
African American race
Multiparous
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4
Q

What is the most common cause of HF in pregnancy?

A

Chronic HTN with superimposed preeclampsia

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5
Q

Dilated cardiomyopathy is classically associated with:

A

HIV

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6
Q

What are the clinical findings of peripartum cardiomyopathy?

A

Cardiomegaly
Perihilar opacification
Ejection Fraction < 45%

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7
Q

What is the treatment for peripartum cardiomyopathy?

A

Diuretics to reduce preload
Hydralazine to reduce afterload
Digoxin for inotropic effects

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8
Q

What is the prognosis for those with peripartum cardiomyopathy?

A

Takes a year to regain function –> DO NOT GET PREGNANT until you are better!

Return to normal in 6 months has better prognosis

Long-term prognosis worse in nonpregnant ladies with idiopathic cardiomyopathy

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9
Q

What is the control drug of choice for asthma in pregnancy? **potential test question

A

Budesonide (inhaled corticosteroid)

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10
Q

What are the outcomes of pregnant asthmatics?

A

1/3 no change
1/3 improve
1/3 worsen (during weeks 24-36)

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11
Q

Asthma worsens pregnancy outcomes in patients with these conditions

A

Preeclampsia
Pre-term birth
Low birth weight

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12
Q

How does FRC change during pregnancy?

A

Decrease ~ 20%

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13
Q

How does bronchial responsiveness change during pregnancy?

A

More responsive (to methacholine challenge)

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14
Q

What are some reasons pregnancy worsens asthma?

A

GERD, mucosal edema, URI, stress, decreased FRC

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15
Q

When are pregnant women most likely to have an asthma attack?

A

Wks 17-24

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16
Q

What effects can asthma have on the fetus?

A 
Increased:
IUGR
Hypoxia
LBW
Mortality
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17
Q

How should you monitor pregnant asthmatics?

A

Monthly spirometry

Peak flow meter 2x/d

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18
Q

Inhaled steroids are pregnancy category __ and oral steroids are category __

A

B, C

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19
Q

How should you monitor the fetus in pregnant asthmatics?

A

US @ 32 wks, every 4 weeks, when suspecting IUGR, and after exacerbations

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20
Q

Diagnostic definition of APAS?

A

Prior or current VTE or characteristic OB complications + a relevant lab value (anticardiolipin or lupus anticoagulant) on two or more occasions, 6 weeks apart

Note: moms without APAS may have + antibody titer

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21
Q

What hemodynamic changes occur in thromboembolic disease of pregnancy?

A 
High progeserone increases decidua
Fibrinogen levels double
Clotting factors increase
vWF increases
Protein S decreases
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22
Q

What are the high risk thromboembolic disorders of pregnancy?

A

Factor V Leiden homozygous mutants
Antithrombin III deficiency
Prothrombin gene homozygous mutants

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23
Q

What are the lower risk thromboembolic disorders of pregnancy?

A

Factor V Leiden heterozygous mutants
Prothrombin heterozygosity
Protein C deficiency
Protein S deficiency

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24
Q

What are some pregnancy-specific risk factors for thromboembolic disease?

A

Increased parity
Postpartum endomyometritis
Operative delivery
C/S

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25
Q

The inherited thrombophilias are all __ inherited except for __

A

AD

Hyperhomocysteinemia (AR)

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26
Q

What is the most important modifier of risk for inherited thrombophilias?

A

Personal or family hx of venous thrombosis (duh)

27
Q

What are some diagnostic methods for DVT?

A

Venous US: MC method
D-dimer: product of fibrin degradation
Contrast venography: 20% are intolerant
MRI: superior to US

28
Q

What is the characteristic EKG change in PE?

A

S1, Q3, inverted T3

29
Q

What is an adverse event associated with long-term therapy with unfractionated heparin? **potential test question

A

Osteoporosis

30
Q

At what time in pregnancy should you switch from LMWH back to unfractionated and why?

A

36 weeks; because LMWH is hard to reverseand don’t want to deal with that during L&D

31
Q

When is warfarin most teratogenic and what anomalies does it cause?

A

6-12 weeks

MR, nasal hypoplasia, microphthalmia

32
Q

What drug is used to reverse the effects of unfractionated heparin? **potential test question

A

Protamine

33
Q

What are some signs of a trophoblastic mole?

A

Passing grape-like structures and very high hCG

34
Q

What disease does DES exposure increase your risk for?

