Normal Pregnancy & Complications Flashcards
how should anemia in pregnancy be treated?
- treatment is with 60-120mg of elemental iron/day (with vitamin C or with meals)
- if intolerant or no improvement with oral iron, may require IV iron
Anemia in pregnancy is catergorized as what specific to gestation?
1st trimester: <11g/dL
2nd trimester: <10g/dL
3rd trimester: 11g/dL
postpartum: <10g/dL
- screening performed as part of early prenatal labs
- always treat when >100k (increased risk of cystitis, and pyelonephritis)
- GBS bacteria at any point is indication for antibiotics during labor
- urinary frequency is common in pregnancy, but should have not dysuria, urgerncy, hematuria, foul smell, fever or flank pain
- pyelonephritis can develop, often requires inpatient treatment
Asymptomatic bacteriuria
- flank pain with hematuria (+/-) but no fever (unless secondarily infected)
- diagnosis: labs: UA+ culture, BMP; imaging: ultrasound to evaluate renal and ureteral dilation
- treatment: hydration and pain management
renal stones in pregnancy
how should genital herpes be treated in pregnancy?
treat outbreak with acyclovir
AND
prophylaxis (from 36 weeks until delivery (3x/day until delivery)
* any active lesions at delivery—> C-section recommended
treatment of yeast infection in pregnancy
topical clotrimazole or miconazole
NO oral medication in pregnancy
what should be done for obesity in pregnancy with a BMI over 40?
EKG at baseline
Sleep apnea evaluation
anesthesia consult
growth ultrasounds
what are the 4 categories of hypertensive disorders of pregnancy?
- chronic hypertension
- chronic hypertension with superimposed preeclampsia
- preeclampsia/Eclampsia
- gestational hypertension
- Two BP readings >140/90 at least 4 hours apart
- prior to pregnancy or before 20 weeks’ genstation
- associated with adverse perinatal outcomes (preeclampsia, fetal growth restriction, placental abruption)
Chronic hypertension in pregnancy
treatment of chronic hypertension in pregnancy?
medication
* nifedipine, labetalol, methylopa
* ACE/ARB are contraindicated
increased monitoring required later in pregnancy to indentify complications (poor fetal growth, preterm birth, placental abruption, preeclampsia an eclampsia)
risk of having diabetes in pregnancy?
- large babies (increased risk of operative delivery, shoulder dystocia, brachial plexus injury, fracture, neonatal depression)
- preeclampsia and gestational hypertension (related to insulin resistance
- polyhydraminos
- stillbirth
- other morbidity (hypoglycemia, hyperbilirubinemia, low calcium, low magnesium, polycythemia, respiratory distress, cardiomyopathy
- previously diagnosed chronic hypertension PLUS the addition of the following
- proteinuria
- sudden increase in BP previously well controlled
- s/sx preeclampsia (RUQ pain, headache, vision change, pulmonary edema, change in creatinine/transaminases, thrombocytopenia)
chronic hypertension with preeclampsia
treatment hypertension with preeclampsia
- may include need for urgent delivery
- growth ultrasounds throughout remainder of pregnancy
- antenatal testing
- Two BP readings > 140/90 at least 4 hours apart
- after 20 weeks’ gestation (no prior elevation in blood pressure to suggest chronic hypertension)
- evaluation negative preeclampsia (no signs of preeclampsia (HA, vision change, RUQ pain, edema) no proteinuria or other concerning lab findings
gestational hypertension
treatment of gestation hypertension?
- expectant management
- increased monitoring (women may still go on to develop preeclampsia)
- delivery by 37 week gestation
Disorder of placental function which results in
* endothelial damage
* vasospasm
* placental insufficiency
* affects all maternal organs
* affects fetus due to decreased placental flow
preeclampsia
risk factors of preeclampsia?
- first pregnancy
- new paternity
- age <18 years or >35 years
- history of preeclampsia
- family hx preeclampsia in first degree relative
- black race
- BMI >3o
- interpregnancy interval <2 years or >10 years
what are potential complications of preeclampsia?
- placental abruption
- acute kidney injury
- cerebral hemorrhage (mom or baby or both)
- liver failure/liver rupture
- pulmonary edema
- DIC
- eclampsia
what is preeclampsia without severe features?
