Ob/Gyn- Medical Conditions in Pregnancy- Dr. Wooton

Question 1

what weeks is screening for gestational diabetes?

Answer 1

weeks 24-28

Question 2

what test do you do for screening for gestational diabetes?

Answer 2

50 gm one hour oral load glucose challenge test.

if abnormal follow by a 3 hour 100 gm oral load glucose tolerance test.

Question 3

what is the most common fetal complication of gestational diabetes?

Answer 3

increased risk of spontaneous abortions

Question 4

what are the two classes of gestational diabetes?

Answer 4

class A1: gestational diabetes; diet controlled 
Class A2: gestational diabetes: insulin or oral meds controlled

Question 5

in part of the antepartum management in GDM, ultrasound for fetal weight. what weight is recommended for cesarean delivery?

Answer 5

4250 g

Question 6

In postpartum management of GDM, what causes the insulin requirements to drop?

Answer 6

delivery of the placenta

Question 7

what should be monitored throughout pregnancy in maternal hyperthyroidism?

Answer 7

TSH levels

Question 8

can medications for hyperthyroidism cross the placenta?

Answer 8

yes… fetal hypothryroidism and fetal goiter can develop

Question 9

what should hypothyroidism be treated with?

Answer 9

levothyroxine

Question 10

monitor what levels monthly in hypothyroidism?

Answer 10

TSH and free T3/T4 levels monthly

Question 11

whats the most common lesion in Rheumatic heart disease?

Answer 11

mitral stenosis

Question 12

what is an absolute contraindication to pregnancy due to decompensation during pregnancy?

Answer 12

primary pulmonary HTN

Question 13

what is the moratality rate in postpartum cardiomyopathy?

Answer 13

20%

Question 14

Should all pregnant cardiac patients be co-managed w/ a cardiologist?

Answer 14

TRUE

Question 15

which delivery method is preferred in cardiac patients unless there are obstetric indications?

Answer 15

vaginally delivered

Question 16

what syndrome may coexist with SLE and has presence of lupus anticoagulant and or anticipation antibody. also assoc. w/ arterial and venous thormbosis?

Answer 16

Antiphospholipid Syndrome

Question 17

what are the three types of Acute renal failure?

Answer 17

prerenal- seen with acute blood or fluid loss
renal- usually preexisting disease or hypercoaguable state
postrenal- rare, urologic obstructive lesions (kidney stones)

Question 18

treatment for acute renal failure?

Answer 18

prerenal- restore volume
renal- tx is to prevent further damage
postrenal- mechanics to remove the obstruction

Question 19

what serum creatinine worsens prognosis? and with what patient condition is this seen with?

Answer 19

Chronic Renal Failure

greater than 1.5 to 2 serum creatine

Question 20

how many women complain of nausea and vomiting during prenancy?

Answer 20

60-80%

Question 21

what is Hyperemesis gravidarum?

Answer 21

persistent nausea and vomiting associated with >5% loss of pregnancy weight.

Question 22

hyperemesis gravidarum occurs more frequently in?

Answer 22

first pregnancies, multiple pregnancies, molar pregnancies

Question 23

what is Mendelson’s syndrome?

Answer 23

also known as acid aspiration syndrome

Question 24

what is the prognosis for pregnant patients with IBS?

Answer 24

usually do well

Question 25

What hepatic disorder is very scary and has a real bad prognosis?

Answer 25

acute fatty liver of pregnancy

Question 26

what is the tx of acute fatty liver of pregnancy?

Answer 26

termination of pregnancy

supportive care

Question 27

pregnancy is a _______________ state. (hemodynamically speaking)

Answer 27

HYPERCOAGULABLE

Question 28

NEVER MISS DVT, ALWAYS INVESTIGATE AND make sure you rule out a DVT first.

Answer 28

TRUE

Question 29

what anticoagulation treatment do you NOT use during pregnancy?

Answer 29

Coumadin

Question 30

what should you immediately consider and be quick to treat if a pregnant patient presents with with chest pain and shortness of breath?

Answer 30

Pulmonary embolism- in 70% of cases a DVT is instigating factor

Question 31

patients with deep venous thormbosis or PE require what work up?

Answer 31

thrombophilia work-up. ex: factor V leiden, antithrombin 3, etc.

Question 32

what does a baby suffer last in a patient with severe asthma?

Answer 32

fetal hemoglobins increased affinity for oxygen

Question 33

what anti seizure medication should not be used with pregnant patients because it is more teratogenic than other antiepileptics?

Answer 33

Valproate

Question 34

women on antiepileptics should also be on what?

Answer 34

1 to 4 mg of folic acid