Pregnancy complications 3 Flashcards
Gestational hypertension
hypertension that develops after 20 weeks gestation without proteinuria or signs of end-organ dysfunction
distinguish gestational HTN from chronic HTN
chronic = hypertension precedes pregnancy or starts prior to 20 weeks gestation
what percent of pts diagnosed w gestational HTN will develop preeclampsia
10-50%
The recommended monitoring of patients with gestational hypertension
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
severe HTN
Patients with blood pressure of ≥ 160 mm Hg systolic or 110 mm Hg diastolic are considered to have severe hypertension
lifestyle changes for gestational HTN
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
when is tx recommended in gestational HTN
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
MC used antihypertensives for gestational HTN
labetalol, extended-release nifedipine, and hydralazine
delivery for gestational HTN
Women with hypertension consistently > 140 mm Hg systolic or 90 mm Hg diastolic are typically delivered at 37 weeks
when does a fetus have a 100% and 50% chance of being RhD positive
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
when will alloimmunization occur
The first pregnancy involving an RhD-negative mother and an RhD-positive fetus will result in alloimmunization
consequences of Rh incompatibility
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
subsequent pregnancies w Rh incompatibility
Subsequent pregnancies involving RhD-positive fetuses will produce more rapid and aggressive antibody response, with symptoms of fetal demise at an earlier gestational age
Prevention of alloimmunization in cases of RhD incompatibility
administration of anti-D immune globulin at 28 weeks of the first and each subsequent gestation
If RhD incompatibility is suspected due to parental genetics
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
MCA and decreased hemoglobin - Rh alloimmunization
Increased velocity through the middle cerebral artery correlates with decreased hemoglobin
what should you do if velocity indicates critical fetal anemia
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
If autoantibodies have already been developed in previous pregnancies
plasmapheresis and intravenous administration of immunoglobulin G may be considered to slow the progression of fetal complications
severe fetal anemia
fetal hematocrit under 30% or fetal hemoglobin more than two standard deviations below the mean value for gestational age
Hydrops fetalis
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
dx hydrops fetalis
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
when should anti-D immune globulin be administered
at 28 weeks gestation in Rh-negative mothers and again after delivery if the infant is Rh positive
Management of hydrops fetalis secondary to Rh incompatibility
cardiopulmonary stabilization, drainage of ascites or effusion if ventilation is compromised, and blood transfusion for severe anemia
What is the term for hemolytic disease of the newborn when the infant is still in utero?
Erythroblastosis fetalis
when is GBS screening recommended
between 35 and 37 weeks gestation
what can GBS cause in a neonate
neonatal sepsis
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
recommended tx GBS
PCN
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
MC pathogen in cystitis
E coli
dx cystitis
urine culture
what on UA can support dx of cystitis
pyuria, leukocyte esterase, nitrites, and hematuria
Pregnant women with cystitis are at increased risk of developing
pyelo
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
recurrent cystitis during pregnancy
at least 3 episodes
tx recurrent cystitis in pregnancy
postcoital prophylactic therapy or daily suppressive therapy
should pts w asx bacteriuria be treated during pregnancy
yes, due to increased risk of preterm birth, low birth weight, and perinatal mortality
Which medication used to treat cystitis can be administered as a single dose?
Fosfomycin
when does pyelo during pregnancy most often occur
during 2nd or 3rd trimester
tx pyelo in pregnancy
regnant patients with acute pyelonephritis are admitted to the hospital for intravenous antibiotics (use broad spectrum beta lactams)
what abx is used most often in pyelo in pregnancy
ceftriaxone
if immunocompromised or incomplete urinary drainage - piperacillin-tazobactam or a carbapenem
