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OBGYN > Other medical complications of pregnancy > Flashcards

Other medical complications of pregnancy Flashcards

1
Q

Hyperemesis gravidarum:

A

Persisting past wk 16

Very common in setting of molar pregnancy (document IUP!)

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2
Q

Management of Hyperemesis gravidarum:

A 
Maintain FEN/GI status! 
Can get hypoCl, hypoK, met acidosis 
Use NS + D5W
Can use antiemetics safely
Also B12 supplementation
Small frequent meals
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3
Q

Seizure disorders:

A

Increase in pregnancy
Watch doses (increased GFR → faster clearance)
Phenobarb / primidone / phenytoin = folate antagonists → NTD risk
Valproic acid → NTDs too

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4
Q

Management of seizure disorders

A

Take lots of folate prior to pregnancy, follow AFP, may or may not decide to switch (to single AED, lowest possible dose) - but seizures are bad for baby too

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5
Q

Maternal cardiac disease:

A

Remember 50% CO increase.

Highest risk with primary pulmonary HTN, Eisenmenger physiology, severe MS / AS, or Marfan

Remember big fluid shifts PP (autotransfusion) → big demand on heart

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6
Q

Management of maternal cardiac dx

A

ACEi, coumadin contraindicated in pregnancy, diuretics risky too.

May do assisted vaginal delivery to avoid valsalva - better than C/S results.

Hx MI: get baseline ECG

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7
Q

Eisenmenger syndrome / pulmHTN

A

Really bad, up to 50% mortality, especially postpartum 2-4 wks (follow closely!

Eisenmenger: from R → L shunts (PDA, VSD).

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8
Q

Valvular disease management:

A

SBE (subacute bacterial endocarditis) ppx during labor if valuvular disorder

Consider fixing MS/AS 1 yr prior to pregnancy. If really bad, may even do it while pregnant!

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9
Q

Valvular disease

A

AS sx may get better early in pregnancy (as SVR decreases, less afterload)

MS pts may not be able to meet increased CO → CHF sx!

Mitral valve prolapse: small % of women with sx (anxiety, palpitations, atypical chest pain, and syncope).

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10
Q

Management of Mitral valve prolapse

A

If pt has sx, beta-blockers are given to decrease sympathetic tone, relieve chest pain and palpitations, and reduce the risk of life-threatening arrhythmias.

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11
Q

Marfan syndrome risk

A

Watch out for aortic dissection / rupture

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12
Q

Marfan syndrome management

A

Should be on beta blockers & not exert self during pregnancy

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13
Q

Peripartum cardiomyopathy:

A

Dilated cardiomyopathy before / during / after delivery

EF drops to 20-40%

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14
Q

Management of peripartum cardiomyopathy

A

Manage with diuretics, digoxin, vasodilators like HF pt.
If > 34wks, deliver
If earlier, BMZ → check lung maturity

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15
Q

Maternal renal disease:

A

Pregnancy can make it worse
Higher risk PEC.
Screen qtrimester with 24h urine for Cr/prot Antenatal testing from 32-34 wks onward
If s/p transplant, may need to increase meds to avoid rejection (higher Vd- volume of distribution)

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16
Q

Maternal coagulopathies

A

Pregnancy → extra coagulable. mechanism not precisely known.

Higher risk pelvic vain thrombus 2/2 IVC compression).

17
Q

Superficial vein thrombosis presentation:

A

Painful, visible venous cord.

18
Q

Superficial vein thrombosis Rx:

A

Warm compress / analgesic (won’t cause PE) and watch for si / sx of DVT/PE

19
Q

DVT management

A

Treat with IV heparin → subQ heparin for rest of pregnancy.

No coumadin → nasal hypoplasia, skeletal problems

20
Q

PE management

A

Get EKG, spiral CT
Rx IV heparin → subQ heparin / LMW heparin
Will switch to unfractionated heparin @ 36 wks - shorter half life, so can d/c if presents to L&D

Can switch to Coumadin x 6mo postpartum

If unstable / massive, consider tPA / thrombectomy

21
Q

Maternal thyroid disease: Grave’s disease Rx

A

Methimazole (MMI) and propylthiouracil (PTU) Depends on practitioner, PTU is classic but more using MMI now

22
Q

Maternal thyroid disease: Hashimoto’s Rx

A

Levothyroxine

23
Q

SLE:

A

Early pregnancy: high risk loss in 1st/2nd trimester 2/2 placental thrombosis, esp if antiphospholipid Ab

Later pregnancy: also can lose 2/2 thrombosis. Antenatal testing @ 32wks onwards. Higher risk PEC

24
Q

Lupus flares

A

Can look like PEC, but have low complement.

25
Q

Treatment of lupus flares

A

If flaring, try high dose steroids → cyclophosphamide if that doesn’t work
If PEC, deliver.

26
Q

Neonatal problems in SLE

A

Can get irreversible congenital heart block 2/2 anti-Ro (and anti-La, but more Ro)
antibodies which cross-react with fetal cardiac conduction system.

Screen for anti-Ro at first visit; interventions vary.

27
Q

Substance abuse:

A 
Alcohol
Caffeine
Cigarettes
Cocaine
Opiates
28
Q

Fetal alcohol syndrome, # of drinks to put at risk

A

FAS possible with > 2-5 drinks / day

29
Q

Sequelae of fetal alcohol syndrome

A

Growth retardation, CNS effects, abnormal facies, cardiac defects, etc.

30
Q

Treatment of alcohol withdrawal in pregnancy

A

Try barbituates instead of benzos (less teratogenic)

31
Q

Caffeine

A

> 1 cup coffee (150 mg) may increase miscarriages

32
Q

Cigarettes

A

a/w SAB, preterm birth, placental abruption, LBW risk, also higher risk SIDS. Stop!

33
Q

Cocaine

A

a/w placental abruption, IUGR, preterm birth.

34
Q

Opiates:

A

Heroin, methadone most common.
No teratogenicity.
Risk is with withdrawal → put on NAS (neonatal abstinence syndrome) protocol with tincture of opium, etc for baby.

35
Q

Asthma in pregnancy chronic Rx

A

Short-acting beta agonists, then inhaled corticosteroids or cromolyn, then theophylline.

36
Q

Asthma in pregnancy acute Rx

A

Subq terbutaline, systemic corticosteroids.

37
Q

Pruritis gravidarum:

A

Mild variant of intrahepatic cholestasis of pregnancy; retain bile salt → dermis deposits → pruritis
Use antihistamines / topical emollients initially, then can try cholestyramine →
ursodeoxycholic acid if really bad.

38
Q

If appendicitis suspected

A

Get a graded compression ultrasound (best for eval - CT has lots of radiation)

39
Q

Depression

A 
Paxil (Paroxetine) is class D 
Increased risk fetal cardiac malformations & persistent pulmonary HTN

OBGYN (32 decks)

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