Pregnancy Complications - Wootton

Question 1

Risk factors for GDM

Answer 1

Obesity, previous history, strong family history, known glucose intolerance

Question 2

Complications (mom) of GDM

Answer 2

• HTN
• Preeclampsia
• C-section
• DM later

Question 3

Complications (fetus) of GDM

Answer 3

• Macrosomia
• Hypoglycemia @ birth
• Hyperbilirubinemia
• Operative delivery
• Shoulder dystocia
• Birth trauma

Question 4

Pre-gestational DM is most crucial in what time period?

Answer 4

Embryogenesis - birth defects (6x increase)

Question 5

How to screen for GDM?

When do you screen? Why?

Negative value (1 hr)?

Answer 5

Glucose tolerance test

26-28 weeks (hPL is at highest, will make you glucose intolerant if it’s gonna happen at all)

Less than 135

Question 6

When are you diagnosed w/ GDM?

Treatment?

Answer 6

2+ abnormal GTT values (1 hr + 3 hr tests)

Diet counseling, oral hypoglycemic meds (glyburide), insulin

Question 7

Normal blood glucose fasting level (w/ treatment)

Normal post-prandial (2 hr) glucose level (w/ treatment)

Answer 7

Less than 90

Less than 120

Question 8

Maternal complications of GDM?

Main fetal complication? Requires what? Risk for what?

Other important complications?

Answer 8

DM later, birth trauma, HTN, preeclampsia

Macrosomia (large abdomen)

• C-section
• Risk for shoulder dystocia (can’t get belly out at birth)

Intrauterine death, hyperbilirubinemia, operative delivery, birth trauma

Question 9

A baby greater than ____ must be delivered via C-section

Answer 9

4500 grams

Question 10

32 G2P1 at 14 weeks, has had DM for 7 years, takes Metformin and Glyburide. High HbA1c

Maternal complications? (3)

Baby defects? (4)

Answer 10

• Worsening retinopathy or nephropathy
• Preeclampsia
• DKA
• ***Fetal cardiac defects
• Spontaneous aboriton
• Growth restrictions
• Prematurity

Question 11

Studies to evaluate maternal health in DM pregnancy? (5)

Answer 11

• Kidney function
• EKG (vascular dz)
• Ophthalmology
• Thyroid studies
• Glycemic control

Question 12

Studies to evaluate fetal health in DM pregnancy? (5)

Answer 12

• Ultrasound for dating, etc
• Biochemical testing/nuchal translucency
• Detailed ultrasound for fetal anatomy (EKG, etc.)
• Growth ultrasounds
• Antenatal testing

Question 13

How to deliver DM pregnancy? When?

Answer 13

Vaginal - try to get to wk 39 (lungs mature slower than normal)

Question 14

25 G3P1 at 30 weeks, has fever and tachycardia. Diaphoretic. Overactive thyroid and can’t remember what drugs she takes…

Dx?

Answer 14

Thyroid storm

• Beta blockers
• IV fluids
• Antipyretics
• PTU/Methimazole

Question 15

Fetal effects w/ hyperthyroidism

Answer 15

• Fetal goiter (can’t deliver)

- Fetal hypothyroidism

Question 16

How to treat hyperthyroidism in pregnancy?

Answer 16

PTU - 1st trimester (hepatotoxicity after)

Methimazole - 2nd/3rd (aplasia cutis before)

Question 17

How to treat hypothyroidism in pregnancy?

Monitor? Like in what else?

Answer 17

Thyroid replacement (levothyroxine)

TSH and free T4 (just like in hyperthyroidism)

Question 18

Fetal effects from untreated hypothyroidism

Answer 18

• CRETINISM
• Spontaneous abortion
• Preeclampsia
• Abruption
• Low birth weight
• Stillbirth
• Lower intelligence

Question 19

28, G2P1 at 28 weeks, pain in calf that is red, swollen and tender. Obese. Palpates a cord on palpation.

Most important test?
Dx?
Risk factors? (2)
Tx?

Answer 19

LE venous doppler

Superficial thrombophlebitis (NOT DVT)

Sedentary, pregnant

Tylenol, ice, heat, etc.

Question 20

35, G1P1, 6 weeks post-partum. Pain in R calf worse with walking. Edema and tenderness, bigger than L calf. Pain w/ dorsiflexion…

Testing?
Dx? Why?
Tx?
Med monitoring? (3)
Long-term management? (3)

Answer 20

LE venous doppler

DVT - from pregnancy

Anticoagulation (Lovenox, then Warfarin)

INR (once on Warfarin)
Factor Xa (Lovenox)
aPTT (Heparin)

3-6 months post-partum, prophylax future pregnancies, NO combo OCPs

Question 21

Treating DVT DURING pregnancy? Why?

Answer 21

Lovenox, then Heparin at 36 weeks until birth (can be reversed before birth)

Question 22

29, G1 at 30 weeks w/ pleuritic chest pain, shortness of air and palpitations. 2 months ago complained of back pain, pelvic pain, leg pain, and headaches. Coughing up blood now.

Dx?
Findings on PE?
How to evaluate? (5)
Tx?
Work-up?

Answer 22

PE

Tachypnea, tachycardia, fever, pleural friction rub, chest splinting, pulmonary rales, accentuated pulmonic valve S2

V/Q scan or CT angiography, ABG, EKG, CXR

Anticoagulation (Lovenox, then Heparin at 36 wks)

Thrombophilia workup (LAC, Factor V Leiden, Protein C and S, AT3, Prothrombin mutation)

Question 23

Read through the rest of the powerpoint

Answer 23

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