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Mary's Tests - Spring 2016 > Last maternal test > Flashcards

Last maternal test Flashcards

1
Q

Chronic hypertension

A

high blood pressure that is known to predate conception of detected BEFORE 20 weeks gestation

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2
Q

Chronic hypertension

A

high blood pressure that is known to predate conception of detected BEFORE 20 weeks gestation

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3
Q

Chronic hypertension with Superimposed Preeclampsia

A

HTN with proteinuria that develops after 20th week OR HTN and proteinuria that develops before the 20th week WITH at least one:
Increase in BP, increase in liver enzymes, platelets below 100,000, RUQ pain, severe headache, pulmonary congestion or edema, renal insufficiency, sudden or sustained increase in protein excretion

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4
Q

Transient gestational HTN

A

increase in blood pressure that occurs without proteinuria late in pregnancy or in the early pp period, but RETURNS TO NORMAL by 12 weeks pp

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5
Q

Chronic gestational hypertension

A

increase in blood pressure without proteinuria late in pregnancy or in the early pp period, but REMAINS INCREASED after 12 wks pp

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6
Q

Pre-eclampsia/Eclampsia

A

hypertension that develops after the 20th week of gestation AND proteinuria
OR
thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral or visual symptoms

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7
Q

> or = 140 systolic or > or = 90 diastolic on two occasions AT LEAST 4 hours apart in a woman with previous normal BP

A

pre-eclampsia diagnostic procedure

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8
Q

> or = 160 systolic or > or = 110 diastolic can be confirmed within a short interval to facilitate timely treatment

A

Pre-eclampsia diagnostic procedure

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9
Q

increase in BP after 20 wks gestation

A

pre-eclampsia diagnostic procedure

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10
Q

Proteinuria in pre-eclampsia

A

> or = 300 mg per 24 hour urine collection GOLD STANDARD

OR

protein/cretinine ratio > or = 0.3 mg/dL

Dipstick reading of 1+ (used only if other quantitative methods are not available)

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11
Q

thrombocytopenia in patients with pre-eclampsia

A

platelet count

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12
Q

Renal insufficiency in pre-eclampsia

A

protein/ creatinine ratio > or = 0.3 mg/dL

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13
Q

Impaired liver function in pre-eclampsia

A

elevated blood concentrations >1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal diseases

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14
Q

Eclampsia

A

presence of new-onset grand mal seizure in a woman with pre-eclampsia

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15
Q

Predisposing Factors to Preeclampsia

11

A 
Primiparity
Previous preeclamptic pregnancy
Chronic hypertension or chronic renal disease
History of thrombophilia
Multigestational pregnancies
In vitro fertilization
Family Hx of preeclampsia
Type I DM or Type II DM
Obesity
Systemic lupus erythematosus
Maternal age 40
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16
Q

Changes in Normal Pregnancy

cardiac output, blood volume, peripheral vasc resistance, BP, renin, GFP, ECF, aldosterone

A 
increased Cardiac output by 50%
 increased Blood volume by 1500ml
 decreased Peripheral vascular resistance
 decreased BP
 increased Renin
 increased GFR
 increased ECF
 Aldosterone effects blocked
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17
Q

Treatment of preeclampsia without severe features:

A 
Daily kick counts
Ultrasound for fetal growth every 3 weeks
Amniotic fluid at least assessed 1/week
NST twice a week (non-reactive=BPP)
Daily wt for gain
Monitor BP daily
Monitor lab tests: CBC, liver enzymes, serum 
Creatinine once a week
Reg diet with no salt restrictions
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18
Q

hospital care for mild preeclampsia

A

bed rest, left lateral recumbent position to increase renal perfusion and promote diuresis and lowers BP

Diet must be well balanced, moderate increase protein to replenish what is spilled in kidneys

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19
Q

Assess fetal well being in hospital care for mild preeclampsia by assessing..

