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Repro 2 Final > Medical Conditions in Pregnancy > Flashcards

Medical Conditions in Pregnancy Flashcards

1
Q

Can you palpate a DVT?

A

No

-but you can palpate superificial thrombophlebitis

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2
Q

What value for glucose is abnormal?

A

-130-140

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3
Q

Risk factors for development of GDM?

A
  • obesity
  • previous GDM
  • Strong family hx of DM
  • know glc intolerance
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4
Q

Maternal complications of GDM?

A
  • increased risk of gestational htn
  • increased risk of preeclampsia
  • greater risk of cesarean delivery
  • increase risk of developing diabetes later in life
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5
Q

Fetal complications of GDM?

A
  • Macrosomia
  • neonatal hypoglycemia
  • hyperbilirubinemia
  • operative delivery
  • shoulder dystocia
  • birth trauma
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6
Q

will DM increase the risk of spontaneous abortions?

A

-yes

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7
Q

When is the baby recommended for a cesarean delivery?

A

-if weight is greater than 4500 gm

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8
Q

What drops significantly after the delivery of placenta?

A

-insulin

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9
Q

Maternal hyperthyroidism, how is the diagnosis made?

A

-elevated free T4 and suppressed TSH

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10
Q

What is the treatment for maternal hyperthyroidism?

A
  • PTU

- methimazole

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11
Q

When do we give methimazole?

A

-2nd 3rd trimester

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12
Q

When is PTU used?

A

-increased risk of liver toxicity so only used in 1st trimester

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13
Q

Thyroid storm

A
  • hyperthermia
  • tachycardia
  • perspiration
  • high output cardiac failure
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14
Q

tx of thyroid storm?

A
  • B blockers: propanolol
  • block secretion of thyroid hormone: Na I
  • stop synth of Thyroid hormone: PTU
  • Halting peripheral conversion of T4-T3: dexamethasone
  • Replacing fluid losses
  • bring temperature down
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15
Q

Hypothyroidism tx

A
  • thyroid replacement: levothyroxine

- monitor TSH and free T3/4 levels monthly

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16
Q

What is neonatal thyrotoxicosis?

A

-transplacental transfer of thyroid stimulating antibodies

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17
Q

causes of neonatal ypothyroidism?

A
  • thyroid dysgenesis
  • inborn errors of thyroid function
  • drug induced
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18
Q

What is the most common lesion for rheumatic heart disease?

A

-mitral stenosis

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19
Q

What is a contraindication to pregnancy due to decompensation during pregnancy and a high mortality rate?

A
  • primary pulmonary hypertension

- epidural anesthesia is preferred and vaginal delivery may be an option for these patients

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20
Q

What is the most common cardiac arrhythmia with preggo ppl?

A
  • supraventricular tachycardia

- usually benign

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21
Q

What develops within last weeks of pregnancy or within 6 months postpartum

  • women with preeclamsia, htn, and poor nutrition are at risk for developing
  • mortality rate is about 10%?
A

-postpartum cardiomyopathy

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22
Q

Who should all pregnant cardiac patients be co-managed with?

A
  • a cardiologist

- fetus will need ECG

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23
Q

How should cardiac patients be delivered?

A
  • vaginally
  • unless there are obstetric indications
  • Ab prophylaxis for endocarditis in high risk patients
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24
Q

What is Immune idiopathic Thrombocytopenia

A
  • Ig’s attach to maternal platelets

- can be confused with gestational thrombocytopenia

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25
Q

Tx of IIT?

A
  • begun after platelets drop 50,000
  • prednisone
  • IV Ig if severe
  • Platelet transfusion
  • Splenectomy
  • neonatal thrombocytopenia can occur due to placental transfer of antiplatelet antibodies
26
Q

SLE

A

-flared are treated with prednisone
-preterm delivery
-fetal growth restrictions
-stillbirth
-miscarriage
-

27
Q

Antiphospholipid syndrome

A
  • presence of lupus anticoagulant and or anticardiolipin antibody
  • may coexist with SLE
  • associated with arterial or venous thrombosis
  • pregnancy complications: miscarriage, preeclampsia, fetal growth restriction
28
Q

Tx of antiphospholipid syndrome?

A
  • treat during preggo with heparin.low molecular weight heparin and low-dose aspirin
  • if hx of thrombosis: full anticoagulation
29
Q

Acute Renal Failure ARF

A
  • due to preexisting renal disease or pregnancy induced

- three types: Prerenal, renal, postrenal

30
Q

how do you treat ARF?

A
  • prerenal: restore volume
  • renal: treatment is directed at preventing further damage
  • postrenal: remove the obstruction
31
Q

What is a worsening prognosis thing for Chronic renal failure?

