Pregnancy

Question 1

Management of sickle cell disease in pregnancy?

RE: hydroxyurea, folic acid, transfusions

Answer 1

Hold hydroxyurea 3 months before conception; increase folic acid to 4mg; unnecessary unless necessary for the mother.

Patients are at increased risk of pre-eclampsia and VOC.

Question 2

Pregnancy + n/v, RUQ pain, headache, jaundice, and/or polyuria/polydipsia = ?

Name condition and treatment. What enzyme deficiency is this associated with?

(Not HELLP, which often presents similarly)

Answer 2

Acute fatty liver of pregnancy, which can be associated with a transient diabetes insidious. Treatment is immediate delivery of the fetus - the mother remains at risk for this in future pregnancies, however.

Associated with 3-hydroxyacylCoA dehydrogenase deficiency - screen both mother and children

Question 3

Intrahepatic cholestasis of pregnancy occurs in the 2nd or 3rd trimester and occurs due to ___ induced inhibition of __ export from hepatocytes. Treated who ___, and can cause fetal distress or premature labor.

Answer 3

sex-hormone; bile salt; ursodeoxycholic acid

Question 4

Treatment of HBV during pregnancy. HBV DNA>200k between weeks __ and __ should start on oral ___.

Following birth, what should be administer to newborns within 12 hours of delivery?

Answer 4

24 and 28; antivirals such as lamivudine, telbivudine or tenofovir.

Administer HBV immune globulin AND HBV vaccine

Question 5

Management of autoimmune hepatitis during pregnancy - what meds are continued?

Answer 5

Prednisone and AZA

Question 6

Pregnant + concern for PTE - what imaging modality?

Answer 6

Get a v/q scan

Question 7

Pregnancy + Marfan’s = increased risk for _, especially if aortic diameter is >4.5

Answer 7

Aortic dissection - recommend repair before pregnancy in these cases