Pregnancy Flashcards
Hyperthyroidism
PTU first trimester, Methimazole thereafter
Avoid radioactive iodine in pregnancy/breastfeeding.
Diabetes
Screening for gestation at 24-28 weeks with 75g 2 hour OGTT
History of gestational DM, high risk for DM2, screen annually.
Use insulin only, not orals. Dont use ACE/ARB or cholesterol meds. Eye exam once per trimester.
Valve disorders
Replace/repair valves that meet criteria for severe prior to pregnancy, even if asymptomatic.
Sickle Cell
Treat simple occlusive crises the same as with non-pregnant people. NSAIDS safe before 30 weeks.
Transfuse only for significant anemia with symptoms, including fetal distress, end organ damage, acute chest syndrome, stroke.
Exchange transfusion is also not routinely indicated.
Hydroxyurea is teratogenic.
Pulmonary Embolism
If there is suspicion for PE, do LE duplex first because diagnosing DVT will lead to anticoagulation anyway as well as spare radiation/contrast.
V/Q is first choice if duplex is not diagnostic, then do CT angiogram if V/Q unavailable.
D-dimer is elevated in pregnancy anyway therefore it is useless.
Pre-eclampsia
New onset HTN after 20weeks with presence of proteinuria (>300mg), thrombocytopenia (<100K), kidney dysfunction, LFT abnormalities, pulmonary edema or visual/cerebral symptoms.
HTN and pregnancy
Is chronic if existed before pregnancy, starts before 20 weeks, or persists longer than 12 weeks postpartum.
Treat HTN if systolic greater than 150.
Methyldopa, labetalol, nifedipine all safe
Mammary Souffle
Murmur heard over the breast, during late pregnancy and lactation. From increased blood flow.
Gallstones
Lap chole is ok in the 2nd trimester. If gallstone pancreatitis, still take the gallbladder out.
ERCP ok but surgery is preferred
Anticoagulation in pregnancy
Afib/VTE/dose >5mg/day should switch to LMWH
Mechanical heart valve: Continue warfarin, ASA ok too
TDaP
Every pregnancy, best between 27-36 weeks.
Peripartum Cardiomyopathy
Diagnosed towards the end of pregnancy or within a few months of delivery.
Digoxin, B-blocker, nitrate/hydralazine, diuretic. Avoid ACE/ARB and spironolactone until delivery.
Anti coagulate with warfarin if EF <35%
Should avoid subsequent pregnancy if EF remains low
Gestational thrombocytopenia
OK if between 100K-150. No other symptoms can be reported (gingival bleeding, petechiae, bruising,etc)
If <80K should be evaluated for other etiologies.
Intrahepatic cholestasis of prenancy
Pruritis (worse on palms/soles)
Occurs late 2nd/early 3rd trimester
Inc AST/ALT, Inc Bili, Normal INR!
Tx with ursodeoxycholic acid and delivery at 36 weeks.
Gestational diabetes
Target glucose: fasting <95
1 hour post prandial <140
2 hour post prandial <120
