Mod 7 + 8 Flashcards
(224 cards)
1
Q
Can pregnant women take asthma medications?
A
Yes
2
Q
_________ does not commonly involve wheezing and coughing while asthma does
A
Dyspnea
3
Q
Risks associated with_______:
FGR
SGA
PTB
A
Asthma
4
Q
Pregnancy causes ___% of cases to improve, ____% of cases to unchange, ____% of cases will worsen
A
33%, 33%, 33%
5
Q
first test to order when PE is suspected
A
CXR
6
Q
pregnant women are in stable respiratory:
A
alkalosis
7
Q
progesterone causes decreased ___________ and _____________
A
airway conduction and pulmonary resistance
8
Q
elevated diaphragm causes ___________ and ___________
A
functional residual capacity and residual air volume
9
Q
GERD can make asthma:
A
worse
10
Q
Asthma Severity: symptom frequency: 2 days per week or less night waking: 2x/month or less NO intereference with normal activity PFR > 80% of personal best
A
Intermittent
11
Q
Asthma Severity:
symptom frequency: >2 days per week but not daily
night waking: >2x/month
Intereference with normal activity: minor
PFR > 80% of personal best
A
Mild Persistent
12
Q
Asthma Severity: symptom frequency: daily night waking: >1x/week Intereference with normal activity: some limitation PFR 60-80% of personal best
A
Moderate Persistent
13
Q
Asthma Severity: symptom frequency: throughout day night waking: 4x/week or more Intereference with normal activity: extreme limitation PFR <60% of personal best
A
Severe Persistent
14
Q
Treatment for _________ Asthma:
No daily meds
Albuterol PRN
A
Mild Intermittent
15
Q
Treatment for _________ Asthma:
Preferred: Low-dose inhaled corticosteroids
Alternative: Cromolyn, Leukotriene Receptor Antagonist, Theophylline
A
Mild Persistent
16
Q
Treatment for _________ Asthma:
Preferred: Low-dose inhaled corticosteroids AND Salmeterol or Medium-dose inhaled corticosteroids
Alternative: Low-dose or Medium-dose inhaled corticosteroids AND Leukotriene Receptor Antagonist or Theophylline
A
Moderate Persistent
17
Q
Treatment for _________ Asthma:
Preferred: High-dose inhaled corticosteroids AND Salmeterol AND oral corticosteroid (if needed)
Alternative: High-dose inhaled corticosteroids AND Theophylline AND oral corticosteroid (if needed)
A
Severe Persistent
18
Q
Maternal Implications of \_\_\_\_\_\_\_\_\_: Variable - 23% improve, 30% worsen Need monitoring w/ PEFR and FEV1 testing + tracking symptoms throughout pregnancy LBW Prematurity Susceptibility to hypoxia and hypoxemia Slight increase (studies not consistent): -stillbirth -preeclampsia -PTL -FGR -perinatal mortality -abruption -previa -PROM -GDM Morbidity (severe disease, poor control, or both) **Otherwise usually good outcomes Status asthmaticus can → morbidity, muscle fatigue, resp arrest, pneumothorax, pneumomediastinum, acute cor pulmonale, cardiac arrhythmias
A
Asthma
19
Q
**Fetal Implications of \_\_\_\_\_\_\_\_\_: Fairly uncommon--If any risk it is slight and studies are not consistent** SAB PTL/PTB FGR (with increased severity) Abruption/Previa PROM Fetal response to maternal hypoxemia → ↓umbilical blood flow, ↑systemic and pulmonary vascular resistance, ↓cardiac output Possible teratogenic or adverse effects of Meds Slight risk for abnormalities: -Cleft lip and palate -Autism spectrum disorders
A
Asthma
20
Q
Differential Dx for \_\_\_\_\_\_\_\_: Dyspnea of pregnancy GERD Chronic cough from postnasal drip Bronchitis
A
Asthma
21
Q
Collaborate or refer for ANY level of _______ asthma
A
persistent
22
Q
Avoid ______ corticosteroid in ____ trimester
A
oral in 1st
23
Q
Give stress dose of corticosteroids to women in labor that have used ___________ in the past 4 weeks
A
oral steroids
24
Q
med that is possibly teratogenic or may have adverse fetal effects - several reports show slightly higher risk for abnormalities such as cleft lip/palate and autism spectrum
A
oral steroids
25
ICS usually bumped up to q__-__ hours to reduce need for extra SABAs in persistent asthma
3-4
26
Interventions for Asthma during __________:
Keep rescue inhaler at bedside
Continue ICS
Labor
27
Avoid nubain during:
acute asthma attack
28
Labetolol and Hemabate - not first line for:
asthmatics
29
If patient also allergic to ASA, DO NOT give ____________ during labor, consult physician
corticosteroids
30
Medication for all severities of asthma
SABAs
31
Add __________ to SABA for Mild Persistent Asthma
Low-dose ICS
32
Add __________ to SABA for Moderate Persistent Asthma
Low-dose ICS + LABA
33
Add __________ to SABA for Severe Persistent Asthma
High-dose ICS + LABA
34
Add __________ to SABA for VERY Severe Persistent Asthma
High-dose ICS + LABA + PO corticosteroids
35
Do not _______ asthma medications DURING pregnancy
step-down
36
What to assess if asthma symptoms ___________:
| medication technique, adherence, and environmental control
not controlled
37
```
Nonpharmacologic Interventions for ________:
Control of triggers
Herbal remedies (NOT in place of meds!)
