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OB S.Horvath > pre-eclampsia, PIH, obesity > Flashcards

pre-eclampsia, PIH, obesity Flashcards

1
Q

what is the most common medical problem of pregnancy

A

diabetes

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2
Q

what is the pathophys behind DM

A

hyperplasia of pancreatic B-cells

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3
Q

how prevalent is GD? (first diagnosed in pregnancy)

A

4%

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4
Q

____ is associated with advanced maternal age, obesity, fam hx of DM, hx of stillbirth, neonatal death, fetal malformation or macrosomia

A

GD

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5
Q

GD is most prevalent in __ and ___ trimesters

A

2nd and 3rd

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6
Q

T/F GD is associated with higher incidence of gestational HTN, polyhedramnios and cesarean delivery

A

TRUE

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7
Q

normal range for A1C is ___, risk of vascular dz increases at ____

A

4-6%, 6.5%

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8
Q

stiff joint syndrome incidence ___ in type 1 diabetics

A

30-40%

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9
Q

T/F Stiff Joint syndrome occurs in patients with long-standing type 1 diabetes and is associated with non-familial short stature, joint contractures and tight skin.

A

TRUE

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10
Q

T/F all Type 1 DM pt’s should have pre-anesthetic flexion-extension cerical spine x-rays

A

FALSE - no evidence indicates that this makes a difference

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11
Q

maternal insulin requirements ___ progressively during the __ and ___ trimester and ___ at the onset of labor and continue to ___ following delivery

A

maternal insulin requirements increase progressively during the 2nd and 3rd trimester and decrease at the onset of labor and continue to decrease following delivery

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12
Q

tighter glucose control is req for which anesthetic techinque

A

c/s

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13
Q

mom has ___ response to atropine and propanolol

A

decreased

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14
Q

protamine sulfate anaphylaxis is seen in patients taking ___ or ___

A

NPH or protamine zinc insulin

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15
Q

diabetic patients have ____ clearance and ___ serum levels following epidural lidocaine

A

delayed, higher

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16
Q

DKA: plasma glucose >___, pH < ___, acetone positive :

A

> 300, 7.30. acetone positive 1:3

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17
Q

T/F Ketones cross placenta and decrease fetal oxygenation

A

TRUE

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18
Q

T/F continuous fetal heart monitoring is not required for DKA

A

FALSE

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19
Q

MLAC (minimum local anesthetic concentration) of bupivacaine in women at term gestation - obese women was ___% ___ than non-obsese

A

41% lower

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20
Q

T/F Despite lower anesthetic concentrations administered to obese women, they achieved higher sensory blockade with no differences in pain scores

A

TRUE

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21
Q

T/F Non-obese women have a greater distribution of epidural LA within epidural space compared to obese.

A

FALSE. greater distribution in obese

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22
Q

maternal DPB > ___ is associated with increased risk of placental abruption and fetal growth restriction

A

110

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23
Q

superimposed ____ with htn causes most of the morbidity

A

pre-eclampsia

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24
Q

PIH = sustained BP increase to SBP > ___ or DBP > ___

A

140, 90

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25
Q

T/F PIH is usually mild and early in pregnancy

A

FALSE - early

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26
Q

T/F PIH usually does not have renal or other systemic involvement

A

TRUE

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27
Q

T/f PIH resolves after delivery

A

FALSE - 12w postpartum

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28
Q

PIH may evolve to ____

A

preeclampsia

29
Q

Preeclampsia resolves within ___h postpartum

A

48

30
Q

preeclampsia is new onset HTN after ___ weeks gestation or early ____, previously normotensive.