A

NST, amniocentesis, DFMC, BPP

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20
Q

Assess maternal well being in hospital care for mild preeclampsia by assessing

A

BP every 4 hours, headaches, visual changes, lab tests such as daily urine dipstick for protein, 24 hour protein, CBC with platelet every 2 days, serum creat, uric acid and liver function tests such as AST, ALT, LDH

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21
Q

Severe preeclampsia

A

BP of 160/110 or higher on 2 occasions in at least 4 hours apart while on bedrest

might complain of HA, RUQ pain, epigastric pain, thrombocytopenia

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22
Q

proteinuria in severe preeclampsia

A

greater than 5g/L in 24 hour of 3+ on 2 random urine samples 4 hours apart

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23
Q

oliguira in severe preeclampsia

A

less than 500ml/24 hrs

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24
Q

impaired liver function in severe preeclampsia

A

increased AST and APT

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25
Q

treatment of severe preeclampsia

A

bedrest.
quiet environment to reduce stimuli
delivery >34 weeks gestation

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26
Q

Medications used in treatment: seiizure prophylaxis: Mag sulfate dose…

A

Mag sulfate: 4-6 gm bolus is given IV over 20 minutes then continuous infusion of 2gm/hr generally advocated

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27
Q

Mag sulfate what…

A

a CNS depressant and needs to be maintained at a therapeutic level as determined by each lab.

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28
Q

excessive levels of mag sulfate lead to

A

respiratory paralysis and cardiac arrest

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29
Q

what is given to reverse mag sulf

A

calcium gluconate

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30
Q

Medications used in treatment: Antihypertensives

Examples and doses

A

given for sustained BP’s of 160-110

FIRST LINE:
Labetalol: 20mg IV over 2 min, can give q10 min if needed (max of 300mg)- avoid with asthma or CHF

Hydralazine: 5mg IV over 1-2 min, can give q 20 min if needed (max of 30

NO DIURETICS AND ACE INHIBITORS SHOULD BE USED

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31
Q

Eclampsia: symtpms of impending seizure : (11)

A 
Persistent occipital or frontal headaches
Blurred vision
Photophobia
Epigastric or right upper quadrant pain
Altered mental status
Hyperreflexia— 4+
Scotomata—dark spots or flashing lights
Vomiting
Neurologic hyperactivity
Pulmonary edema
Cyanosis
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32
Q

Safety precautions for Eclampsia

A

quiet environment- no phone calls, TV, lights
Padded side rails in bed
O2 ready
Suction ready

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33
Q

HELLP syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelets

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34
Q

HELLP is sometimes associated wtih

A

severe preeclampsia

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35
Q

S/S of HELLP

A

n&v, malaise, flu lke sx, epigastric pain with or without HTN

anyone with these s/s should have their CBC and liver enzymes drawn

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36
Q

HELLP and corticosteroids

A

they are usually given to foster fetal maturity but they have been found to stabilize platelet counts and hepatic enzymes and LDH levels.

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37
Q

What med is typically chosen for HELLP syndrome

A

Dexamethasone

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38
Q

maternal glucose crosses the placenta. true or false

A

true

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39
Q

CHO Metabolism in the first trimester:

A

increase in estrogen and progesterone which stimulates beta cells of pancreas to increase insulin production

increase use of glucose leads to decrease in serum glucose levels

increase in tissue glycogen (energy) stores

decrease in liver glycogen production

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40
Q

CHO metabolism in the 2nd and 3rd trimesters

A

hormone levels lead to decrease tolerance to glucose

increase insulin resistance
HPL- Human Placental Lactogen wont let insulin work

Placental insulinases- break down insulin at placental site

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41
Q

placental insulinases

A

breakdown insulin at placental site

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42
Q

Net result

A

changes in insulin needs for mother during pregnancy

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43
Q

first trimester net result

A

decrease need for insulin, increase insulin production, N&V, decrease food intake, increase transfer of fetus

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44
Q

2nd trimester net result

A

gradual increase of insulin

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45
Q

3rd trimester net results

A

2-4 times higher need for insulin by 36 weeks, then levels off til labor

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46
Q

after delivery net result

A

decrease insulin, glucose insulin balance OK by 7-10 days

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47
Q

Pregestational diabetic risks to the mother

A

poor control very early in pregnancy can cause miscarriage

macrosomic baby

PTL

pre-eclampsia

polyhydramnios

ketoacidosis/hypoglycemia

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48
Q

Gestational onset risks to the mother

A

2X more likely to have pre-eclampsia and macrosomic baby

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49
Q

pregestational risks to baby for diabetes:

