complications of pregnancy Flashcards

Question

Gestational diabetes: Pregnancy implications

Answer 1

``` Excessive fetal growth Shoulder dystocia Cesarean section Pre-eclampsia Fetal hypoglycemia ```

Answer 2

Screening – 50g glucose tolerance test (1 hour) - between 24-48 weeks - if greater than 140 do dx test ``` Diagnostic – 100g glucose tolerance test (3 hours) normal glucose levels: fasting: 95 or less 1 hr: 180 2 hr: 155 3 hr: 140 ``` *if 2 abnormal, dx with GDM

Answer 3

A1: controlled with diet A2: controlled with medication: *Insulin, glyburide, metformin

Answer 4

Labor before 37 weeks RF: prior PTD, PPROM, multiple gestation, intrauterine infection, mullerian anomalies, smoking, substance abuse, BV (bac bag), low socioeconomic status Testing: Tocometer (see if contracting), FHTs, Cervical exams, Fetal fibronectin

Answer 5

-Between 24-34 weeks: corticosteroids -less than 32 weeks: magnesium sulfate (prevent CP) Antibiotics Tocolysis (stop labor): Terbutaline, Nifedipine, Indomethacin (stops contractions only use for about 48 hrs, dec. fluid around baby) Prevention: IM progesterone?

Answer 6

-Cervical dilation without contractions -Short cervical length -Treatment: Cervical cerclage Vaginal progesterone

Answer 7

Too little amniotic fluid (less than 0.5L) Measured by Amniotic Fluid Index: less than 5, DVP (deep pouch): less than 2 Fetal complications: POTTER sequence: Pulmonary hypoplasia, Oligohydramnios (trigger), Twisted face, Twisted skin, Extremity defects, Renal failure (in utero) NRFS ``` Causes: Placental insufficiency Bilateral renal agenesis Posterior urethral valves PPROM ```

Answer 8

Too much amniotic fluid (more than 1.5-2L) By AFI: greater than 24, DVP more than 8 Causes: Fetal malformations: Esophageal/duodenal atresia (can't swallow it), Anencephaly Maternal DM, Fetal anemia, Multiple gestation Risk of: maternal respiratory issues, malpresentation, PTD/PPROM, cord prolapse, abruption, stretch of uterus, uterine atony (doesn't contract down like it should-->bleeding-->hemorrhage)

Answer 9

Oligohydramnios: Amnioinfusion Hydration Polyhydramnios: Indomethacin Amnioreduction

Answer 10

Placental abruption Placenta previa Placenta accreta Vasa previa

Answer 11

``` Labor/PTL/CI Infection Disorder of lower genital tract Cervical trauma Systemic disease ```

Answer 12

``` Premature separation of the placenta RF: *HTN, *cocaine, multiparity, smoking, prior abruption, thrombophilias Symptoms: PAINFUL bleeding, frequent contractions Non-reassuring fetal status Severe hemorrhage slide 41: too many contractions? ```

Answer 13

Placenta covers internal cervical os: - Placenta accreta: Placental tissue invades through the endometrium - Placenta increta: invasion to myometrium - Placenta percreta: invasion through uterine serosa ("higher percentage", may invade bladder) RF: prior c-section** Symptoms: PAINLESS vaginal bleeding Delivery: C-section Appropriate planning, can result in massive hemorrhage-->hysterectomy (can only consider vaginal delivery with low lying

Answer 14

``` Uncommon Prior uterine scar (0.3-1%) C-section Myomectomy PAINFUL bleeding Non-reassuring fetal heart tones Management: immediate delivery ```

Answer 15

Portion of membranes cover the internal cervical os with fetal blood vessels: - Velamentous umbilical cord - Placental lobes with connection

Answer 16

``` Loss of pregnancy >20 weeks Similar work up as recurrent abortion Add syphilis testing, parvovirus B19 and maternal-fetal hemorrhage screen Possible fetal autopsy Delivery: Induction of labor Prior c-section not a contraindication Increased surveillance in subsequent pregnancies ```

Answer 17

Mastitis Chorioamnionitis Endometritis

Answer 18

``` Staph aureus more than 3 months after delivery Engourged breast Cellulitis Fever/chills Eval for abscess (esp with MRSA) ``` Tx: dicloxacillin or cephalosporin Continue nursing Abscess drainage

Answer 19

Uterine infection diagnosed during pregnancy Polymicrobial RF: prolonged labor, c-section, internal monitors, mutliple exams, prolonged ROM, lower genital infection Maternal sequelae: abnormal labor, hemorrhage Fetal sequelae: sepsis, pneumonia, IVH, CP

Answer 20

Uterine infection diagnosed after pregnancy

Answer 21

``` dx: Fever One of the following: Maternal tachycardia Fetal tachycardia Foul smelling lochia Uterine tenderness +/- amniocentesis -screen at 35 wks for GBS tx: Broad spectrum antibiotics: (during labor) Ampicillin/Gentamycin Ertapenem ```

Answer 22

``` Anemia Antiphospholipid Antibody Syndrome Thyroid disease Diabetes Mellitus Chronic Hypertension Heart DiseaseAsthma Seizure disorders ```

