Other Medical Complications of pregnancy Flashcards
what is hyperemesis gravidarium?
when pts’ N&V makes them dehydrated & they dvp electrolyte abnormalities.
what kind of metabolic abnormality dvps in hyperemesis gravidarium?
hypochloremic alkalosis
tx of hyperemesis gravidarium?
NS with 5% dextrose infusion
frequent small meals to maintain blood sugars
what anti-emetic meds are safe for pg’y?
Compazine Phenergan Tigan Reglan Droperidol Zofran
what route should anti-emetics be given?
IM, IV, or suppository (not PO)
tx of hyperemesis gravidarium that is rfr to rehydration & anti-emetics?
corticosteroids, acupuncture, acupressure, n. stim
rarely, feeding tubes or parenteral nutrition
what’s a concern with pregnant epileptic patients?
higher rates of fetal malformations, even higher rates if anti-epileptic meds used
what happens to the frequency of seizures during pregnancy?
increased
why does seizure freq increase?
increased ES => upregl’n of CYP450s => faster metab of anti-epileptic drugs. Plus ES itself decreases seizure thr.
rise in creatinine clearance => faster drug clearance
increased total bvol => decreased drug levels
increased stress, decreased sleep => lower seizure thr
decreased compliance w/anti-epileptic meds 2/2 concern for fetal effects
what congenital abnormalities are more common in epileptic moms?
cleft lip & palate
cardiac defects
NTDs (esp w/carbamazepine & valproic acid)
EEG abnormalities/dvp’l delay
mech of teratogenicity of phenytoin:
folate antagonist
mech of teratogenicity of primidone:
folate antagonist
mech of teratogenicity of phenobarbital:
folate antagonist
mgt of epileptic pts, pre-conception?
swtich to a single anti-epileptic drug and taper down to lowest possible dose before conception.
If seizure-free for past 2-5 years, can try complete withdrawal.
Supp’l folate.
how should valproate dosing change during pg’y?
don’t do higher-dose BID. Do smaller-dose TID or QID.
mgt of epileptic pg pt?
Get a level II fetal survey u/s at 20w to get good look at heart, face, CNS.
Get MSAFP level.
Check drug levels monthly.
mgt of epileptic pt on L&D:
check drug levels on admission. If low, give some.
give baby vit K after delivery. Check clotting studies on cord blood samples.
why check baby’s vit K level if born to an epileptic mom?
increased risk of spont hemorrhage in newborns b/c of increased vit K metab by anti-epil drugs.
mgt of seizures in an epileptic pt on L&D?
phenytoin
what CV meds need to be d/c’d during pg’y?
ACEi’s
Warfarin
diuretics
what to do for pts w/cardiac anomalies during labor?
endocarditis ppx
mgt of a pg pt w/mitral or aortic stenosis requiring surgery? During labor?
recommend termination of pregnancy so they c/h it repaired. If decline, prepare them & family for risk of morbidity & mortality.
During labor, give epidural early to decrease pain response. assisted vag delivery to diminish effects of Valsalva.
mgt of pts w/Eisenmenger physiology & pulm HTN?
recommended termination of pg’y. If decline, serial echocardiograms.
Assisted vaginal delivery.
mgt of pg pts w/Marfans syndrome?
avoid physical activity, beta blocker to decrease CO and decrease risk of aortic dissection.
what is peripartum cardiomyopathy?
dilated cardiomyopathy immediately before, during, or after delivery, mostly caused by pg’y. EF will be 20-40%.
mgt of pt w/peripartum cardiomyopathy?
if after 34 weeks, deliver. If earlier, give betamethasone and deliver asap.
Diuretics
Digoxin
vasodilators
prognosis of peripartum cardiomyopathy
most pts heart fct returns to baseline w/in several months of delivery
mgt of pg pts w/chronic renal dis?
get a 24-hr urine collection each trimester. If severe, recommend termination due to likelihood of worsening renal dis.
Tests of fetal well-being start at 32-34 weeks.
mgt of pg pts w/renal transplants?
need increased doses of immunosuppressants 2/2 increased metab of drugs. Encourage pts to keep taking them b/c risk of rejection is high.
pts w/mild renal dis are at increased risk of what?
preeclampsia
IUGR
mgt of superf venous thrombosis:
low risk of emboli, so don’t need to heparinize. Just warm compresses & analgesics.
mgt of DVT during pg’y:
LMWH
don’t use warfarin!
mgt of PE during pg’y:
IV LMWH, then subQ heparin. Warfarin post-partum.
Streptokinase if massive PE.
leading cause of maternal death?
PE
mgt of a pg pt w/Graves dis?
check TSI levels. If elevated, risk of fetal goiter.
Keep TSH levels near 0.5 (low-normal)
mgt of a pg pt w/Hashimoto’s?
increased supplemental T4 to keep TSH near 0.5 (low-normal)
what SLE meds are continued during pg’y and what are d/c’d?
aspirin & corticosteroids are continued. Cyclophosphamide & MTX are d/c’d.
what are the collagen vasc diseases?
SLE
Sjogrens
antiphospholipid antibody syndrome
what complc’ns are more likely in pts w/collagen vasc diseases?
IUGR
preeclampsia
preterm delivery
early pregnancy loss
mgt of a pg pt w/SLE?
low-dose aspirin
heparin to prevent placental thrombosis
corticosteroids
screen for anti-Ro and anti-La
how to distinguish a SLE flare from preeclampsia:
check complement levels.
SLE flare = low C3 and C4
preeclampsia = normal C3 and C4
mgt of a SLE flare during pg’y
high-dose steroids
if that doesn’t work, cyclophosphamide
what 2 complications in neonate can occur if mom had SLE?
1) neonatal SLE
2) irreversible congenital heart block
why does neonatal SLE occur?
maternal Ag-Ig complexes cross placenta and cause SLE in neonate
why does neonatal SLE heart block occur?
anti-Ro and anti-La binds to tissues in fetal cardiac conduction system
mgt of a pg pt who abuses alcohol?
aggressive counseling.
tx of alcohol withdrawal in a pg pt?
barbiturates. Don’t use benzos.
how much caffeine is safe during pg’y?
< 150 mg/d
mgt of a pg pt who uses heroin:
enroll in methadone program, don’t try to quit b/c withdrawal is bad for fetus.
Methadone taper postpartum.
