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Repro 2 > Pregnancy Complications - Wootton > Flashcards

Pregnancy Complications - Wootton Flashcards

1
Q

Risk factors for GDM

A

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

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2
Q

Complications (mom) of GDM

A
  • HTN
  • Preeclampsia
  • C-section
  • DM later
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3
Q

Complications (fetus) of GDM

A
  • Macrosomia
  • Hypoglycemia @ birth
  • Hyperbilirubinemia
  • Operative delivery
  • Shoulder dystocia
  • Birth trauma
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4
Q

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

A

Embryogenesis - birth defects (6x increase)

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5
Q

How to screen for GDM?

When do you screen? Why?

Negative value (1 hr)?

A

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

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6
Q

When are you diagnosed w/ GDM?

Treatment?

A

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

Diet counseling, oral hypoglycemic meds (glyburide), insulin

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7
Q

Normal blood glucose fasting level (w/ treatment)

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

A

Less than 90

Less than 120

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8
Q

Maternal complications of GDM?

Main fetal complication? Requires what? Risk for what?

Other important complications?

A

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

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9
Q

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

A

4500 grams

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10
Q

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

Maternal complications? (3)

Baby defects? (4)

A
  • Worsening retinopathy or nephropathy
  • Preeclampsia
  • DKA
  • ***Fetal cardiac defects
  • Spontaneous aboriton
  • Growth restrictions
  • Prematurity
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11
Q

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

A
  • Kidney function
  • EKG (vascular dz)
  • Ophthalmology
  • Thyroid studies
  • Glycemic control
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12
Q

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

A
  • Ultrasound for dating, etc
  • Biochemical testing/nuchal translucency
  • Detailed ultrasound for fetal anatomy (EKG, etc.)
  • Growth ultrasounds
  • Antenatal testing
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13
Q

How to deliver DM pregnancy? When?

A

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

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14
Q

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

Dx?

A

Thyroid storm

  • Beta blockers
  • IV fluids
  • Antipyretics
  • PTU/Methimazole
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15
Q

Fetal effects w/ hyperthyroidism

A
  • Fetal goiter (can’t deliver)

- Fetal hypothyroidism

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16
Q

How to treat hyperthyroidism in pregnancy?

A

PTU - 1st trimester (hepatotoxicity after)

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

17
Q

How to treat hypothyroidism in pregnancy?

Monitor? Like in what else?

A

Thyroid replacement (levothyroxine)

TSH and free T4 (just like in hyperthyroidism)

18
Q

Fetal effects from untreated hypothyroidism

A
  • CRETINISM
  • Spontaneous abortion
  • Preeclampsia
  • Abruption
  • Low birth weight
  • Stillbirth
  • Lower intelligence
19
Q

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?

A

LE venous doppler

Superficial thrombophlebitis (NOT DVT)

Sedentary, pregnant

Tylenol, ice, heat, etc.

20
Q

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)
A

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

21
Q

Treating DVT DURING pregnancy? Why?

A

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

22
Q

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?
A

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)

23
Q

Read through the rest of the powerpoint

A

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Repro 2 (28 decks)

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