Tuesday, 2-28-Medical conditions in pregnancy (Wootton) Flashcards
when do you screen for Gestational DM? How do you screen?
24-28 weeks
50 gm 1 hr oral load glucose challenge test –> if abnormal followed by a 3 hr 100 gm oral load glucose tolerance test
risk factors for GDM development?
- fat
- previous hx of GDM
- strong FH of DM
- known glucose intolerance
maternal complications of GDM?
- increase risk of gestational HTN
- increased risk of preeclampsia
- greater risk of C section
- increase risk of developing diabetes later
fetal complications of GDM?
- MACROSOMIA
- neonatal hypoglycemia
- hyperbilirubinemia
- operative delivery
- SHOULDER DYSTOCIA
- birth trauma
maternal complications of Pregestational diabetes?
worsening nephropathy and retinopathy, increased risk of developing preeclampsia, greater risk of DKA
fetal complications from pre gestational diabetes?
increase risk of spontaneous abortions, anatomic birth defects (sacral agenesis), fetal growth restriction and prematurity
with good glycemic control, fasting glucose should be less than __ mg/dl, 2 hour postprandial glucose less than __ mg/dl
fasting < 90
2 hr postprandial <120
maternal evaluation for antepartum mgmt of preexisting diabetes?
renal-24 hr collections every trimester
cardiac-EKG
ophthalmic-detailed eye exam in 1st tri
glycemic control-monitor daily fingerstick glucose values and HgBA1C
fetal evaluation for anterpartum mgmt of preexisting diabetes?
early dating US
BCHEM testing for congenital malformations at 16-20 wks
fetal testing (NST/BPP) every week starting 32-34 wks
at what US-estimated fetal weight would you want to recommend caesarean delivery?
4500 gm
how to dx maternal hyperthyroidism?
elevated free T4 and suppressed TSH
When to use methimazole and/or PTU for maternal hyperthyroidism?
methimazole in 2nd and 3rd trimester –> can cause aplasia cutis and choanal atresia in 1st tri
PTU in 1st trimester only –> increased risk of liver toxicity if beyond 1st tri
monitor levels of what throughout pregnancy with maternal hyperthyroidism?
TSH
signs and symptoms of thyroid storm? tx?
s/s: hyperthermia, tachy, perspiring, high CO failure, maternal mortality rate of ~25%
tx: B-blockers (propanolol)), block secretion of thyroid hormone (Na iodide), stop synthesis of thyroid hormone (PTU), halting peripheral conversion of T4 to T3 (dexamethasone), replace fluid loss, bring temp down
increased risk associated with untreated maternal hypothyroidism? tx? monitor what monthly?
increased risk: spontaneous abortion preeclampsia abruption low birth weight infants stillbirth low intelligence
tx: thyroid replacement, i.e., Levothyroxine
monitor TSH and free T3/4 levels monthly
result of neonatal hypothyroidism?
deficiency results in generalized developmental retardation
flares of SLE tx with? fetal complications?
tx with prednisone
fetal complications: preterm delivery, fetal growth restrictions, stillbirth, miscarriage
pregnancy complications in mother w/ antiphospholipid syndrome? tx w/?
increase risk of miscarriage
risk for developing preeclampsia
fetal growth restriction
tx: heparin/LMW heparin and low-dose aspirin
most common cause of asymptomatic bacteriuria/UTI in pregnant mom? tx?
E coli
may need suppressive abx tx with recurrent infx
pyelonephritis in mom can result in what? tx?
can result in adult RDS
Tx: IV hydration, abx, antipyretics, tocolytics if needed, will need suppression for remainder of pregnancy
tx of n/v of pregnancy?
symptomatic-vit B6, doxylamine, promethazine
50-80% of women complain of n/v during first 8-12 weeks
when does hyperemesis gravidarum frequently occur? outcomes? tx?
frequently in 1st pregnancies, multiple pregnancies, trophoblastic disease
outcomes are good
tx is symptomatic
tx of GERD? tx of peptic ulcer?
GERD: symptomatic –> small meals, avoid lying down after eating, elevate head when sleeping, antacids, H2 blockers/PPIs
Ulcers: pregnancy may improve condition, tx is avoid caffeine, alcohol, tobacco, spicy foods; antacids, H2 blockers/PPIs, abx tx to tx H pyolori
tx of acute fatty liver of pregnancy?
- termination of pregnancy
- supportive care –> IV fluids w/10% glucose, FFP and cryoprecipitate
- maternal mortality 7-18%
- fetal mortality 9-23%
- if survive, usually full recovery
most common cause of anemia in pregnancy? when to screen? how to tx?
Fe-deficiency
screened at initial prenatal visit and again at 26-28 wks
Fe supplementation
symptoms and tx of superficial thrombophlebitis in pregnant woman?
symptoms: swelling, tenderness
tx: bed rest, pain meds, local heat, no need for anticoag, wear support hose
symptoms of DVT? Dx? Tx?
symptoms: more common in left leg than right, pain in calf with dorsiflexion (Homanns sign), may also have dull ache, tingling, or pain with walking
Dx: clinically difficult (50% are asymptomatic), compression US with doppler flow, MRI may be used if suspect pelvic thrombosis
tx: anticoag tx should be initiated when clinically dx
- use LMW or UFH –> follow aPTT values with Heparin and Factor Xa values w/LMW to assure therapeutic values
- Coumadin used for 6 wks postpartum but NOT during pregnancy d/t risk of fetal hemorrhage or teratogenesis (Follow INR)
symptoms of PE? signs?
symptoms: pleuritic chest pain, short of air, air hunger, palpitations, hempotysis
signs: tachypnea, tachycardia, low grade fever, pleural friction rub, chest splinting, pulm rales, accentuated pulm valve 2nd heart sound
evaluation of PE? tx?
Eval: EKG, CXR, ABG, VQ scan, helical CT
tx: Anticoag (Lovenox then heparin)
what do pts with DVT or PE have to get worked up for?
thrombophilia work up –> lupus anticoag, anticardiolipid Ab, Factor V leiden, Protein c and s, ATIII, Prothrombin G20210A
severe asthma associated with increase in?
miscarriage preeclampsia intrauterine fetal demise intrauterine fetal growth restriction preterm delivery
most common type of HA in pregnancy? how to tx?
Tension –> tx with acetaminophen
which anti-seizure med is more teratogenic than the others? which anti-seizure meds most commonly used?
valproate
most commonly used seizure meds are dilantin and phenobarbital
how long after giving birth should you be concerned for postpartum depression if the mother is depressed after giving birth?
2 weeks post-birth
