OB 3 Flashcards
(44 cards)
chronic hypertension
BP >140/90 before the patient became pregnant
what rx to treat maternal HTN
methydopa, labetalol, nifedipine
gestational HTN
BP >140/90 that starts after 20 weeks gestation; no proteinuria and no edema; only tx patient during pregnancy
preeclampsia risk factors
chronic HTN. Renal dz
what are some antihypertensives contraindicated in pregnancy
ACE inhibitors and ARBs because they cause fetal malformations
presentation of mild preeclampsia
BP >140/90; proteinuria (dipstick = 1-2+; 24 hr urine >300mg); edema of hands, feet, face
presentation of severe preeclampsia
BP >160/110; proteinuria (dipstick = 3-4+; 24 hr urine >5 gms); generalized edema, mental status and vision changes, impaired liver fn
eclampsia
tonic-clonic seizure in patient with h/o preeclampsia
treatment of eclampsia
stabilize the mother then deliver the baby; seizure control with magnesium sulfate and BP control with hydralazine
HELLP syndrome
hemolysis, elevated liver enzymes, low platelets
treatment of HELLP
stabilize the mother then deliver the baby; seizure control with magnesium sulfate and BP control with hydralazine
pregestational diabetes
woman had diabetes before becoming pregnant
maternal complications of pregestational diabetes
4x more likely to have preeclampsia, 2x more likely to have a spontaneous abortion, increased infxn rate, increased PPH
fetal complications of pregestational diabetes
increase in congenital abnormalities, macrosomia, preterm labor
evaluation of patient with pregestational diabetes
EKG, 24-hour urine (CrCl, protein), HbA1C, ophtho exam
treatment of diabetes during pregnancy; type 1
insulin pump with NPH
treatment of diabetes during pregnancy; type 2
subQ insulin with NPH and lispro
complications of gestational diabetes
preterm birth, fetal macrosomia, birth injuries, neonatal hypoglycemia, mothers are 4-10x more likely to develop DM2
neonatal hypoglycemia
increase in fetal insulin secondary to living in hyperglycemic environment
when to screen for gestational diabetes
between 24 and 28 weeks
how to screen for gestational diabetes
glucose load test then if positive glucose tolerance test
glucose load test
non-fasting ingestion of 50g of glucose, measurement of serum glucose 1 hour later; >140mg/dL is postive
glucose tolerance test
fasting ingestion of 100mg of glucose then 3 measurments of serum glucose at 1, 2 and 3 hours. If any are elevated = gestation diabetes
first line treatment of gestational diabetes
diabetic diet and exercise (walking)