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OB/GYN > Other Medical Complications of pregnancy > Flashcards

Other Medical Complications of pregnancy Flashcards

1
Q

what is hyperemesis gravidarium?

A

when pts’ N&V makes them dehydrated & they dvp electrolyte abnormalities.

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2
Q

what kind of metabolic abnormality dvps in hyperemesis gravidarium?

A

hypochloremic alkalosis

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3
Q

tx of hyperemesis gravidarium?

A

NS with 5% dextrose infusion

frequent small meals to maintain blood sugars

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4
Q

what anti-emetic meds are safe for pg’y?

A 
Compazine
Phenergan
Tigan
Reglan
Droperidol
Zofran
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5
Q

what route should anti-emetics be given?

A

IM, IV, or suppository (not PO)

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6
Q

tx of hyperemesis gravidarium that is rfr to rehydration & anti-emetics?

A

corticosteroids, acupuncture, acupressure, n. stim

rarely, feeding tubes or parenteral nutrition

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7
Q

what’s a concern with pregnant epileptic patients?

A

higher rates of fetal malformations, even higher rates if anti-epileptic meds used

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8
Q

what happens to the frequency of seizures during pregnancy?

A

increased

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9
Q

why does seizure freq increase?

A

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

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10
Q

what congenital abnormalities are more common in epileptic moms?

A

cleft lip & palate
cardiac defects
NTDs (esp w/carbamazepine & valproic acid)
EEG abnormalities/dvp’l delay

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11
Q

mech of teratogenicity of phenytoin:

A

folate antagonist

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12
Q

mech of teratogenicity of primidone:

A

folate antagonist

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13
Q

mech of teratogenicity of phenobarbital:

A

folate antagonist

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14
Q

mgt of epileptic pts, pre-conception?

A

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.

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15
Q

how should valproate dosing change during pg’y?

A

don’t do higher-dose BID. Do smaller-dose TID or QID.

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16
Q

mgt of epileptic pg pt?

A

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.

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17
Q

mgt of epileptic pt on L&D:

A

check drug levels on admission. If low, give some.

give baby vit K after delivery. Check clotting studies on cord blood samples.

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18
Q

why check baby’s vit K level if born to an epileptic mom?

A

increased risk of spont hemorrhage in newborns b/c of increased vit K metab by anti-epil drugs.

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19
Q

mgt of seizures in an epileptic pt on L&D?

A

phenytoin

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20
Q

what CV meds need to be d/c’d during pg’y?

A

ACEi’s
Warfarin
diuretics

21
Q

what to do for pts w/cardiac anomalies during labor?

A

endocarditis ppx

22
Q

mgt of a pg pt w/mitral or aortic stenosis requiring surgery? During labor?

A

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.

23
Q

mgt of pts w/Eisenmenger physiology & pulm HTN?

A

recommended termination of pg’y. If decline, serial echocardiograms.
Assisted vaginal delivery.

24
Q

mgt of pg pts w/Marfans syndrome?

A

avoid physical activity, beta blocker to decrease CO and decrease risk of aortic dissection.

25
Q

what is peripartum cardiomyopathy?

A

dilated cardiomyopathy immediately before, during, or after delivery, mostly caused by pg’y. EF will be 20-40%.

26
Q

mgt of pt w/peripartum cardiomyopathy?

A

if after 34 weeks, deliver. If earlier, give betamethasone and deliver asap.
Diuretics
Digoxin
vasodilators

27
Q

prognosis of peripartum cardiomyopathy

A

most pts heart fct returns to baseline w/in several months of delivery

28
Q

mgt of pg pts w/chronic renal dis?

A

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.

29
Q

mgt of pg pts w/renal transplants?

A

need increased doses of immunosuppressants 2/2 increased metab of drugs. Encourage pts to keep taking them b/c risk of rejection is high.

30
Q

pts w/mild renal dis are at increased risk of what?

A

preeclampsia

IUGR

31
Q

mgt of superf venous thrombosis:

A

low risk of emboli, so don’t need to heparinize. Just warm compresses & analgesics.

32
Q

mgt of DVT during pg’y:

A

LMWH

don’t use warfarin!

33
Q

mgt of PE during pg’y:

A

IV LMWH, then subQ heparin. Warfarin post-partum.

Streptokinase if massive PE.

34
Q

leading cause of maternal death?

A

PE

35
Q

mgt of a pg pt w/Graves dis?

A

check TSI levels. If elevated, risk of fetal goiter.

Keep TSH levels near 0.5 (low-normal)

36
Q

mgt of a pg pt w/Hashimoto’s?

A

increased supplemental T4 to keep TSH near 0.5 (low-normal)

37
Q

what SLE meds are continued during pg’y and what are d/c’d?

A

aspirin & corticosteroids are continued. Cyclophosphamide & MTX are d/c’d.

38
Q

what are the collagen vasc diseases?

A

SLE
Sjogrens
antiphospholipid antibody syndrome

39
Q

what complc’ns are more likely in pts w/collagen vasc diseases?

A

IUGR
preeclampsia
preterm delivery
early pregnancy loss

40
Q

mgt of a pg pt w/SLE?

A

low-dose aspirin
heparin to prevent placental thrombosis
corticosteroids
screen for anti-Ro and anti-La

41
Q

how to distinguish a SLE flare from preeclampsia:

A

check complement levels.
SLE flare = low C3 and C4
preeclampsia = normal C3 and C4

42
Q

mgt of a SLE flare during pg’y

A

high-dose steroids

if that doesn’t work, cyclophosphamide

43
Q

what 2 complications in neonate can occur if mom had SLE?

A

1) neonatal SLE

2) irreversible congenital heart block

44
Q

why does neonatal SLE occur?

A

maternal Ag-Ig complexes cross placenta and cause SLE in neonate

45
Q

why does neonatal SLE heart block occur?

A

anti-Ro and anti-La binds to tissues in fetal cardiac conduction system

46
Q

mgt of a pg pt who abuses alcohol?

A

aggressive counseling.

47
Q

tx of alcohol withdrawal in a pg pt?

A

barbiturates. Don’t use benzos.

48
Q

how much caffeine is safe during pg’y?

A

< 150 mg/d

49
Q

mgt of a pg pt who uses heroin:

A

enroll in methadone program, don’t try to quit b/c withdrawal is bad for fetus.
Methadone taper postpartum.

OB/GYN (29 decks)

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