A

congenital defects :heart, skeletal, CNS

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50
Q

Gestational diabetes risks for baby

A 
macrosomia
trauma
hypoglycemia
RDS
hypocalcemia
hyperbilirubinemia
thrombocytopenia
polycythemia
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51
Q

Management of pre-gestational diabetes

A

establish glycemic control BEFORE pregnancy

understand very close monitoring - 4-8 times a day

If type 2- oral hypoglycemic agents are teratogenic- insulin subq during pregnanacy

diet carefully balanced

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52
Q

Management of pre-gestational diabetes: Hgn A1c

A

Good control: 2.5-5.9 %
Fair control: 6-8%
Poor control: >8%

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53
Q

for mothers with pre-gestational diabetes, when is exercise best

A

after meals

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54
Q

Management of pre-gestational diabetes- INSULIN

A

multiple times a day, mixed longer acting and rapid acting in the morning and pm

humulin and novolin, NOT PORK OR BEEF INSULINS

humulog if NEWLY diagnosed

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55
Q

goal for insulin in pre-gestational diabetes

A

fasting 60-90 mg/dl

2 hour postprandial= 90=120

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56
Q

Management of Pre-gestational Diabetes-Delivery

A

Careful determination of ACTUAL due date
Amniocentesis —-Fetal lung maturity
Induce 39-40 wks-NO LATER THAN 40 WKS
If estimated fetal weight greater than 4000-4500 gms—C/S
In L&D- Watch maternal glucose levels EVERY 2 hours

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57
Q

low risk for gestational diabetes screening

A

less than 25 y/o
no family Hx
normal BMI
no abnormal GTT

58
Q

high risk for gestational diabetes screening

A

history of diabetes,
overweight, obese
high risk group- african american, native, latina, pacific

59
Q

Gestational diabetes screening- First pre-natal visit.

A

50 gm glucose load, draw serum 1 hour later

negative less than 140
positive greater than 140

screen again at 24-28wks gestation

60
Q

if positive result of gestational diabetes screening

A

do 3 hour GTT (100g of glucose)

positive for GDM- 2 or more levels are met or exceeded:
Fasting

61
Q

managment of gestational diabetes

A 
keep blood sugars within levels 
3 meals and 3 snacks diet
exercise
insulin- 20% will need insulin during pregnancy
blood glucose monitoring
delivery by 40 wks
prequent NST/ BPP in last 2 mo
62
Q

Group B hemolytic strep

A

major cause of perinatal infections
found in vagina and urine
increase fetal mortality and morbidity
screen 35-37 weeks

63
Q

IF positive for GBS

A

treat with penicillin: 5 milli units IV X 1; 2.5-3 milli units every 4 hours

treat with ampicillin: 2 GMS X 1; 1 GM every 4 hrs

treat with clindamycin: 900 mg q 8 hr or
erythromycin 500mg q 6 hrtil delivery IF ALLERGIC TO PENICILLIN

64
Q

GBS: prophylactic treatment is indicated if

A

previous infant with GBS, GBS bacteria during pregnancy, PTL, temp in labor of greater than 100.4, membranes ruptured for more than 18 hours

65
Q

TORCH

A

toxoplasmosis
rubella
cytomegalovirus
herpes

66
Q

why are steroids given to patients with HELLP

A

it can stabilize the platelets

67
Q

patients might complain of what symptoms when experiencing HELLP

A

flu like symptoms

68
Q

ectopic pregnancy

A

egg implants outside of uterus

lots of pain and internal bleeding

surgical intervention needed

69
Q

hydatidiform mole

A

no fetus, fluid filled vesicle, N&V, no FHT, 2nd trimester bleeding, d&C, not get pregnant for 1 year, choriocarinoma if HCG evelated

70
Q

cerclage: McDonalds or Shirodkar procedure

A 
10-14 weeks gestation
no intercourse, prolonged stanging, heavy lifting
bedrest 
teach signs of preterm labor
take tocolytics
uterine monitoring
remove suture at 37 weeks
leave suture in for c/section
71
Q

hyperemesis gravidarum

A

vomiting during pregnancy, 5% loss of body weight, ketosis, metabolic alkalosis
rule out gestational trophoblastic Dz by ultrasound
needs hospitalization if it doesnt respond to small frequent meals (IV fluids with Kcl to prevent hypokalemia)
B vitamin replacement
TPN temporary

