Maternal Disease Flashcards
(44 cards)
Bad fetal SFX thiazide
Thrombocytopenia, electrolyte
Bad fetal SFX ethacrynic acid
Ototoxicity, HTN
Bad fetal SFX furosemide
PDA (stimulates PGE2 synthesis)
How to make them worse?
- Eisenmenger
- Aortic stenosis
- Mitral stenosis
- IHSS
In order…
- HypoTN (need to keep pressures > pulmonary)
- HypoTN (need the preload)
- Fluid overload, tachycardia
- Tachycardia
Refractory VTach treatment
Amiodarone then defibrillate then (maybe) lido
Refractory maternal SVT treatment
CCB / beta blockers then adenosine then pace
Preeclampsia heme changes.
What increases?
What decreases?
- INCREASE
- Platelet production, platelet activation, TXA2 (which is supposed to activate platelet aggregation and yet…)
- Endothelin. Cellular fibronectin, GF, VCAM-1, Factor 8 antigen, thrombomodulin.
- Ischemic placenta => shoots sFlt-1 (VEGF antagonist) into the circulation
- DECREASE
- Platelet aggregation. Why?
- Exhaustion
- Count overall
- Prostacyclin (PGI2) (which is an aggregation inhibitor so decrease of inhibitor should see more but nope because of previous bullet)
- Nitric oxide
- Anti-thrombin III, Angiotensin II [though activity of them increased; see below]
- Renin, Aldosterone, GFR, Na and Cl in urine.
- Platelet aggregation. Why?
What happens to Antithrombin III and Angiotensin II in PreE?
Antithrombin III levels decreased.
Angiotensin II same-ish but increased sensitivity => vasoconstriction.
What LDH/AST ratio predictive of HELLP over TTP? (Low or high)
LOW = less hemolysis more LFT elevation = HELLP.
Eclampsia timing
- 50% week 20-30
- 20% intrapartum
- 21% postpartum (and of these 90% will be w/in 7 days)
Highest asthma risks in pregnancy
PreE, IUGR = 15%
Ristocetin-cofactor result and why for…
- vWD
- Bernard-Soulier
- Glanzmann
- Wiskott-Aldrich
- Low levels/quality vWF; abnormal.
- vWF receptor deficiency; abnormal.
- Integrin defect. NORMAL result!!
- Defective platelets + eczema. Abnormal.
Inheritance vWD Type 1, 2, 3
AutoD (80%)
AutoD
AutoR
vWD treatment options
DDAVP increases f8 and vWF by 3-5x baseline in 30-60 min.
Also vWF, FActor 8, cryo
Electrophoresis result for beta thal minor / intermedia / major?
80-90% A, 5-10% A2, maybe F
In between; maybe 20-40% F
NO A. Variable A2. Basically ALL F.
Alpha thal cis/trans ethnicities
- Alpha Thalassemia
- Blacks: trans
- Asians: cis
What is Factor XIII deficiency assoc with?
- AutoR. XIII: persistent even fatal bleeding from umbilical stump.
Mechanism of TH storm treatment... Beta blocker Thionamide Iodine Iodinated contrast Glucocorticoids Bile acid sequestrant
Beta blocker Decreases adrenergic tone * If severe asthma and want to avoid BB, can use CCB (diltiazem) Thionamide Decreases synthesis Iodine Decreases RELEASE of Th hormone Iodinated contrast Decreases peripheral conversion Glucocorticoids Decreases peripheral conversion + correct adrenal insuff Bile acid sequestrants Reduce recycling TH
Fetal effect of maternal HyperPTH?
IN utero hypercalcemia.
=> Fetal PTH is suppressed = BONES not calcified
Plus gest hypocalcemic once born
DDx neonatal hypocalcemia
- EARLY
- Prematurity
- Maternal DM
- Birth asphyxia
- IUGR
- LATE
- HypoPTH (can be due to DiGeorge — CATC-H = hypocalcemia)
- High phosphate intake [bovine milk]
- HypoMg
- Vitamin D deficiency
Maternal hypOparathyroidism. Fetal effect?
Neo HyperPTH, bone demin, IUGR, skeletal fractures, increased Ca.
Mechanisms oral DM Rx? What two mechanisms in common? What unique to glyburide? to metformin?
- BOTH decrease hepatic glucose and increase insulin sensitivity
- Glyburide also stimulates beta cell release
- Metformin also decreases intestinal absorption
Breastfeeding and... Active TB? Active VZV? CMV? Hep B? C? Hep A? Syphilis?
- Active TB? Wait 2 weeks on anti-tuberculin therapy before starting to breastfeed
- Active varicella? NO breastfeeding.
- CMV? Breastmilk has both virus and the antibodies. OK!
- Hepatitis B and C? Both in breastmilk (but they get a vaccine for Hep B.
- Hep A not in breastmilk. OK!
- Syphilis not in breastmilk. OK!
HIV CD4 prophylaxis #s and Rx.
PTMC Prophylaxis Takes Much Concentration CD4 < 200 Bactrim for PCP CD4 < 100 Bactrim for PCP and toxo CD4 < 75 Add azithro for MAC CD4 < 50 Add fluconazole for crypto
