9 Medical Complications

Question 1

ASD, VSD, PDA

Corrected TOF has a MMR of

Answer 1

<1% low maternal mortality risk

Question 2

MS with AF, uncorrected TOF, artificial heart valve, Marfan syndrome with normal aortic root diameter has an MMR of

Answer 2

5-15% (moderate)

Question 3

Presence of pulmo HTN ⏩ Eisenmenger’s syndrome raises MMR upto

Answer 3

25-50% (high)

Question 4

Most common acquired lesion

Answer 4

RHD

Question 5

MC valvular defects

Answer 5

Mitral stenosis

Question 6

MMR in the setting of biventricular cardiac failure seen in late pregnancy or months postpartum among multiparous

Answer 6

Peripartum Cardiomyopathy

MMR upto 75%

Question 7

Management of Eisenmenger Syndrome

Answer 7

Avoid ⬇️ BP

Question 8

⬇️TSH
⬆️free T4
(+) TSHR Ab

Answer 8

Graves Disease

Question 9

Management of Graves Dse

Answer 9

PTU (1st tri), Methimazole (later part)

Subtotal Thyroidectomy

Question 10

⬆️TSH
⬇️ free T4
Anovulation

Answer 10

Hypothyroidism

Question 11

MCF of hypo/hyperthyroidism

Answer 11

Graves Dse

Hashimotos Thyroiditis

Question 12

Mngt of Hypothyroidism

Answer 12

Synthroid (⬆️ dose 30% prepregnancy)

Question 13

Effects of Pregnancy in Seizure Dso

Answer 13

Seizures unchanged (upto 75%)

Anticonvulsant metabolism ⬆️⬆️⬆️

Question 14

Congenital malformation rate with use of anticonvulsants

Answer 14

3-10%

Question 15

Antiseizure drug implicated in neonatal deficiencies of vit K dependent CF

Answer 15

Phenytoin

Question 16

Overt DM with calcified vessels

with nephropathy

with retinopathy

Answer 16

Class E

Class F

Class R

Question 17

GDM screening is performed on all gravida at 24-28w aog. Why?

Answer 17

Anti insulin effect of HPL is maximal

Question 18

GDM is

Answer 18

FBS >95mg/dl, screening value >200mg/dl

OR

2/3 abN 3h 100g OGTT

Question 19

Overt Diabetes is

Answer 19

FBS > 125mg/dl

Question 20

Computation for total daily insulin units

Answer 20

Actual BW in kg X

0.8 (1st tri)
1 (2nd)
1.2 (3rd)

Question 21

OHA in GDM

Answer 21

Glyburide

Question 22

AbN screening value (1hr 50g OGTT)

Answer 22

> 140mg/dl

Question 23

Most common fetal anomalies in overt DM

Answer 23

NTD

CHD

Question 24

What should be done among with highest fetal demise risk factors?

Answer 24

NST and AFI weekly at 32 wks aog

Question 25

Fetal Demise Risk Fx

Answer 25

Insulin or glyburide therapy Previous stillbirth Macrosomia HTN

Question 26

Neonatal problems in GDM

Answer 26

``` Hypoglycemia Hypocalcemia Polycythemia Hyperbilirubinemia ARDS ```

Question 27

LS ratio of _____ in the presence of phosphatidylglycerol ensures fetal lung maturity

Answer 27

2.5

Question 28

``` Hgb <10g MCV <80 um3 RDw > 15% ⬇️serum iron and iron stores ⬆️TIBG ```

Answer 28

IDA

Question 29

Anemia in general predisposes to

Answer 29

IUGR and preterm birth

Question 30

A 29 yo primigravida is at 33wks aog, mentally confused. Flu like symptoms. Icteric and febrile. No seizures. ⬆️BP, ⬇️Plt, prolonged PR ⬆️liver enzymes, serum crea, uric acid, LDH Urine dipstick 3+ ⬇️RBG, ⬆️ammonia

Answer 30

Acute Fatty Liver

Question 31

The previous condition is caused by

Answer 31

Disorder of FA metabolism by fetal mitochondria due to deficiency in long-chain 3-hydroxyacyl coenzyme A DH enzyme

Question 32

Parameters that set it apart from preeclampsia

Answer 32

Hypoglycemia | ⬆️serum ammonia

Question 33

No urgency, frequency or burning No fever Urine culture > 100k CFU of one organism

Answer 33

ASB

Question 34

(+) urgency, frequency or burning (-) fever (+) Urine culture

Answer 34

Cystitis

Question 35

Presence of fever and CVAT

Answer 35

Pyelonephritis

Question 36

MC serious medical complications in pregnancy that predisposes to preterm L/D

Answer 36

Acute Pyelonephritis

Question 37

Antiphospholipid syndrome dx requires at least 1 clinical and laboratory criterion each. Clinical parameters include either:

Answer 37

Vascular thrombosis | Unexplained pregnancy morbidity : fetal demise or consecutive miscarriages at least 3

Question 38

Laboratory parameter for APA: 1 or more of the ff is/are positive on 2 or more occasions at least 12w apart

Answer 38

Lupus anticoagulant Anticardiolipin Ab Anti 132-gp I Ab

Question 39

Superficial TP is managed with

Answer 39

Bed rest Heat application NSAIDs

Question 40

DVT is managed by

Answer 40

IV heparin (to cause an ⬆️ in PTT by 1.5-2.5x SQ heparin once therapeutic level is achieved Warfarin only at PP Thrombophilia work ups

Question 41

PE is the MC complication of DVT, presenting with chest pain and dyspnea. MC sources of emboli are

Answer 41

Pelvic veins | Lower ext

Question 42

Most definitive dx in PE

Answer 42

Pulmonary angiography

Question 43

High risk thrombophilias

Answer 43

Homozygous FVL and PGM; all ATD

Question 44

Low risk thrombophilia

Answer 44

Hererozygous FVL and PGM; PCD and PSD

Question 45

Antipartum and PP anticoagulants: * oral, inexpensive, reversed by ProtSO4 * IV, longer half life, no monitoring

Answer 45

UFH - APTT monitoring LMWH

Question 46

AC used only during PP It needs ______ monitoring

Answer 46

Warfarin, INR monitoring