72
Q

Chronic hypertension with Superimposed Preeclampsia

A

HTN with proteinuria that develops after 20th week OR HTN and proteinuria that develops before the 20th week WITH at least one:
Increase in BP, increase in liver enzymes, platelets below 100,000, RUQ pain, severe headache, pulmonary congestion or edema, renal insufficiency, sudden or sustained increase in protein excretion

73
Q

Transient gestational HTN

A

increase in blood pressure that occurs without proteinuria late in pregnancy or in the early pp period, but RETURNS TO NORMAL by 12 weeks pp

74
Q

Chronic gestational hypertension

A

increase in blood pressure without proteinuria late in pregnancy or in the early pp period, but REMAINS INCREASED after 12 wks pp

75
Q

Pre-eclampsia/Eclampsia

A

hypertension that develops after the 20th week of gestation AND proteinuria
OR
thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral or visual symptoms

76
Q

> or = 140 systolic or > or = 90 diastolic on two occasions AT LEAST 4 hours apart in a woman with previous normal BP

A

pre-eclampsia diagnostic procedure

77
Q

> or = 160 systolic or > or = 110 diastolic can be confirmed within a short interval to facilitate timely treatment

A

Pre-eclampsia diagnostic procedure

78
Q

increase in BP after 20 wks gestation

A

pre-eclampsia diagnostic procedure

79
Q

Proteinuria in pre-eclampsia

A

> or = 300 mg per 24 hour urine collection GOLD STANDARD

OR

protein/cretinine ratio > or = 0.3 mg/dL

Dipstick reading of 1+ (used only if other quantitative methods are not available)

80
Q

thrombocytopenia in patients with pre-eclampsia

A

platelet count

81
Q

Renal insufficiency in pre-eclampsia

A

protein/ creatinine ratio > or = 0.3 mg/dL

82
Q

Impaired liver function in pre-eclampsia

A

elevated blood concentrations >1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal diseases

83
Q

Eclampsia

A

presence of new-onset grand mal seizure in a woman with pre-eclampsia

84
Q

Predisposing Factors to Preeclampsia

11

A 
Primiparity
Previous preeclamptic pregnancy
Chronic hypertension or chronic renal disease
History of thrombophilia
Multigestational pregnancies
In vitro fertilization
Family Hx of preeclampsia
Type I DM or Type II DM
Obesity
Systemic lupus erythematosus
Maternal age 40
85
Q

Changes in Normal Pregnancy

cardiac output, blood volume, peripheral vasc resistance, BP, renin, GFP, ECF, aldosterone

A 
increased Cardiac output by 50%
 increased Blood volume by 1500ml
 decreased Peripheral vascular resistance
 decreased BP
 increased Renin
 increased GFR
 increased ECF
 Aldosterone effects blocked
86
Q

Treatment of preeclampsia without severe features:

A 
Daily kick counts
Ultrasound for fetal growth every 3 weeks
Amniotic fluid at least assessed 1/week
NST twice a week (non-reactive=BPP)
Daily wt for gain
Monitor BP daily
Monitor lab tests: CBC, liver enzymes, serum 
Creatinine once a week
Reg diet with no salt restrictions
87
Q

hospital care for mild preeclampsia

A

bed rest, left lateral recumbent position to increase renal perfusion and promote diuresis and lowers BP

Diet must be well balanced, moderate increase protein to replenish what is spilled in kidneys

88
Q

Assess fetal well being in hospital care for mild preeclampsia by assessing..

A

NST, amniocentesis, DFMC, BPP

89
Q

Assess maternal well being in hospital care for mild preeclampsia by assessing

A

BP every 4 hours, headaches, visual changes, lab tests such as daily urine dipstick for protein, 24 hour protein, CBC with platelet every 2 days, serum creat, uric acid and liver function tests such as AST, ALT, LDH

90
Q

Severe preeclampsia

A

BP of 160/110 or higher on 2 occasions in at least 4 hours apart while on bedrest

might complain of HA, RUQ pain, epigastric pain, thrombocytopenia

91
Q

proteinuria in severe preeclampsia

A

> 5g/L in 24 hour of 3+ on>2 random urine samples e4 hours apart

92
Q

oliguira in severe preeclampsia

A

less than 500ml/24hr

93
Q

impaired liver function in severe preeclampsia

A

increased AST and APT

94
Q

treatment of severe preeclampsia

A

bedrest.
quiet environment to reduce stimuli
delivery >34 weeks gestation

95
Q

Medications used in treatment: seiizure prophylaxis: Mag sulfate dose…

A

Mag sulfate: 4-6 gm bolus is given IV over 20 minutes then continuous infusion of 2gm/hr generally advocated

96
Q

Mag sulfate what…

A

a CNS depressant and needs to be maintained at a therapeutic level as determined by each lab.