- new-onset hypertension and proteinuria after 20 weeks gestation
- proteinuria (urine protein/creatinine > 0.3; proteinuria > 300mg in 24 hour period)
- other laboratory features
preeclampsia with severe features
New onset hypertension after 20 weeks gestation along with any of the following signs of end organ dysfunction
* BP >160/110
* elevation in serum creatinine > 1.1 or doubling of previously normal creatinine
* liver enzyme elevation 2x greater than normal
* severe RUQ pain
* severe headache or visual distrubance
* pulomary edema
management of preeclampsia and hypertension at less than 37 weeks, without severe features?
- increased fetal and maternal monitoring
- maternal BP monitoring at home
- twice weekly nonstress tests
some debate about managment between 34-36 weeks
after weeks or with worsening condition= delivery
management of preeclampsia with severe features
- may require IV or oral medications to lowere BP
- seizure prophylaxis with magnesium sulfate
- 4-6mg IV loading dose followed by a drip
- monitor for hypermagnesemia (loss of DTRs, decreased respiratory drive, decreased cardiac conduction)
management of eclampsia (seizures)
- call in back up
- seizure precautions
- supplemental O2
- magnesium bolus (IV vesus IM)
- characterized by pruritis (itching) no rash and an elevation in serum bile acid concentrations, typically developing in the late second and/ or the third trimester and rapidly resolving after delivery
- risks for the fetus are significant (stillbirth, meconium, preterm delivery, respiratory distress syndrome)
- treatment: ursodiol to decrease itching
- antenatal testing indicated until delivery
- timing of delivery: induction of labory by 37 weeks `
cholestasis of pregnancy
- painless dilatation of the cervix in the second and early third trimester
- can be accompanied by prolapse of membranes through the cervix and consequent rupture of membranes
- loss of pregnancy is accompanied by minimal labor
- US of cervical length can be done for at risk patients and monitored through gestation
preterm cervical dilation: incompetent cervix
presenting signs and symptms of cervical dilation: incompetent cervix
- increased pressure
- increased mucous or watery discharge
- increased vaginal spotting
- increase in mild cramping
what are common symptoms of preterm labor and preterm rupture
contractions
pelvic pressure
increased discharge
leakage of fluid
vaginal spotting
abdominal cramps
backache
how can you predict preterm labor?
- measurement of cervical length (> 25 mm is reassuring)
- fetal fibronectin (negative=reassuring; positive=less helpful)
- bishop scores
treatment of gential herpes during pregnancy?
- treat outbreak with acyclovir AND prophylaxis (from 36 weeks until delivery)
- any active lesions —> C-section
Treatment of bacterial vaginosis?
- oral metronidazole
Treatment of Yeast infection?
- Topical clotrimazole or miconazole
no oral medicatinos in pregnancy
Preterm labor and preterm rupture of membranes
- admit to hospital
- < 34 weeks: betamethasone, tocolysis (to delay delivery 48 hours and allow betamethasone to advance fetal lung maturity), antibiotics for GBS, magnesium sulfate
- > 34 weeeks: Admit for observation, if no progressive cervical dilation, can dishcarge to home and follow up outpatient and/or with further signs and sx of labor.
If mom is not given RhoGam what are potential consequences?
- the baby’s RBC will be phagocyotized in the fetal spleen
- this will cause profound anemia and fetal hydrops
- Premature separation of part of the placenta from the uterine wall
- amount of vaginal bleeding can range from non(concealed abruption) to significant
- often accompanied by tense uterus, frequent contration and fetal distress
- can be precipitated by blunt trauma or motor vehicle accident
- medical risks: cocaine use, tobacco use, hypertensive disorders or pregnancy
Placental abruption
- implantation of the placenta over the cervial os
- increases risk of abruption
- may cause massive bleeding
- DO not perform digital examination
- Bleeding from placenta previa is indication for immediate hospitalization
- CM: sudden onset of painless vaginal bleeding in the third trimester- absence of abdominal pain or uterine tenderness
Placenta previa
- often diagnosed by lagging fundal height
- may be seen on screening ultrasound
- serial ultrasounds to monitor growth
- timing of delivery- Often between 37w0d and 39w0d (based on variety of factors)
Intrauterine growth restriction
