Flashcards in complications2-Table 1 Deck (77)
What is the effect of asthma on pregnancy?
Rule of thirds
How is asthma managed in pregnancy?
maintain adequate oxygenation, use of inhaled B-agonists (albuterol), steroids &/or nebulizers PRN - depending on severity
What do influenza A/B increase the risk of in preggos?
Susceptibility to pneumonia
Can pregnant women get the flu vaccine?
Yes at any time
If you suspect your pt has been exposed to influenza, what can you do?
What heat disease is common in pregnancy?
Rheumatic heart dz
What can rheumatic heart dz cause?
subacute bacterial endocarditis, HF, pulmonary edema, mitral valve stenosis
Why does mitral valve stenosis worsen with pregnancy?
increased cardiac output needs d/t pregnancy
What is the most common arrhythmia in pregnancy?
paroxysmal atrial tachycardia (PAT)
When might peripartum cardiomyopathy present?
Last month of pregnancy through the first 6 mo PP
What are the 5 proposed mechanisms for HTN dz of pregnancy?
-Changes in prostanoids
-Changes in endothelium-derived factors
-Lipid peroxide, free radical, antioxidant release
What is the predominant change in preeclampsia and GHTN?
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
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
What are the neuro effects of HTN dz of preggo?
hyperreflexia w/possible progression to grand mal (eclamptic) seizures
What are the pulmonary effects of HTN dz of preggo?
Edema, left heart failure, fluid overload
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
What are risk factors for preeclampsia?
—Prior hx w/IUP
—Chronic HTN, chronic renal dz or both
—Multi-fetal gestation or in vitro fertilization
—DM type 1 or 2; obesity
--- > 40 y/o
What are the classifications of HTN dz of preggo?
Chronic HTN with superimposed preeclampsia
Preeclampsia- eclampsia syndrome
What constitutes chronic HTN?
Elevated BP that predates conception or before 20 weeks EGA
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
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
What is eclampsia?
Additional presence of seizures in patient w/pre-eclampsia & w/out hx of neurologic disease
What is a complication of Preeclampsia- eclampsia syndrome?
What is HELLP syndrome?
Hemolysis, Elevated Liver enzymes, Low Platelet count
How is HELLP managed?
-Requires cardiovascular stabilization, correction of coag abnormalities (platelet transfusion) & delivery
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
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
Is proteinuria necessary for diagnosing preeclampsia?