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1

What is the effect of asthma on pregnancy?

Rule of thirds

2

How is asthma managed in pregnancy?

maintain adequate oxygenation, use of inhaled B-agonists (albuterol), steroids &/or nebulizers PRN - depending on severity

3

What do influenza A/B increase the risk of in preggos?

Susceptibility to pneumonia

4

Can pregnant women get the flu vaccine?

Yes at any time

5

If you suspect your pt has been exposed to influenza, what can you do?

Chemoprophylaxis
(tamiflu)

6

What heat disease is common in pregnancy?

Rheumatic heart dz

7

What can rheumatic heart dz cause?

subacute bacterial endocarditis, HF, pulmonary edema, mitral valve stenosis

8

Why does mitral valve stenosis worsen with pregnancy?

increased cardiac output needs d/t pregnancy

9

What is the most common arrhythmia in pregnancy?

paroxysmal atrial tachycardia (PAT)

10

When might peripartum cardiomyopathy present?

Last month of pregnancy through the first 6 mo PP

11

What are the 5 proposed mechanisms for HTN dz of pregnancy?

-Vascular changes
-Hemostatic changes
-Changes in prostanoids
-Changes in endothelium-derived factors
-Lipid peroxide, free radical, antioxidant release

12

What is the predominant change in preeclampsia and GHTN?

Maternal vasospasm

13

What are the hematological effects of HTN dz of preggo?

Plasma volume contraction ↑Hct = risk of hypovolemic shock in event of hemorrhage
Risk of DIC, liver involvement, third spacing of fluid (↑BP / ↓plasma oncotic pressure

14

What are the renal effects of HTN dz of preggo?

decreased GFR & proteinuria d/t atherosclerotic-like changes in renal vessels
↓uric acid filtration leading to ↑maternal serum levels
oliguria

15

What are the neuro effects of HTN dz of preggo?

hyperreflexia w/possible progression to grand mal (eclamptic) seizures

16

What are the pulmonary effects of HTN dz of preggo?

Edema, left heart failure, fluid overload

17

What are the fetal effects of HTN dz of preggo?

Decreased placental perfusion 2˚ to vasospasm leads to IUGR, oligohydramnios, placental abruption, increased incidence of perinatal mortality
Placental size & function are decreased -> progressive fetal hypoxia & malnutrition

18

What are risk factors for preeclampsia?

—Primiparity
—Prior hx w/IUP
—Chronic HTN, chronic renal dz or both
—Hx thrombophilia
—Multi-fetal gestation or in vitro fertilization
—FHx
—DM type 1 or 2; obesity
—SLE
--- > 40 y/o

19

What are the classifications of HTN dz of preggo?

Chronic HTN
Gestational HTN
Chronic HTN with superimposed preeclampsia
Preeclampsia- eclampsia syndrome

20

What constitutes chronic HTN?

Elevated BP that predates conception or before 20 weeks EGA

21

What constitutes gestational HTN?

New onset BP elevation > 20 weeks EGA/near term in absence of associated proteinuria
This can progress to preeclampsia 1-3 weeks after diagnosis

22

What is preeclampsia?

New onset HTN, new onset proteinuria > 20 weeks EGA
Alternate symptomatology w/ new onset HTN
Preeclampsia w/out severe symptoms progress to severe w/in days

23

What is eclampsia?

Additional presence of seizures in patient w/pre-eclampsia & w/out hx of neurologic disease

24

What is a complication of Preeclampsia- eclampsia syndrome?

HELLP syndrome

25

What is HELLP syndrome?

Hemolysis, Elevated Liver enzymes, Low Platelet count

26

How is HELLP managed?

-Requires cardiovascular stabilization, correction of coag abnormalities (platelet transfusion) & delivery
—Stat delivery:

27

What is preeclampsia without severe features?

—HTN w/proteinuria & edema > 20th week of pregnancy
—New onset HTN & TCP ( 20 weeks EGA
—New onset HTN & elevated LFTs (transaminases 2x normal) > 20 weeks EGA
—New onset HTN & serum creatinine > 1.1 mg/dL or doubling serum creatinine in absence of other renal dz > 20 weeks EGA
—New onset HTN & pulmonary edema or cerebral-visual disturbances > 20 weeks EGA

28

How is it diagnosed?

HTN: Persistent SBP >140-160 mm Hg or DBP > 90-110 mm Hg on 2 occasions 4 hours apart in pt w/previously normal BP
Proteinuria: 1+/dipstick or > 300 mg per 24 hr urine or protein/creatinine ratio > 0.3 mg/dL

29

Is proteinuria necessary for diagnosing preeclampsia?

NO

30

What is preeclampsis with severe features?

—HTN w/proteinuria & edema > 20th week of pregnancy??? WHY IS THIS THE SAME
-Persistent SBP >160 mm Hg or DBP > 110 mm Hg on 2 occasions 4 hours apart in pt on bed rest
-TCP 1.1 mg/dL or doubling serum creatinine in absence of other renal dz
-Pulmonary edema or new onset cerebral-visual symptoms