OB Flashcards
(29 cards)
Diagnostic criteria for HTN in pregnancy, office and ambulatory.
Office:
SBP ≥ 140 or DBP ≥ 90mmHg
Ambulatory BP monitor:
SBP ≥ 135 or DBP ≥ 85mmHg
Severe hypertension in pregnancy
SBP ≥ 160 or DBP ≥ 110 mmHg
DBP target for hypertension in pregnancy
DBP < 85 mmHg
Symptoms and management of Mg Sulfate toxicity
– Symptoms: respiratory suppression, bradycardia, hypotension, reduced GCS
– Monitoring: decreased reflexes, decreased urine output, NOT Mg levels
– Treatment: stop Mg, calcium gluconate, dialysis
Fetal complications of warfarin in first and second trimester
– First trimester: warfarin embryopathy (mid facial and limb hypoplasia and stippled bone)
Second/third trimesters: CNS malformations, microcephaly, and optic atropy
Which oral hyperglycemics are safe UNTIL pregnancy?
Metformin and Glyburide safe in pre-conception. STOP when pregnant and switch to insulin.
if on other oral antihyperglycemic agents, switch to insulin prior to conception
*If pt is refusing insulin, can use Metformin and Glyburide in pregnancy but does cross placenta (so does Insulin). Also safe in breastfeeding
Blood glucose targets in pregnancy?
Fasting <5.3
1h post-prandial <7.8
2h post-prandial <6.7
Cut offs for 50g 1hr OGCT in pregnancy?
> =11.1 GDM diagnosed
7.8-11.1 Borderline – move to OGTT
<=7.8 Normal
Cut offs for 75g 2hr OGTT in pregnancy?
Cutoff if used as 2nd step (e.g. after borderline 50g)
FPG ≧5.3
1hr ≧10.6
2hr ≧9.0
When to screen for GDM?
24-28 weeks
Plt threshold for delivery (vaginal, c, neuroaxial) in ITP and pregnancy?
Vaginal delivery >30
C-section >50
Neuraxial anesthesia >80
Plt threshold for delivery (vaginal, c, neuroaxial) in HELLP/Preeclampsia and pregnancy?
<20 transfuse all
<50 +C section–> transfuse
>50 – transfuse if actively hemorrhaging or rapidly falling counts with other coagulopathy
Changes to PFTs in pregnancy
- No change in TLC
- Increased tidal volume
- Increased Inspiratory Volume
- Decreased FRC, ERV
- No change in vital capacity
3 antihypertensives to avoid in pregnancy?
- ACE/ARB
- Atenolol
- Prazosin
RFs for pre-eclampsia in pregnancy? Hint: Split into Epidemiological, maternal and fetal
Epidemiological
- First pregnancy
- New partner or IVF
- Family history (OR 6)
- Age < 20 or > 35
Maternal
- Previous pre-eclampsia
- Chronic HTN, Diabetes, CK, obesity
- Auto-immune disorders (SLE, APLA)
Fetal
- Multiple gestation
- Hydrops fetalis
- Molar pregnancy
Who needs ASA for pre-clampsia prevention?
- Previous pre-eclampsia
- Chronic hypertension
- Type 1 or 2 diabete
- CKD
- SLE
- APLA syndrome
- multiple gestation
- Two or more minor factors (ex. Nulliparous, Age >40, BMI>30, IVF…)
Give 81-162mg daily, start before 16wks and continue until 36 weeks.
If you suspect DVT in pregnancy, what is your approach to imaging and treatment?
- If you suspect DVT–> anticoagulate on spec
- Perform bilateral Dopplers, if you suspect isolated iliac vein and doppler negative, get MR
- If ultrasound is negative, REPEAT in 7 days!
If you suspect PE in pregnancy, what is your approach to imaging and treatment?
- If you suspect PE–> anticoagulate on spec
- Perform bilateral Dopplers, if negative…
- CXR first then V/Q
- If non diagnostic:
Low pre-test prob–> Perform serial dopplers
High pre-test prob–> Spiral CTA
What is the upper limit of radiation you tolerate in pregnancy?
<5 rad (or 50 milligray)
For reference:
Maternal radiation: CTPA <0.5 rads, VQ 0.007-0.03 rads, CXR 0.005 rads
How much folate is required pre-pregnancy? When do you start and how long do you continue?
Folate 1 mg for 3 months pre- and 3 months post-conception
In DM1 patients, what endocrinopathy should you screen for in the post-partum period?
Post-partum thyroiditis
In patients with Gestational DM, when should you screen for diabetes post-partum? How do you screen?
75g OGTT at 6 weeks – 6 months postpartum to rule out T2DM
50% will have GDM in subsequent pregnancies;
20% of women will develop T2DM in 10 years
How do you treat cholestatis of pregnancy?
Urso!
How to treat ITP in Pregnancy?
Prednisone and IVIG