Answer 23

Arterial/venous thrombosis and adverse pregnancy outcomes + lab evidence of antiphospholipid antibodies Treatment in pregnancy: Heparin (LMWH) and low dose aspirin

Answer 24

Diagnosis: Sydney crideria (Sapporo classification criteria) Diagnosis = 1 clinical + 1 lab criteria Clinical: -1+ episode of venous, arterial, small vessel thrombosis -Pregnancy morbidity: Unexplained fetal death more than 10 wks gestation, 1+ PTD less than 34 wks 2/2 eclampsia, preeclampsia, placental insufficiency, 3+ fetal losses less than 10 wks gestation -Lab: 2+ occasions, 12 wks apart: IgG or IgM anticardiolipin abs, Abs to beta2-glycoprotein I, Lupus anticoaculant activity

Answer 25

SAB, PTD, preeclampsia, placental abruption, impaired neuropyschological development Treat with levothyroxine Serial labs

Answer 26

SAB, PTD, preeclampsia, maternal heart failure Thyroid storm: life threatening Propylthiouracil: hepatotoxicity, agranulocytosis First trimester Methimazole: congenital aplasia cutis, choanal/esophageal atresia Second/third trimester Beta blocker NO radioiodine ablation

Answer 27

SAB and IUFD Fetal malformations: Cardiac, skeletal and neural tube defects; caudal regression syndrome Slow fetal growth Inverse relationship with glucose control

Answer 28

ddx from preeclampsia! Superimposed preeclampsia: 20-50% Antihypertensives when BP over 150/100 or end organ damage *No ACE-I or ARB Diuretics: don’t start in pregnancy, but may continue

Answer 29

``` Treat similarly in pregnancy Pulmonary function tests Beta 2 agonists Inhaled corticosteroids Systemic corticosteroids ``` **Minimize hypoxic episodes to fetus

Answer 30

Discontinuation of meds if seizure free 2-5 years Consider teratogenicity of medications: D/C valproic acid -Newer antiepileptic drugs:Lamotrigine, Topiramate, Oxcarbazepine, Levetiracetam -Folic acid

Answer 31

``` UTI GBS Varicella Tuberculosis HIV/AIDS Hepatitis B/C Herpes Genitalis Syphilis, Gonorrhea, Chlamydia ```

Answer 32

``` Very common in pregnancy Predisposition to urinary stasis 2-8% have asymptomatic bacteriuria  TREAT Risk of PTD 20-40% develop pyelonephritis ```

Answer 33

``` Nitrofurantoin, ampicillin, cephalexin No sulfonamides in 3rd trimester Neonatal hyperilirubinemia No flouroquinolones Fetal carilage and bone defects Always do test of cure ```

Answer 34

Carriage rate 10-30% 30% spontaneous clearing 10% recolonization Neonatal sepsis: 20-30% mortality in premature infants (2-3% in term) Mental retardation Neurologic disability

Answer 35

``` Anyone with + vaginal/rectal culture Anyone with + urine culture Prior infant with invasive GBS disease Unknown culture with Elevated temperature Ruptured membranes more than 18 hours Preterm (less than 37 weeks) ```

Answer 36

``` -Congential VZV syndrome: Skin lesions Limb/digit abnormalities Limb abnormalities: hypoplasia Microcephaly Ocular defects: cataracts, microphthalmos ``` -2nd, 3rd trimesters: Protected by maternal IgG Risk: maternal infection 5 days before – 2 days after delivery -VZIG within 96 hrs of exposure (up to 10 days) Maternal risk of pneumonia

Answer 37

``` Latent disease: treatment postpartum Active disease: Isoniazid and ethambutol Isoniazid and rifampin Vitamin B6 ``` Good prognosis if appropriately treated

Answer 38

High neonatal transmission rate (66%) in the past Now 2% CD4 count, viral load Continue current antiretroviral regimen 3 drug therapy regardless of viral load and CD4 count Second trimester *IV zidovudine before delivery when viral load greater than 400* *Cesarean delivery if viral load more than 1000*

Answer 39

Vertical transmission blocked by hep B IG and hep B vaccine Repeat vaccine 1 month and 6 month Hep C: 5-6% transmission rate 14% when also HIV+

Answer 40

Primary infection late in pregnancy High risk of transmission Acyclovir 400mg TID Recurrent infection: - Lower neonatal attack rate - Asymptomatic shedding is common - Cesarean if active lesion or prodromal symptoms - Acyclovir prophylaxis at 36 weeks -Neonatal infection: SEM, CNS, Disseminated disease

Answer 41

Neonatal infection Skin, eye mouth Central nervous system Disseminated disease

Answer 42

Abortion, IUFD, transplacental infection, congenital syphilis

Answer 43

Hepatomegaly, rhinitis, rash, nonimmune fetal hydrops, myocarditis, pneumonia, etc.

Answer 44

frontal bossing, saddle nose, hutchinson teeth, mulberry molars, saber shins, etc.

Answer 45

Gonorrhea: Large joint arthritis, ophthalmia neonatorum (Ulceration, scarring, visual impairment) Chlamydia: inclusion conjunctivitis, pneumonia

Answer 46

- transmitted by mosquitos - if pregnant: baby-->microencephaly, neurologic deficits - may get late abortions

complications of pregnancy Flashcards

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