Medical Complications in Pregnancy

Question 1

What is Hyperemesis Gravidarum?

Answer 1

Persistent nausea and vomiting during pregnancy that does NOT resolve after the 1st trimester

Question 2

When does “morning sickness” resolve with pregnancy?

Answer 2

Before the end of the 1st trimester
– Hyperemesis Gravidarum will NOT

Question 3

With what 3 conditions is Hyperemesis Gravidarum common?

Answer 3

Molar pregnancies
Multiple gestations
1st pregnancies

Question 4

What lab finding may be seen with Hyperemesis Gravidarum?

Answer 4

HIGH b-hCG

Question 5

What test should be done if you suspect Hyperemesis Gravidarum?

Answer 5

Ultrasound to rule out molar pregnancies and multiple gestations

Question 6

What are some treatment options for Hyperemesis Gravidarum? (4)

Answer 6

• Doxylamine-Pyridoxine (B6)
• Ondansetron
• Promethazine
• Metoclopramide

Question 7

If Hyperemesis Gravidarum is severe enough, low food intake and weight loss will be present with what metabolic/urine abnormalities?

Answer 7

Ketonuria – low glucose from not eating
Hypochloremic Hypokalemic Metabolic Alkalosis

Question 8

When do you screen for Gestational DM?

Answer 8

24 weeks

Question 9

When screening for Gestational DM at 24 weeks, what is done? What is an abnormal result?

Answer 9

1 hour 50g glucose challenge
** Abnormal = glucose > 140

Question 10

If the initial Gestational DM screening comes back abnormal, then what is done?

Answer 10

3 hour 100g glucose challenge

Question 11

To diagnose Gestational DM, what must the glucose levels be above at 1, 2, and 3 hours with the 100g challenge?

Answer 11

1 hour = > 180
2 hour = > 160
3 hour = > 140

Question 12

Gestational DM may be able to be managed with dietary modifications but if not, what medication should be used?

Answer 12

Insulin

Question 13

Is the mother at an increased risk for Type 2 DM if she has Gestational DM?

Answer 13

YES

Question 14

If HTN is present before pregnancy or before 20 weeks, what is it considered throughout pregnancy?

Answer 14

Chronic hypertension

Question 15

When does Gestational HTN develop and resolve?

Answer 15

Develops after 20 weeks gestation
Resolves after 12 weeks postpartum

Question 16

What are the 4 antihypertensive medications used during pregnancy?

Answer 16

Methyldopa
Hydralazine
Nifedipine
Labetolol

Question 17

What are the 4 antihypertensive medications used during pregnancy?

Answer 17

Methyldopa
Hydralazine
Nifedipine
Labetolol

Question 18

What is needed to diagnose Gestational HTN?

Answer 18

2 blood pressure elevations more than 4 hours apart

Question 19

When does Preeclampsia develop?

Answer 19

After 20 weeks gestation

Question 20

What is present with Preeclampsia?

Answer 20

New onset HTN + Proteinuria

Question 21

How much proteinuria is too much?

Answer 21

> 300mg in 24 hours

Question 22

What symptoms can develop if Preeclampsia is more severe?

Answer 22

Edema
Headache and blurry vision
RUQ pain
Pulmonary Edema

Question 23

What is the treatment for Preeclampsia?

Answer 23

Deliver no later than 37 weeks!
- BP control
- Magnesium to prevent seizures

Question 24

What is the treatment for Preeclampsia?

Answer 24

Deliver no later than 37 weeks!
- BP control
- Magnesium to prevent seizures

Question 25

What is HELLP syndrome?

Answer 25

Hemolytic anemia Elevated Liver enzymes Low Platelets

Question 26

What is Eclampsia?

Answer 26

Women with Preeclampsia then develop a grand mal seizure

Question 27

What is the management of Eclampsia?

Answer 27

Magnesium +/- Diazepam - BP control - Deliver once STABLE

Question 28

Asymptomatic Bacteriuria is common in pregnancy. How will it present?

Answer 28

Asymptomatic but (+) urine culture at initial OB visit

Question 29

If a patient is pregnant and gets a UTI, what are the treatment options?

Answer 29

Cephalexin Amoxicillin/Clavulanate Nitrofurantoin AFTER 1st TRIMESTER

Question 30

If a patient is pregnant and gets Pyelonephritis, what is the treatment?

Answer 30

Admission + IV 3rd Gen Cephalosporin

Question 31

What defines an Antepartum hemorrhage?

Answer 31

Bleeding AFTER 20 weeks gestation

Question 32

3 common causes of bleeding after 20 weeks gestation?

Answer 32

Placental Abruption Placenta Previa Vasa Previa

Question 33

What often causes Placental Abruption? (3)

Answer 33

Trauma Cocaine HTN

Question 34

How will a Placental Abruption present?

Answer 34

PAINFUL bleeding + fetal distress

Question 35

Placental Abruption is a clinical diagnosis. What is the treatment?

Answer 35

Stabilize and Deliver soon

Question 36

Painful vaginal bleeding after 20 weeks with fetal distress is likely?

Answer 36

Placental Abruption

Question 37

What is Placenta Previa?

Answer 37

Abnormally low placental implantation near or covering the cervical os

Question 38

How will Placenta Previa present?

Answer 38

PainLESS bleeding that often ceases after a few hours

Question 39

Painless vaginal bleeding after 20 weeks that stops after a few hours is likely?

Answer 39

Placenta Previa

Question 40

How is Placenta Previa confirmed?

Answer 40

US

Question 41

Should you preform a vaginal exam with Placenta Previa?

Answer 41

NO

Question 42

What is Vasa Previa?

Answer 42

Uncovered umbilical cord vessels pass over the cervical os

Question 43

How will Vasa Previa present usually?

Answer 43

Painless vaginal bleeding + rupture of membranes

Question 44

Is it possible to see fetal bradycardia/demise with Vasa Previa?

Answer 44

YES

Question 45

How will Vasa Previa often present?

Answer 45

Painless vaginal bleeding after 20 weeks with rupture of membranes

Question 46

If a patient is at high-risk for developing Gestational DM, when do you screen them?

Answer 46

1st trimester

Question 47

If a patient developed GDM during the pregnancy, what should be performed at the 6 week postpartum visit?

Answer 47

2 hour 75g glucose challenge test

Question 48

What level of urine protein:Cr ratio can diagnose the proteinuria associated with Preeclampsia?

Answer 48

> 0.3

Question 49

What 24 hour urine protein level can diagnose the proteinuria associated with Preeclampsia?

Answer 49

> 300mg in 24 hours

Question 50

What BP level is diagnostic if Preeclampsia with severe features?

Answer 50

> 160 OR > 110

Question 51

If preeclampsia WITH severe features is present, when should delivery occur?

Answer 51

After 34 weeks

Question 52

If a patient experienced Preeclampsia in a prior pregnancy, what should they be taking during subsequent prenancies?

Answer 52

Low-dose Aspirin for prophylaxis

Question 53

What is the delivery method for Placenta/Vasa Previa?

Answer 53

C-section

Question 54

If Placenta Previa or Vasa Previa is present, what should be given in the 3rd trimester and how should they deliver?

Answer 54

Steroids --> C-section

Question 55

If placenta accreta/increta/percreta spectrum is present, what is the treatment?

Answer 55

C-section with Hysterectomy!