A

Clear cell vaginal cancer

35
Q

Very heavy bleeding with first menses should prompt testing for:

A

Von WIllebrand disease

36
Q

What drugs are associated with abnormal uterine bleeding?

A

Anticoagulants, salicylates, prostaglandin inhibitors (mifepristone), contraceptives, psychotropic drugs

37
Q

What’s the predominant cause of AUB in reproductive years?

A

Anovulation

others: PCOS, pituitary, and thyroid dysfunction

38
Q

What are the risk factors for endometrial cancer?

A

> 3, obesity, infertility, family hx of colon cancer, excess estrogen exposure

39
Q

What is the gold standard diagnostic method for HSV and what finding is expected?

A

Viral culture; intranuclear inclusion bodies

40
Q

Contrast HSV IgM and IgG seropositivity

A

IgM: not useful; positive during recurrent episodes

Use IgG for diagnosis

41
Q

DOC for HSV?

A

ACV

42
Q

When should you begin HSV suppression during pregnancy?

A

36 weeks to reduce need for C/S from outbreak

43
Q

The classic clinical scenario for CMV?

A

Day-care workers (also think of pregnant women with young children)

44
Q

When is risk of CMV transmission greatest during pregnancy, and when is fetal injury greatest?

A

3rd trimester infections - greatest transmission

1st trimester infections - greatest harm

45
Q

What are the manifestations of CMV infection?

A

Most common: asymptomatic
Mono-like syndrome
Guillain-Barré: progressive polyneuropathy that begins peripherally associated with CMV infection

46
Q

What is the incubation period of CMV?

A

About 40 days

Viremia detected 2-3 weeks after infection

47
Q

What is CMV avidity?

A

Reflects modifications to IgG and tells you age of infection

Avidity less than 25% indicates infection in previous 3 months

48
Q

How is maternal CMV during pregnancy diagnosed?

A

Serum samples 3-4 weeks apart tested for IgG

> 4x increase in titer

49
Q

What ultrasound findings would you expect for a fetal CMV infection?

A

Cerebral calcifications (pathognomonic!)
Hepatosplenomegaly
Ascites
Hydrops

50
Q

How is fetal CMV diagnosed?

A

Amniocentesis and then PCR (more sensitive) or viral culture

51
Q

During preconception counseling it is important to say this about obesity

A
  1. “It’s a health condition” - use classifications
  2. Explain risks
  3. Encourage lifestyle changes (FRAMES motivational interviewing)
  4. Refer as needed
52
Q

What risks are associated with obesity in pregnancy?

A

Low rates of fertility (rev. with WL) due to anovulation (PCOS), leptin, infrequent intercourse, and spontaneous abortion

53
Q

Bariatric surgery is indicated for whom?

A

BMI > 40, or BMI > 35 with complications of obesity

54
Q

Gastric bypass is associated with lower risk of these complications

A

Preeclampsia, gestational diabetes, congenital abnormalities, avg. weight gain

55
Q

Bypass is associated with higher risk of these complications

A

C/S

PPROM

56
Q

Which nutrients should you screen for during pregnancy counseling?

A

B12, iron, vit. D, Ca2+

57
Q

What is Dumping syndrome?

A

Rapid absorption of simple sugars –> don’t use glucola to test for gestational diabetes! Use fasting and post-prandial sugar levels

58
Q

What disorder is classically associated with high birth weight?

A

Diabetes

59
Q

What disorder is associated with newborns with large organs and tongues?

A

Beckwith-Wiedemann

60
Q

What is the definition of IUGR?

A

A fetus that fails to reach growth potential / technically, birth weight < 10th percentile

61
Q

What are some extrinsic causes of IUGR?

A

*Maternal vascular disease (e.g., pre-eclampsia –> low perfusion) - 30%

*Nutrition abnormalities:
Vitamins: zinc, folate
Oxygen delivery: Hgb-opathies, COPD, high alt.

Infection
TORCH, esp. Rubella

Toxins: EtOH, tobacco, drugs, warfarin, anticonvulsants

Placental

62
Q

What are some intrinsic causes of IUGR?

A

Genetics: chromosomal abnormalities, esp. trisomies and TUrner’s
Multiparity

If IUGR is early-onset (< 26 wks), 25% have abnormal karyotype

63
Q

What does Doppler US for IUGR look for?

A

Umbilical artery: for placental vascular resistance Middle cerebral artery: for ‘brain sparing effect’

Should never show backward flow

64
Q

Examination of amniotic fluid would show this finding in IUGR

A

Oligohydramnios

OS Reproductive (9 decks)

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