Pregnancy complications 3

Question 1

Gestational hypertension

Answer 1

hypertension that develops after 20 weeks gestation without proteinuria or signs of end-organ dysfunction

Question 2

distinguish gestational HTN from chronic HTN

Answer 2

chronic = hypertension precedes pregnancy or starts prior to 20 weeks gestation

Question 3

what percent of pts diagnosed w gestational HTN will develop preeclampsia

Answer 3

10-50%

Question 4

The recommended monitoring of patients with gestational hypertension

Answer 4

measuring blood pressure once or twice weekly; measuring urine protein, platelets, creatinine, and liver transaminases weekly; conducting a biophysical profile or nonstress test of the fetus weekly beginning at 32 weeks gestation; and performing an ultrasound every 3 to 4 weeks after diagnosis to assess fetal growth

Question 5

severe HTN

Answer 5

Patients with blood pressure of ≥ 160 mm Hg systolic or 110 mm Hg diastolic are considered to have severe hypertension

Question 6

lifestyle changes for gestational HTN

Answer 6

Patients should be educated to avoid strength training and generally avoid aerobic exercise unless it is documented that aerobic exercise does not increase the patient’s blood pressure. In addition, patients with gestational hypertension should be educated to monitor fetal movement daily and to call if it is decreased or absent

Question 7

when is tx recommended in gestational HTN

Answer 7

Treatment is recommended in women with severe hypertension

Furthermore, it is recommended in most women with persistent hypertension of 150–160 mm Hg systolic or 100–110 mm Hg diastolic

Question 8

MC used antihypertensives for gestational HTN

Answer 8

labetalol, extended-release nifedipine, and hydralazine

Question 9

delivery for gestational HTN

Answer 9

Women with hypertension consistently > 140 mm Hg systolic or 90 mm Hg diastolic are typically delivered at 37 weeks

Question 10

when does a fetus have a 100% and 50% chance of being RhD positive

Answer 10

If the father is homozygous for the RhD phenotype, the fetus has a 100% chance of being RhD positive. If the father is RhD heterozygous, the fetus has a 50% chance of being RhD positive

Question 11

when will alloimmunization occur

Answer 11

The first pregnancy involving an RhD-negative mother and an RhD-positive fetus will result in alloimmunization

Question 12

consequences of Rh incompatibility

Answer 12

The maternal blood will produce antibodies that destroy the red blood cells of the fetus. Consequences of this include fetal anemia, hydrops fetalis, preterm labor, and fetal demise

Question 13

subsequent pregnancies w Rh incompatibility

Answer 13

Subsequent pregnancies involving RhD-positive fetuses will produce more rapid and aggressive antibody response, with symptoms of fetal demise at an earlier gestational age

Question 14

Prevention of alloimmunization in cases of RhD incompatibility

Answer 14

administration of anti-D immune globulin at 28 weeks of the first and each subsequent gestation

Question 15

If RhD incompatibility is suspected due to parental genetics

Answer 15

maternal anti-D titers should be measured serially until a critical titer level (usually 1:16 or 1:32) is reached, at which time, Doppler velocimetry of the middle cerebral artery of the fetus should be measured

Question 16

MCA and decreased hemoglobin - Rh alloimmunization

Answer 16

Increased velocity through the middle cerebral artery correlates with decreased hemoglobin

Question 17

what should you do if velocity indicates critical fetal anemia

Answer 17

If the velocity, once adjusted for gestational age, indicates critical fetal anemia, then cordocentesis should be performed to measure fetal hemoglobin and determine the need for transfusion

Question 18

If autoantibodies have already been developed in previous pregnancies

Answer 18

plasmapheresis and intravenous administration of immunoglobulin G may be considered to slow the progression of fetal complications

Question 19

severe fetal anemia

Answer 19

fetal hematocrit under 30% or fetal hemoglobin more than two standard deviations below the mean value for gestational age

Question 20

Hydrops fetalis

Answer 20

a complication of hemolytic disease of the fetus and newborn and is characterized by skin edema, ascites, pericardial effusion, pleural effusion, and severe anemia (e.g., fetal hemoglobin < 5 g/dL or a hematocrit < 15%). Thrombocytopenia and neutropenia may also be present

Question 21

dx hydrops fetalis

Answer 21

Diagnosis is made by comparing maternal and fetal blood type and Rh status, detecting anti-D antibodies in maternal blood, and performing a direct antiglobulin test (Coombs test) on cord blood, which confirms the presence of fetal red blood cells coated with maternal antibodies

Question 22

when should anti-D immune globulin be administered

Answer 22

at 28 weeks gestation in Rh-negative mothers and again after delivery if the infant is Rh positive

Question 23

Management of hydrops fetalis secondary to Rh incompatibility

Answer 23

cardiopulmonary stabilization, drainage of ascites or effusion if ventilation is compromised, and blood transfusion for severe anemia

Question 24

What is the term for hemolytic disease of the newborn when the infant is still in utero?

Answer 24

Erythroblastosis fetalis

Question 25

when is GBS screening recommended

Answer 25

between 35 and 37 weeks gestation

Question 26

what can GBS cause in a neonate

Answer 26

neonatal sepsis

Question 27

exception to screening for GBS

Answer 27

he screening is recommended in all pregnant women with the exception of women who have had a urine culture grow group B Streptococcus during the current pregnancy or who have had an infant with early-onset group B Streptococcus infection previously since these women will be treated prophylactically at delivery regardless of screening

Question 28

recommended tx GBS

Answer 28

PCN

Question 29

True or false: the annual influenza vaccine is contraindicated in pregnancy

Answer 29

False. It is highly recommended because pregnant women can have more severe symptoms of influenza

Question 30

MC pathogen in cystitis

Answer 30

E coli

Question 31

dx cystitis

Answer 31

urine culture

Question 32

what on UA can support dx of cystitis

Answer 32

pyuria, leukocyte esterase, nitrites, and hematuria

Question 33

Pregnant women with cystitis are at increased risk of developing

Answer 33

pyelo

Question 34

tx cystitis in pregnancy

Answer 34

Fosfomycin, amoxicillin-clavulanate, and cefpodoxime

Patients with acute cystitis during pregnancy should have a follow-up urine culture to confirm the urine has become sterile

Question 35

recurrent cystitis during pregnancy

Answer 35

at least 3 episodes

Question 36

tx recurrent cystitis in pregnancy

Answer 36

postcoital prophylactic therapy or daily suppressive therapy

Question 37

should pts w asx bacteriuria be treated during pregnancy

Answer 37

yes, due to increased risk of preterm birth, low birth weight, and perinatal mortality

Question 38

Which medication used to treat cystitis can be administered as a single dose?

Answer 38

Fosfomycin

Question 39

when does pyelo during pregnancy most often occur

Answer 39

during 2nd or 3rd trimester

Question 40

tx pyelo in pregnancy

Answer 40

regnant patients with acute pyelonephritis are admitted to the hospital for intravenous antibiotics (use broad spectrum beta lactams)

Question 41

what abx is used most often in pyelo in pregnancy

Answer 41

ceftriaxone

if immunocompromised or incomplete urinary drainage - piperacillin-tazobactam or a carbapenem