97
Q

excessive levels of mag sulfate lead to

A

respiratory paralysis and cardiac arrest

98
Q

what is given to reverse mag sulf

A

calcium gluconate

99
Q

Medications used in treatment: Antihypertensives

Examples and doses

A

given for sustained BP’s of 160-110

FIRST LINE:
Labetalol: 20mg IV over 2 min, can give q10 min if needed (max of 300mg)- avoid with asthma or CHF

Hydralazine: 5mg IV over 1-2 min, can give q 20 min if needed (max of 30

NO DIURETICS AND ACE INHIBITORS SHOULD BE USED

100
Q

Eclampsia: symptoms of impending seizure : (11)

A 
Persistent occipital or frontal headaches
Blurred vision
Photophobia
Epigastric or right upper quadrant pain
Altered mental status
Hyperreflexia— 4+
Scotomata—dark spots or flashing lights
Vomiting
Neurologic hyperactivity
Pulmonary edema
Cyanosis
101
Q

Safety precautions for Eclampsia

A

quiet environment- no phone calls, TV, lights
Padded side rails in bed
O2 ready
Suction ready

102
Q

HELLP syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelets

103
Q

HELLP is sometimes associated wtih

A

severe preeclampsia

104
Q

S/S of HELLP

A

n&v, malaise, flu lke sx, epigastric pain with or without HTN

anyone with these s/s should have their CBC and liver enzymes drawn

105
Q

HELLP and corticosteroids

A

they are usually given to foster fetal maturity but they have been found to stabilize platelet counts and hepatic enzymes and LDH levels.

106
Q

What med is typically chosen for HELLP syndrome

A

Dexamethasone

107
Q

maternal glucose crosses the placenta. true or false

A

true

108
Q

CHO Metabolism in the first trimester:

A

increase in estrogen and progesterone which stimulates beta cells of pancreas to increase insulin production

increase use of glucose leads to decrease in serum glucose levels

increase in tissue glycogen (energy) stores

decrease in liver glycogen production

109
Q

CHO metabolism in the 2nd and 3rd trimesters

A

hormone levels lead to decrease tolerance to glucose

increase insulin resistance
HPL- Human Placental Lactogen wont let insulin work

Placental insulinases- break down insulin at placental site

110
Q

placental insulinases

A

breakdown insulin at placental site

111
Q

Net result

A

changes in insulin needs for mother during pregnancy

112
Q

first trimester net result

A

decrease need for insulin, increase insulin production, N&V, decrease food intake, increase transfer of fetus

113
Q

2nd trimester net result

A

gradual increase of insulin

114
Q

3rd trimester net results

A

2-4 times higher need for insulin by 36 weeks, then levels off til labor

115
Q

after delivery net result

A

decrease insulin, glucose insulin balance OK by 7-10 days

116
Q

Pregestational diabetic risks to the mother

A

poor control very early in pregnancy can cause miscarriage

macrosomic baby

PTL

pre-eclampsia

polyhydramnios

ketoacidosis/hypoglycemia

117
Q

Gestational onset risks to the mother

A

2X more likely to have pre-eclampsia and macrosomic baby

118
Q

pregestational risks to baby for diabetes:

A

congenital defects :heart, skeletal, CNS

119
Q

Gestational diabetes risks for baby

A 
macrosomia
trauma
hypoglycemia
RDS
hypocalcemia
hyperbilirubinemia
thrombocytopenia
polycythemia
120
Q

