What is the triad of pre-ecclampsia?
proteinuria, HTN ,edema
Describe the deep tendon reflexes of a pre-ecclamptic woman
They are hyper-reflexic, pre-ecclampsia is associated with CNS hyperexcitability
What is the cause of epigastric pain in pre-ecclampsia (classically)?
swelling of Glisson's capsule of the liver due to edema
What placental disorder is correlated with Pre-ecclampsia?
What are 2 important fetal sequelae of pre-ecclampsia?
Intrauterine growth restriction, prematurity
Describe the blood pressure and urine protein changes associated with mild pre-ecclampsia
BP = 140/90, proteinuria > 0.3 g in 24 hours
What are the BP and urine protein in severe pre-ecclampsia?
160/110 and greater than 5 g in 24 hours
Why is increased urine output in a pre-ecclamptic woman after giving birth a "reassuring sign"?
Because they may become oliguric during pre-ecclampsia due to changes in the glomerulus, thus if urine output increases that is a sign that the changes of pre-ecclampsia are starting to return to normal
What does HELLP sydrome stand for?
Hemolysis, Elevated Liver enzymes, and Low Platelets
How does ecclampsia differ from pre-ecclampsia?
ecclampsia is associated with the development of convulsions
What fetal wellbeing tests can you order in an ecclamptic woman?
NST, CST, BPP; even in pre-ecclampsia you should do these 2x per week "that is the single most important thing to do"
If a woman has mild pre-ecclampsia when should you deliver?
If she is 38 weeks gestation, S/S are progressing, or if there is evidence of fetal compromise (i.e. by the wellbeing tests)
T/F: both mild and severe pre-ecclamptics need to be hospitalized
false mild pre-ecclamptics can be managed at home IF THEY ARE A RELIABLE PATIENT, severe pre-ecclamptics should be hospitalized
If a woman has severe pre-ecclampsia when should she deliver?
if the baby is after 32 weeks, with mild preeclampsia it was 38 weeks
Corticosteroids are beneficial to the baby of a pre-ecclamptic for what 2 reasons?
they help with lung maturity and they help the weak vessels of the brain mature
What is the DOC for preventing seizures during the intrapartum mgmt of a pre-ecclamptic woman?
IV magnesium sulfate, directly antagonizes calcium
Name 3 drugs for the antihypertensive Tx of pre-ecclamptics
IV labetalol, IV hydralazine, and alpha methyldopa
What is the goal for HTN correction and why would you not want to drop below it ?
140/90, a drop below this can underperfuse the baby
What is the puerperium? What if a woman is being Tx'd for pre-ecclampsia but is still hypertensive after the puerperium?
The 6-8 week period where a woman's body returns to normal after a pregnancy. If she is still HTN, then it is likely that she had pre-existing HTN
T/F: pre-ecclampsia increases the risk of developing essential HTN
false they usually return to normal after, and if they do not then they probably already had essential HTN
How is gestational HTN different from pre-ecclampsia? How is it different from essential HTN?
It is HTN after 20 weeks of pregnancy without proteinuria. Pre-ecclamptics would have proteinuria and edema and essential HTN is what occurs without pregnancy or would have been present prior to 20 weeks gestation
A diagnosis of chronic HTN can be made if the HTN was found during pregnancy and lasts ________ weeks post-partum
Can you use ACE-I's/ARB's in pregnancy?
Can you use BB's in pregnancy?
You can but they can cause IUGR
Can you use diuretics in pregnant ppl?
no it can compromise the fetus by depleting maternal blood volume, i.e. the fetus will be underperfused
What is chronic HTN with superimposed pre-ecclampsia? How should it be managed?
Pre-existing HTN with the development of >0.3 g proteinuria, mgmt is same as pre-ecclampsia
What 2 issues of fetal body size are associated with maternal diabetes?
opposite ends of spectrum = IUGR and fetal macrosomia
What are 3 congenital anomalies associated with maternal diabetes?
Cardiac (first aid says transposition, especially), neural tube defects, and sacral agenesis
How are the fetal complications of gestational diabetes different from that of pre-existing diabetes?
Both will have fetal macrosomia and IUGR but gestational diabetics don't have the issues with organogenesis probably because organogenesis is complete by the time gestational DM sets in
Why should you do a fasting blood sugar on all pregnant patients in the first trimester?
because they may not know they are diabetic; if they meet diabetic criteria in the FIRST TRIMESTER then they are a REAL diabetic not just gestational
What is the screening test for gestational diabetes?
50 gram glucola test? Drink it, if blood glucose is > 140 one hour later then you do the diagnostic test
What is the diagnostic test for gestational diabetes?
A 100 gram 3 hour glucose tolerance test (normally it would be a 75 g in a nonpregnant person)? If you get 2 abnormal values on a 3 hour (i.e. abnormal at 1, 2, or 3 hours) it is positive
What are the White Categories for gestational diabetes?
A1 does not need insulin because diet and exercise return values to normal and A2 needs insulin b/c diet and exercise is not sufficient
What is the initial treatment of gestational diabetes?
diet and exercise!
Why are serial ultrasounds important in diabetic mothers?
because of the issues with fetal growth, you want to closely watch the fetus to make sure there is no macrosomia or IUGR
What is the glucose goal in the intrapartum period?
Why do insulin requirements drop after delivery?
insulin antagonists from the placenta are no longer present
How is the treatment of a pre-existing diabetic vs. a gestational diabetic different after delivery?
A gestational diabetic's levels will very likely go back to normal, a pre-existing diabetic will probably have a 2-3 day reprieve and then will need to resume Tx
What screening test do you use in gestational diabetes? Confirmatory test?
50 g glucola test, 100 g GTT
What test do you use to see if a gestational diabetic is back to normal after delivery
75 g GTT 6-8 weeks post partum
T/F pre-ecclampsia increases the risk of developing essential/primary HTN
T/F gestational diabetes increases the chances of developing type II DM