A

-serum creatinine greater than 1.5-2

32
Q

What is the most common organism for asymptomatic bacteriuria?

A

-E. Coli

33
Q

Pyelonephritis

A
  • fever, CVA tenerness, malaise
  • elevated WBC and abnormal urinalysis
  • 20% of these patients have increased uterine activity and preterm labor
  • can result in adult respiratory distress syndrome
34
Q

Tx of pyelonephritis?

A
  • IV hydration
  • abx
  • antipyretics
  • tocolytics if needed
  • will need suppression for remainder of preggo
35
Q

What is a common GI thing for Preggo ppl?

A

-GERD

36
Q

Mendelson’s syndrome

A
  • acid aspiration syndrome
  • preggo women at greater risk due to delayed gastric emptying and increased intraabdominal/intragastric pressure
  • can result in adult resp syndrome
37
Q

Tx of mendelson’s syndrome?

A
  • supplemental O2
  • maintain airway
  • tx for acute respiratory failure
38
Q

Inflammatory bowel disease

A
  • they usually do well in preggo

- can increase miscarriage risk if bowel disease is active at time of conception

39
Q

Tx of IBD?

A

-treat acute exacerbation… same as non preggo

40
Q

Intrahepatic Cholestasis of pregnancy (ICP)

A
  • cholestasis and pruritis in second half of preggo not associated with liver enzyme elevations
  • itching without abdominal pain or rash
  • abs reveal elevated serum bile acids
41
Q

Tx of ICP

A
  • local tx- cold baths, bicarb washes
  • use of ursodeoxycholic acid
  • fetal surveillance and delivery at early term
42
Q

Acute fatty liver of pregnancy

A
  • scary…
  • diffuse fatty infiltration of liver resulting in hepatic failure
  • jaundice….
  • increased PT and PTT
  • elevated bilirubin
  • ammonia and uric acid
43
Q

Tx of acute fatty liver of pregnancy?

A
  • termination of pregnancy
  • supportive care
  • people die
  • but if they survive, usually full recovery
44
Q

Anemia

A
  • physiologic decrease in HgB/hematocrit during pregnancy
  • hematocrit less than 30% or a HgB concentration < 10
  • most common reason is iron deficiency
45
Q

Is pregnancy a hypercoagulable state?

A

-yes, upt o 5 fold increase in venous thrombosis and the greatest risk is the first 5 weeks postpartum

46
Q

superficial thrombophlebitis

A
  • most common in pts with varicose veins, obesity, and little physical activity
  • limited to calf, will not turn into PE
  • swelling and tenderness
47
Q

tx of superficial thrombophlebitis

A
  • Bed rest
  • pain medication
  • local heat
  • no need for anticoagulants
  • wear support hose
48
Q

DVT

A
  • more common in left leg than right
  • pain in calf with dorsiflexion (homan’s sign)
  • may also have dull ache, tingling, or pain with walking
49
Q

tx of DVT

A

-low molecular weight or unfractionated heparin

50
Q

Pulmonary embolism

A
  • 70% of the time, DVT is instigating factor

- accentuated pulmonic valve second heart sound

51
Q

Tx of PE

A

-anticoagulation

52
Q

what do patients with a DVT or PE require?

A
  • a thrombophilia work-up

- all patients with history of Thromboembolism will need prohpylactic anticoagulant therapy

53
Q

What is the most common pulmonary disease in pregnancy?

A
  • asthma

- tx is same is with non preggo ppl

54
Q

What is the most common type of Headache and what do we treat it with?

A
  • tension headache

- treat with acetaminophen

55
Q

What kind of headache happens more in childbearing years?

A
  • migraines
  • usually improve during preggo
  • neurology can be helpful in tx
56
Q

Multiple sclerosis

A
  • most common at age 30
  • usually experience fewer and less evere episodes
  • may exacerbate postpartum
  • increased risk of lower birth rate infants
  • increased risk of cesarean delivery
57
Q

Does seizure frequency alter in pregnancy?

A

-no

58
Q

What seizure med should not be used because it is more teratogenic that other antiepileptics?

A

-Valproate

59
Q

What are the most commonly used meds for seizures?

A

-dilantin and phenobarbital

60
Q

if a woman gets depression with preggo, when should we avoid antidepressants?

A

-the first trimester

61
Q

why is post partum depression so common? 70-80%!!

A
  • usually due to hormonal fluctuations
  • raises concern if persists after the first 2 weeks
  • younger women at greater risk
  • severest form- postpartum psychosis

Repro 2 Final (18 decks)

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