A

20 , postpartum

31
Q

PIH proteinuria > ___

A

300mg/24h

32
Q

maternal risk factors for pre-eclamspia

A

first pregnancy, age younger then 18 or older than 35,
prior hx preeclampsia
black
chronic htn, renal dz, DM, antiphospholipid Syndrome
twins
fam hx

33
Q

maternal risk factors for pre-eclamspia

A

first pregnancy, age younger then 18 or older than 35,
prior hx preeclampsia
black
chronic htn, renal dz, DM, antiphospholipid Syndrome
twins
fam hx

34
Q

T/f Headache, visual disturbances, epigastric pain are seen in mild preeclampsia

A

FALSE - severe

35
Q

in pre-eclampsia plasma volume is ___

A

reduced

36
Q

in pre-eclampsia, CO and SVR are

A

increased

37
Q

in pre-eclampsia, CVP is ___ or ___

A

normal or slight increase

38
Q

T/F pulmonary edema occurs in 3% of pre-e pt’s

A

TRUE

39
Q

severe PIH or preeclampsia is complicated by ___ which is characterized by periportal hemm, ischemic lesion, generalized swelling, hepatic swelling, epigastric pain

A

HELLP

40
Q

in pre-e, GFR and CrCl ___

A

decrease

41
Q

in pre-e, BUN ____

A

increases

42
Q

T/F In a patient with pre-eclampsia, oliguria and renal failure may occur in the absence of hypovolemia. Be careful with hydration, as it can cause pulmonary edema

A

TRUE

43
Q

In pre-e, uterine activity is ____, and is ____ to oxytocin

A

increased, hyperactive

44
Q

in pre-e, uterine/placental blood flow is ___ by 50-70%

A

decreased

45
Q

T/F the incidence of uterine abruption is decreased in pre-e

A

FALSE - increased

46
Q

leading cause of maternal death in PIH is

A

ICH

47
Q

T/F DIC is usually associated with placental abruption and is uncommon as a primary manifestation of pre-e.

A

TRUE

48
Q

what does HELLP stand for

A

Hemolysis, elevated liver enzymes, low platelets

49
Q

HELLP is diagnosed at

A

36

50
Q

HELLP : hemostasis is problematic when platelets fall below

A

40k

51
Q

whats the definitive cure of HELLP

A

delivery. plt count is normal within 72h

52
Q

regional anesthesia is ___ in HELLP

A

contraindicated - fall is sudden

53
Q

whats the drug of choice for pre-e

A

MgSO4 (mag sulf)

54
Q

T/F MgSO4 does not significantly reduce systemic BP at the serum concentration that are efficacious in treating preeclampsia.

A

True

55
Q

Goals of care for pre-e

A

control BP, prevent sz, deliver fetus

56
Q

what drug do you not wanna give for htn and why?

A

nitroprusside - risk of cyanide toxicity in the fetus

57
Q

what should you give for magnesium toxicity

A

10 ml of 10% Ca Gluconate IV slowly

58
Q

plasma level of ca should be between

A

4-6

59
Q

5-10 mEq/L you’d see

A

prolonged PR, widened QRS

60
Q

11-14 mEq/L you’d see

A

depressed tendon reflexes

61
Q

15-24 mEq/L you’d see

A

SA, AV node block, resp paralysis

62
Q

> 25 mEq/L you’d see

A

cardiac arrest

63
Q

T/F In a mom, routine coats not recommended unless there is clinical suspicion

A

TRUE

64
Q

T/F Epidurals may reduce vasospasm and htn - may improve uteroplacental blood flow.

A

TRUE

65
Q

T/F Neuraxial anesthesia in pre-e pt is controversial… but can be safely administered.. dilute epidural infusions of LA plus opioids produce adequate sensory block without motor block or clinically significant sympathectomy

A

TRUE

66
Q

GA laryngeal response can be blunted by pre tx with ___ ___ or ___

A

hydralazine, nitroglycerin , labetalol

67
Q

In pt receiving mgso4, succs activity is ___ and ___ sensitivity to non-depolarizing relaxants

A

potentiated (need less), enhanced.

68
Q

T/F MgSO4 blunts response to vasoconstrictors and inhibits catecholamine release after sympathetic stim

A

TRUE

OB S.Horvath (5 decks)

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