pregnancy complications Flashcards
Which autoimmune disorders tend to improve in pregnancy?
Multiple sclerosis and rheumatoid arthritis
What is the pathopysiology of Systematic lupus erythematosus (SLE) (cause not symptoms)?
dysregulation of B cells that creates self antigens. Targets can include membranes, intracellular material, and/or nuclear material
What symptoms of lupus (SLE) may mimic pregnancy symptoms?
anemia and thrombocytopenia, as well as malar erythema (rash of hands) from lupus that can look like cholasma of pregnancy (normal pregnancy pigment changes or “mask” of pregnancy”
What is diagnostic criteria for SLE (lupus)?
Any 4 of the following: antinuclear antibodies, lupus antibodies, hemolytic anemia, anemia, thrombocytopenia, seizures or psychosis, persistent proteinuria, pleuritic or pericarditis, arthritis in two or more joints, oral pharyngeal ulcerations, photo-sensitivity, discoid lupus, or “ butterfly” rash of the face.
What maternal risks are increased in person with SLE (lupus)?
hypertension, nephritis, preeclampsia, thrombophilia (too much clotting), thromboembolism, and thrombocytopenia.
What are the potential complications to the baby or pregnancy of Lupus (SLE)?
miscarriage, IUGR, stillbirth, and neonatal death. Neonatal lupus can be acquired by fetus.
What screening and monitoring tests should be done with a patient with Lupus (SLE)?
baseline and serial labs to assess for a flare, serial utlrasonography, weekly biophysical profile (BPP in third trimester, and echocardiogram from women with anti-Ro/SSA of anti-LA/SSB antibodies.
What medication , if started before conception, is generally safe to continue?
hydroxychloroquine (Plaquenil)
What medications might be recommended if antiphosolipid antibodies are present (hint this increases blood clotting)?
prophylactic aspirin, or low- molecular weight heparin.
What are additional causes of acute abdomen (defined as sudden severe abdominal pain) related to pregnancy?
ectopic pregnancy, placental abruption, fatty liver, HELLP, or uterine rupture
What differences in diagnosing appendicitis in pregnancy people? Note - presenting symptoms usually the same.
Increased leukocytes are not helpful in diagnosis, due to normal elevation in pregnancy but can be use in serial labs for change over time.
Compression Ultrasound which is the standard of care may not be sufficient and MRI may be needed.
What is the pathophysiology of increased Cholecystitis in pregnancy?
increased estrogen levels lead to increased “biliary sludge” combined with slowed gastric emptying can lead to stone formation.
What other conditions are part of the differential diagnosis for Cholecystitis?
HELLP syndrome, acute fatty liver and hepatitis.
What is the pathophysiology of GERD in pregnancy?
decreased GI motility and relaxation of the lower esophageal sphincter
What are some atypical symptoms of GERD that indicate increased severity and need for increased intervention?
dyphagia, non-cardiac chest pain, abdominal pain, sore throats or dental erosions.
