Obstetrics- Physiologic changes & medical complicaitons

Question 1

Magnesium sulfate toxicity

Answer 1

Marked Muscle weakness
Loss od DTR
respiratory depression
cardiac arrest

Question 2

Assessment of headache in pregnancy

Answer 2

Headache with atypical features (AMS, neuro deficits) or in patients >20wks gestation require evaluation to exclude other etiologies, such as preeclampsia or thrombosis due to risk of adverse maternal and fetal outcomes

Question 3

Management of migraine in pregnancy

Answer 3

1. Non pharmacological therapy ( rest, hydration, dark room), Caffeine
2. Acetaminophen (first line pharm)
3. Low potency opioid (Percocet) & antiemetics
4. Potent opioids (oxycodone)

Question 4

Low back pain during pregnancy etiology

Answer 4

Uterine enlargement causes exaggerated lordosis and postural changes.
Weakened abd muscles decreased lumbar support
INcreasaed joint/ ligament laxity from increased progesterone/ relaxin.

Question 5

Risk factors for low back pain during pregnancy

Answer 5

Excessive weight gain
Chronic back pain
Back pain prior to pregnancy
Multiparity

Question 6

Concerning features of Low back pain that require investigation

Answer 6

Non mechanical causes: preterm labor, pyelonephritis, spinal malignancy

Fever
Neurological defects (incontinence)
Constant, non-positional, Nocturnal back pain

Question 7

Risks for preeclampsia

Answer 7

High: 
Prior preeclampsia (specially with severe features) 
CKD
HTN
DM
Autoimmune disease

Medium:
Obesity
Advanced age

Question 8

Preeclampsia prophylaxis

Answer 8

Low dose aspirin. Initiated 12-28wks (ideally before 16) continued until delivery

Question 9

Pregnancy physiologic changes: PULMONARY

Answer 9

Dyspnea
↑Central respiratory drive (↑ Tidal volume= hyperventilation)
↑PaO2 to 110
↓PaO2 (respiratory alkalosis with metabolic compensation)

Question 10

Mechanism of pulmonary changes in pregnancy

Answer 10

↑ progesterone –> triggers sensation of dyspnea –> hypothalamus increases resp. drive

Hormone-induced laxity of the intercostal muscles also enlarges the thoracic cavity.