Management of pre-gestational diabetes

A

establish glycemic control BEFORE pregnancy

understand very close monitoring - 4-8 times a day

If type 2- oral hypoglycemic agents are teratogenic- insulin subq during pregnanacy

diet carefully balanced

121
Q

Management of pre-gestational diabetes: Hgn A1c

A

Good control: 2.5-5.9 %
Fair control: 6-8%
Poor control: >8%

122
Q

for mothers with pre-gestational diabetes, when is exercise best

A

after meals

123
Q

Management of pre-gestational diabetes- INSULIN

A

multiple times a day, mixed longer acting and rapid acting in the morning and pm

humulin and novolin, NOT PORK OR BEEF INSULINS

humulog if NEWLY diagnosed

124
Q

goal for insulin in pre-gestational diabetes

A

fasting 60-90 mg/dl

2 hour postprandial= 90=120

125
Q

Management of Pre-gestational Diabetes-Delivery

A

Careful determination of ACTUAL due date
Amniocentesis —-Fetal lung maturity
Induce 39-40 wks-NO LATER THAN 40 WKS
If estimated fetal weight greater than 4000-4500 gms—C/S
In L&D- Watch maternal glucose levels EVERY 2 hours

126
Q

low risk for gestational diabetes screening

A

less than 25 y/o
no family Hx
normal BMI
no abnormal GTT

127
Q

high risk for gestational diabetes screening

A

history of diabetes,
overweight, obese
high risk group- african american, native, latina, pacific

128
Q

Gestational diabetes screening- First pre-natal visit.

A

50 gm glucose load, draw serum 1 hour later

negative less than 140
positive greater than 140

screen again at 24-28wks gestation

129
Q

if positive result of gestational diabetes screening

A

do 3 hour GTT (100g of glucose)

positive for GDM- 2 or more levels are met or exceeded:
Fasting

130
Q

managment of gestational diabetes

A 
keep blood sugars within levels 
3 meals and 3 snacks diet
exercise
insulin- 20% will need insulin during pregnancy
blood glucose monitoring
delivery by 40 wks
prequent NST/ BPP in last 2 mo
131
Q

Group B hemolytic strep

A

major cause of perinatal infections
found in vagina and urine
increase fetal mortality and morbidity
screen 35-37 weeks

132
Q

IF positive for GBS

A

treat with penicillin: 5 milli units IV X 1; 2.5-3 milli units every 4 hours

treat with ampicillin: 2 GMS X 1; 1 GM every 4 hrs

treat with clindamycin: 900 mg q 8 hr or
erythromycin 500mg q 6 hrtil delivery IF ALLERGIC TO PENICILLIN

133
Q

GBS: prophylactic treatment is indicated if

A

previous infant with GBS, GBS bacteria during pregnancy, PTL, temp in labor of greater than 100.4, membranes ruptured for more than 18 hours

134
Q

TORCH

A

toxoplasmosis
rubella
cytomegalovirus
herpes

135
Q

why are steroids given to patients with HELLP

A

it can stabilize the platelets

136
Q

patients might complain of what symptoms when experiencing HELLP

A

flu like symptoms

137
Q

ectopic pregnancy

A

egg implants outside of uterus

lots of pain and internal bleeding

surgical intervention needed

138
Q

hydatidiform mole

A

no fetus, fluid filled vesicle, N&V, no FHT, 2nd trimester bleeding, d&C, not get pregnant for 1 year, choriocarinoma if HCG evelated

139
Q

cerclage: McDonalds or Shirodkar procedure

A 
10-14 weeks gestation
no intercourse, prolonged stanging, heavy lifting
bedrest 
teach signs of preterm labor
take tocolytics
uterine monitoring
remove suture at 37 weeks
leave suture in for c/section
140
Q

hyperemesis gravidarum

A

vomiting during pregnancy, 5% loss of body weight, ketosis, metabolic alkalosis
rule out gestational trophoblastic Dz by ultrasound
needs hospitalization if it doesnt respond to small frequent meals (IV fluids with Kcl to prevent hypokalemia)
B vitamin replacement
TPN temporary

141
Q

antihypertensives should be given if..

A

diastolic is greater than 105-110

142
Q

Cerlage or McDonalds procedure

A

done for incompetent cervix.
10-14 weeks
sutures taken out at 37 weeks if giving vaginal birth
no intercourse, heavy lifting, etc.

Mary's Tests - Spring 2016 (10 decks)

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