Pregnancy Flashcards
A normal pregnancy is 40 weeks counted from…
the start of the last menstrual period
Pregnancy is considered full term at
37 weeks
What is preterm?
born before 37 weeks
What is premature?
organ systems are not fully developed (usually lungs)
of times a mother has been pregnant (regardless of results)
gravida
of births > 20 weeks (multiples count as 1)
parity/para
How do you notate a mother pregnant with her second child?
gravida 2, para 1
Pre-eclapsia/eclampsia is more common in
primigravids aka first pregnancy
T/F IOP commonly increases in late pregnancy
false, decreases
19% in normal 24% in OHTN
decrease in IOP late pregnancy
What vascular effects account for reduced IOP?
increased aqueous outflow, reduced episcleral venous pressure, decreased scleral rigidity, general acidosis during pregnancy
What is a potential glaucoma tx for pregnant patients?
SLT
What are pregnancy corneal changes?
decreased sensitivity, increased curvature, changes in thickness/index of refraction
T/F OSD commonly leads to CL intolerance?
true
How is tear film physiology altered?
immune reaction in lacrimal duct cells, destruction/disruption of acinar cells by prolactin, and other growth factors, general dehydration from vomiting and anti-emetics
What are ocular physiologic changes?
pigmentation, ptosis, Graves
What two pigment changes occur?
melasma or chloasma “pregnancy mask”
Melasma
increased pigmentation of the skin
Chloasma
specifically pigmentation to the face
Who is at the highest risk for pregnancy mask
patients with light brown skin in areas with high sun exposure
What causes increased pigmentation around the eyes?
increased estrogen, progesterone, and melanocytes-stimulating hormones
When is eye pigmentation common other than pregnancy?
patch contraceptive and HRT
When does pregnancy mask resolve?
after delivery or d/c of meds
Why is ptosis common?
fluid retention and hormonal effect on levator aponeurosis– typically unilateral (resolves postpartum)
T/F Graves orbitopathy may develop or worsen in those with Graves hyperthyroidism during pregnancy
true, tends to resolve postpartum
Development of krukenberg spindles…
develop early in pregnancy and usually tend to decrease in size during the third trimester and postpartum
T/F a decrease in autofluorescence is reported (lens?)
true
Does pregnancy affect cataracts?
increased liquid volume during pregnancy might result in development or exacerbation of cataracts
What lens refractive changes occur?
increasing in central and thinnest corneal thickness in the second and third trimesters of pregnancy which returns to the normal value with delivery
When does pregnancy induced hypertension occur?
after the 20th week
Pre-eclampsia
HTN systolic >140 or dialstolic >90 + peripheral edema, proteinuria (>300 mg/24 hours)
Eclampsia
pre-eclampsia + seizures
Risk factors of pre-eclampsia
having multiples, older or younger mom, vascular disease, fetal abnormalities
Finland study on pre-eclampsia
mother’s with first pregnancy over the age of 35 had higher rate of pre-eclampsia (9.4%) compared to those under 35 (6.4%)
Ocular effects of pregnancy induced HTN
arterial narrowing, exudate and edema, RNFL infarct, neo or vit heme, serous RD, papillary edema, NA-AION, optic atrophy, cortical blindness from occipital lobe infarcts
How often do serous RDs occur?
1% pre-eclampsia 10% eclampsia
Article on pre-eclampsia and visual effects
Pre-eclampsia occurs in about 5% of pregnancies and visual/ocualar effects of pre-eclampsia occur in 1/3 of those cases
HELLP syndrome
hemolysis, elevated liver enzyme, low platelets
Retinal findings of HELLP syndrome
bilateral serous RD, sub-retinal opacities, vitreous hemes
PEHPES
pre-eclampsia-eclampsia HTN posterior encephalopathy syndrome
Ocular effects of PEHPES
HA, blurred vision, cortical blindness
Central serous retinopathy
localized serous RD with white exudate and fibrin in pregnancy and resultant pigment mottling
When does central serous develop?
3rd trimester
T/F pregnancy increased risk of CSCR up to 9x
true
Does CSR recur after delivery?
Yes, there is a higher chance
What makes pregnancy CSR different?
90% of pts have fibrin layer within
Is pregnancy a risk for diabetic retinopathy?
yes, duration of diabetes prior to pregnancy is important
What factors increase risk of diabetic retinopathy?
presence of DR at conception, poor glycemic control, rapid normalization of glycemic levels, HTN/pre-eclampsia
How do you treat diabetic retinopathy during pregnancy?
photocoagulation if severe
Normal and diabetic FBG
normal: <100 mg/dL and diabetic >/=126
Normal and diabetic RBG (same as 2 hr OGTT)
normal: <140 mg/dL and diabetic >/= 200
Normal and diabetic HbA1c
normal: <5.7% and diabetic >/=6.5%
Recommendations for pregnant diabetics
have eye exam prior to conceptions, and during 1st trimester
What is DM follow up during pregnancy?
No ret to moderate NPDR 2-12 months and severe NPDR or worse 1-3 months
Do gestational diabetics require an eye exam?
no
Medication categories A-X
A: human studies no risk. B: animal no risk/no human evaluated. C: animal risk, no human study. D: risk to fetus in humans use caution. X: contraindicated
New drug label system
pregnancy, lactation and male/female reproduction paragraphs
