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Women's health Exam 3 > Normal Pregnancy & Complications > Flashcards

Normal Pregnancy & Complications Flashcards

1
Q

how should anemia in pregnancy be treated?

A
  • 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
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2
Q

Anemia in pregnancy is catergorized as what specific to gestation?

A

1st trimester: <11g/dL
2nd trimester: <10g/dL
3rd trimester: 11g/dL
postpartum: <10g/dL

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3
Q
  • 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
A

Asymptomatic bacteriuria

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4
Q
  • 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
A

renal stones in pregnancy

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5
Q

how should genital herpes be treated in pregnancy?

A

treat outbreak with acyclovir
AND
prophylaxis (from 36 weeks until delivery (3x/day until delivery)
* any active lesions at delivery—> C-section recommended

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6
Q

treatment of yeast infection in pregnancy

A

topical clotrimazole or miconazole

NO oral medication in pregnancy

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7
Q

what should be done for obesity in pregnancy with a BMI over 40?

A

EKG at baseline
Sleep apnea evaluation
anesthesia consult
growth ultrasounds

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8
Q

what are the 4 categories of hypertensive disorders of pregnancy?

A
  • chronic hypertension
  • chronic hypertension with superimposed preeclampsia
  • preeclampsia/Eclampsia
  • gestational hypertension
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9
Q
  • 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)
A

Chronic hypertension in pregnancy

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10
Q

treatment of chronic hypertension in pregnancy?

A

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)

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11
Q

risk of having diabetes in pregnancy?

A
  • 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
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12
Q
  • 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)
A

chronic hypertension with preeclampsia

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13
Q

treatment hypertension with preeclampsia

A
  • may include need for urgent delivery
  • growth ultrasounds throughout remainder of pregnancy
  • antenatal testing
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14
Q
  • 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
A

gestational hypertension

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15
Q

treatment of gestation hypertension?

A
  • expectant management
  • increased monitoring (women may still go on to develop preeclampsia)
  • delivery by 37 week gestation
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16
Q

Disorder of placental function which results in
* endothelial damage
* vasospasm
* placental insufficiency
* affects all maternal organs
* affects fetus due to decreased placental flow

A

preeclampsia

17
Q

risk factors of preeclampsia?

A
  • 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
18
Q

what are potential complications of preeclampsia?

A
  • placental abruption
  • acute kidney injury
  • cerebral hemorrhage (mom or baby or both)
  • liver failure/liver rupture
  • pulmonary edema
  • DIC
  • eclampsia
19
Q

what is preeclampsia without severe features?

A
  • new-onset hypertension and proteinuria after 20 weeks gestation
  • proteinuria (urine protein/creatinine > 0.3; proteinuria > 300mg in 24 hour period)
  • other laboratory features
20
Q

preeclampsia with severe features

A

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

21
Q

management of preeclampsia and hypertension at less than 37 weeks, without severe features?

A
  • 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

22
Q

management of preeclampsia with severe features

A
  • 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)
23
Q

management of eclampsia (seizures)

A
  • call in back up
  • seizure precautions
  • supplemental O2
  • magnesium bolus (IV vesus IM)
24
Q
  • 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 `
A

cholestasis of pregnancy

25
Q
  • 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
A

preterm cervical dilation: incompetent cervix

26
Q

presenting signs and symptms of cervical dilation: incompetent cervix

A
  • increased pressure
  • increased mucous or watery discharge
  • increased vaginal spotting
  • increase in mild cramping
27
Q

what are common symptoms of preterm labor and preterm rupture

A

contractions
pelvic pressure
increased discharge
leakage of fluid
vaginal spotting
abdominal cramps
backache

28
Q

how can you predict preterm labor?

A
  • measurement of cervical length (> 25 mm is reassuring)
  • fetal fibronectin (negative=reassuring; positive=less helpful)
  • bishop scores
29
Q

treatment of gential herpes during pregnancy?

A
  • treat outbreak with acyclovir AND prophylaxis (from 36 weeks until delivery)
  • any active lesions —> C-section
30
Q

Treatment of bacterial vaginosis?

A
  • oral metronidazole
31
Q

Treatment of Yeast infection?

A
  • Topical clotrimazole or miconazole
    no oral medicatinos in pregnancy
32
Q

Preterm labor and preterm rupture of membranes

A
  • 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.
33
Q

If mom is not given RhoGam what are potential consequences?

A
  • the baby’s RBC will be phagocyotized in the fetal spleen
  • this will cause profound anemia and fetal hydrops
34
Q
  • 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
A

Placental abruption

35
Q
  • 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
A

Placenta previa

36
Q
  • 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)
A

Intrauterine growth restriction

Women's health Exam 3 (11 decks)

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