Medical Conditions in Pregnancy

Question 1

Gestational Diabetes- screening

Answer 1

• 50 gm 1 hr oral load glucose challenge (>130-140 abnormal)

- if abnormal- 3 hr 100 gm oral load gluc tolerance test

Question 2

risk factors for GDM

Answer 2

• obesity
• prev hx of GDM
• strong FH of DM
• known glucose intolerance

Question 3

GDM- maternal complications

Answer 3

• gestational HTN
• preeclampsia
• C-delivery
• developing diabetes later in life

Question 4

GDM- fetal comlications

Answer 4

• macrosomia!! (> 4000 gms)
• hypoglycemia
• hyperbilirubinemia
• operative delivery
• shoulder dystocia!!!
• birth trauma

Question 5

GDM pt- should deliver when?

Answer 5

b/w 39-40 wks

Question 6

Pregestational diabetes- maternal complications

Answer 6

• worsening nephropathy and retinopathy
• preeclampsia
• DKA

Question 7

Pregestational diabetes- fetal complications

Answer 7

• spontaneous abortions
• anatomic birth defects (birth defects assoc with inc HgBA1C in period of embryogenesis)
• fetal growth restriction
• prematurity

Question 8

diabetes- management

Answer 8

diet, oral hypoglycemic medications (glyburide), insulin, exercise
-good glycemic control- fasting < 90, 2 hr postprandial < 120

Question 9

Pregestational diabetes- maternal evaluation

Answer 9

• renal- 24 h urine collections
• cardiac- EKG
• eye exam in 1st trimester
• glycemic control

Question 10

Pregestational diabetes- fetal evaluation

Answer 10

• US
• fetal echocardiogram
• congenital malformations- biochemical testing
• fetal growth US every 2-4 wks

Question 11

postpartum management of diabetes

Answer 11

• insulin dep pts need 2/3 of pregnancy dose of insulin
• GDM freq dont need further tx
• GDM- need fasting blood gluc or 2 hr glucose tolerance 6-12 wks postpartum

Question 12

maternal hyperthyroidism- tx

Answer 12

• PTU- 1st trimester

- methimazole- 2-3 trimester

Question 13

maternal hyperthyroidism- fetal effects

Answer 13

-meds can cross placenta- fetal hypothyroidism and fetal goiter can develop

Question 14

thyroid storm

Answer 14

• triggers- infection, labor, c-delivery

- hyperthermia, tachycardia, perspiration, high output cardiac failure, maternal mortality of 25%

Question 15

thyroid storm- tx

Answer 15

• B-blockers- propranolol
• sodium iodide
• PTU
• dexamethasone
• replace fluid losses
• bring T down

Question 16

Hypothyroidism- if untreated, inc risk of?

Answer 16

• sp abortion
• preeclampsia
• abruption
• low birth weight infants
• stillbirth
• lower intelligence levels

Question 17

hypothyroidism- tx

Answer 17

-thyroid replacement

Question 18

neonatal thyrotoxicosis

Answer 18

• due to transplacental transfer of thyroid stim ab’s
• transient
• mortality rate 16%

Question 19

neonatal hypothyroidism

Answer 19

• causes developmental retardation

- caused by- thyroid dysgenesis, inborn errors of thyroid fxn, drug induced

Question 20

Rheumatic HD

Answer 20

• mitral stenosis!!!

- high risk of HF, subacute bacterial endocarditis, thromboembolic dz

Question 21

Cardiac arrhthmias

Answer 21

SVT!

-benign and assoc with overly strenuous exercise

Question 22

postpartum cardiomyopathy

Answer 22

• develops within last wks of pregnancy or 6 months postpartum
• at risk- women with preeclampsia, HTN, poor nutrition
• mortality rate 10%

Question 23

all pregnant cardiac pts should be?

Answer 23

comanaged with a cardiologist!!!

Question 24

Immune Idiopathic Thrombocytopenia

Answer 24

• Igs attached to maternal platelets

- tx- when plts < 50,000- prednisone, IVIG, plt transfusion, splenectomy

Question 25

SLE

Answer 25

- flares tx with prednisone | - fetal complications- preterm delivery, fetal growth restrictions, stillbirth, miscarriage

Question 26

N/V of pregnancy

Answer 26

(50-80% of women complain of during first 8-12 wks)

Question 27

Hyperemesis gravidarum

Answer 27

(1-2%) - persistent N/V assoc with > 5% loss of prepregnancy wt, ketonuria, dehydration - cause unknown

Question 28

GERD

Answer 28

70% of pregnant women) | -small meals, avoid lying down after meals, elevate head when sleeping, antacids, H2 blockers/PPIs

Question 29

Superficial thrombophlebitis

Answer 29

- palpable cord in calf- superficial! - swelling, tenderness - tx- bed rest, pain med, local heat wear support hose; dont need anticoagulants!!

Question 30

DVT

Answer 30

-left leg- pain in calf with dorsiflexion (50% asx) -US with doppler flow -tx- anticoag tx- LMW (lovenox) or unfractionated heparin -follow aPTT values (heparin), factor Xa values (lovenox) have to avoid estrogen for contraception

Question 31

PE- sx's

Answer 31

- pleuritic chest pain, shortness of air, air hunger, palpitations, hemoptysis - tachypnea, tachycardia, low grade fever, pleural friction

Question 32

PE- evaluation, tx

Answer 32

- EKG, chest Xray, ABG, VQ, CT - anticoag - *require a thrombophilia work-up!!!

Question 33

asthma

Answer 33

(3-9%) | -assoc with inc miscarriage, preeclampsia, intrauterine fetal demise, fetal growth restriction, preterm delivery

Question 34

postpartum depression

Answer 34

(10-15 %) | -> first 2 wks postpartum