Pregnancy complications 3 Flashcards

1
Q

Gestational hypertension

A

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

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2
Q

distinguish gestational HTN from chronic HTN

A

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

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3
Q

what percent of pts diagnosed w gestational HTN will develop preeclampsia

A

10-50%

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4
Q

The recommended monitoring of patients with gestational hypertension

A

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

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5
Q

severe HTN

A

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

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6
Q

lifestyle changes for gestational HTN

A

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

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7
Q

when is tx recommended in gestational HTN

A

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

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8
Q

MC used antihypertensives for gestational HTN

A

labetalol, extended-release nifedipine, and hydralazine

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9
Q

delivery for gestational HTN

A

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

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10
Q

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

A

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

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11
Q

when will alloimmunization occur

A

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

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12
Q

consequences of Rh incompatibility

A

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

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13
Q

subsequent pregnancies w Rh incompatibility

A

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

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14
Q

Prevention of alloimmunization in cases of RhD incompatibility

A

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

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15
Q

If RhD incompatibility is suspected due to parental genetics

A

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

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16
Q

MCA and decreased hemoglobin - Rh alloimmunization

A

Increased velocity through the middle cerebral artery correlates with decreased hemoglobin

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17
Q

what should you do if velocity indicates critical fetal anemia

A

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

18
Q

If autoantibodies have already been developed in previous pregnancies

A

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

19
Q

severe fetal anemia

A

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

20
Q

Hydrops fetalis

A

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

21
Q

dx hydrops fetalis

A

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

22
Q

when should anti-D immune globulin be administered

A

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

23
Q

Management of hydrops fetalis secondary to Rh incompatibility

A

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

24
Q

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

A

Erythroblastosis fetalis

25
when is GBS screening recommended
between 35 and 37 weeks gestation
26
what can GBS cause in a neonate
neonatal sepsis
27
exception to screening for GBS
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
28
recommended tx GBS
PCN
29
True or false: the annual influenza vaccine is contraindicated in pregnancy
False. It is highly recommended because pregnant women can have more severe symptoms of influenza
30
MC pathogen in cystitis
E coli
31
dx cystitis
urine culture
32
what on UA can support dx of cystitis
pyuria, leukocyte esterase, nitrites, and hematuria
33
Pregnant women with cystitis are at increased risk of developing
pyelo
34
tx cystitis in pregnancy
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
35
recurrent cystitis during pregnancy
at least 3 episodes
36
tx recurrent cystitis in pregnancy
postcoital prophylactic therapy or daily suppressive therapy
37
should pts w asx bacteriuria be treated during pregnancy
yes, due to increased risk of preterm birth, low birth weight, and perinatal mortality
38
Which medication used to treat cystitis can be administered as a single dose?
Fosfomycin
39
when does pyelo during pregnancy most often occur
during 2nd or 3rd trimester
40
tx pyelo in pregnancy
regnant patients with acute pyelonephritis are admitted to the hospital for intravenous antibiotics (use broad spectrum beta lactams)
41
what abx is used most often in pyelo in pregnancy
ceftriaxone if immunocompromised or incomplete urinary drainage - piperacillin-tazobactam or a carbapenem
42