Licorice, Ginkgo Biloba, Coltsfoot, Hops
Fish Oil, Vitamin C
Yoga, acupuncture, biofeedback
```
Asthma
38
Causes increased risk for __________ in pregnancy:
decreased venous outflow
hypercoagulable state
damage to venous lining
VTE
39
```
V
I
R
C
H ow's Triad
```
Vascular Injury
Reduced blood flow (venous stasis)
HyperCoaguability
40
pauses in respiratory movements greater than 20 sec that is common in preterm infants...involves changes in HR (often <80 bpm)
apnea
41
apnea with no breathing effort and no airflow
central apnea
42
apnea with breathing effort but no airflow
obstructive apnea
43
apnea that begins with no breathing effort then once breathing effort starts, there is no airflow
mixed apnea
44
venous stasis, hypercoagulable state, vascular trauma
Virchow's
45
Venous wall relaxation due progesterone and venous pressure due to gravid uterus
venous stasis
46
DVT is usually in _______ left leg-- ileal femoral veins
proximal
47
Pathophysiology of ____________:
| the placenta experiences ischemia because the spiral arteries of the uterus fail to reshape and increase in diameter
preeclampsia
48
Preeclampsia: ___creased serum creatinine
increased
49
Preeclampsia: ___creased creatinin clearance
decreased
50
Preeclampsia: ___creased liver enzymes
increased
51
Preeclampsia: ___creased Lactate Dehydrogenase (LDH)
increased
52
level that indicates proteinuria in 24-hour urine
>300
53
```
Risk Factors for __________:
Obesity (BMI>30)
Smoking
Age>35
Hx thrombosis
Inherited thrombophilias
Antiphospholipid antibody syndrome
Sickle cell disease
Heart disease
Diabetes
Immobility (paraplegia)
[Due to Pregnancy:]
Hypercoagulable state
Venous stasis
Multiple pregnancy
Preeclampsia
[Due to Labor and Birth:]
Operative vaginal birth
C/S
Infection
Vascular trauma
Immobilization
PPH
Preterm birth
Stillbirth
```
DVT
54
LOOK AT ACOG Chronic HTN & Gestational HTN tables that explain difference b/t severe and nonsevere features
!!!!!!!!
55
LOOK AT CLINICAL RISK FACTORS FOR ASPIRIN USE IN PREGNANCY
!!!!!!!!!
56
Management of ____________:
**Immediate referral
Thrombophilia testing first if indicated
Anticoagulation w/ unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH)
PP: simultaneously start warfarin (safe during lactation)
Anticoagulation continues for 6 months minimum
Limited activity, leg rest, elevation
Over several days leg pain should subside
After symptoms pass - graded ambulation started, fit elastic stockings, continue anticoagulation
Graduated compression stockings are worn for 2 yrs to prevent post-thrombotic syndrome
DVT
57
Recovery of DVT is usually __-___ days
7-10
58
PE incidence: 1 in _______
7,000
59
```
Symptoms of _______:
Dyspnea
Chest pain
Cough
Syncope
Hemoptysis
Tachypnea
Apprehension
Tachycardia
Pulmonic closure sound
Rales
Friction rub
Deceptively nonspecific - s/s and lab testing
```
PE
60
Diagnostics for _______:
ECG (right axis deviation + T wave inversion)
CXR (results normal 40% of the time, otherwise may have atelectasis, infiltrate, cardiomegaly, or effusion)
Most hypoxemic--Normal arterial blood glass does not exclude
⅓ have PO2 value of >80mmHg
Alveolar-arterial oxygen tension difference more useful indicator - 86% have alveolar-arterial difference >20mmHg
PE
61
Gestational HTN will deliver @ ___ weeks
37
62
Risk Factors for __________:
Rapid labor
MSAF
Tears into uterine/other large pelvic veins (permits fluid exchange b/w mother & fetus)
```
AMA
Post-term pregnancy
Labor induction or augmentation
Eclampsia
Cesarean, forceps, or vacuum delivery
Abruption or previa
Hydramnios
```
AFE
63
Risk Factors for __________:
Rapid labor
MSAF
Tears into uterine/other large pelvic veins (permits fluid exchange b/w mother & fetus)
```
AMA
Post-term pregnancy
Labor induction or augmentation
Eclampsia
Cesarean, forceps, or vacuum delivery
Abruption or previa
Hydramnios
```
Male gender fetus
Fetal distress
PROM
IUFD
AMA >35
Multiparity
Diabetes
C/S
cervical laceration
Uterine rupture
Uterine Hypertonus - likely effect rather than cause, hypertonus from oxytocin not implicated
AFE
64
Symptoms of __________:
Classic triad:
hemodynamic compromise, respiratory compromise, DIC
Classic example:
dramatic behavior
late stages of labor immediately postpartum
gasping for air
Seizures or cardiorespiratory arrest rapidly follows w/ massive hemorrhage from consumptive coagulopathy
Manifestations can be variable
AFE
65
```
Management for ___________:
Protect airway
2 large-bore IVs
Type+Cross
Consider vasopressors
Contact OR
Emergent C/S
ICU
Volume resuscitation
serial ACT/ABG/VBG
PRBC/FFP/platelets
```
AFE
66
Most efficient way for NB to temporarily increase ventilation and compensate for hypoxia and hypercarbia
tachypnea
67
developmental deficiency in surfactant synthesis accompanied by lung immaturity and hypoperfusion
Neonatal Respiratory Distress
68
Do NOT give ___________ to protect against infections from MVP (mitral valve prolapse)
prophylactic abx
69
Causes of ___________:
Prematurity and exacerbated by asphyxia
Impaired or delayed surfactant synthesis
Neonatal Respiratory Distress
70
Risk Factors for ____________:
Fetal - Prematurity, asphyxia, anemia
Maternal - poorly controlled GDM
Pregnancy- polyhydramnios, oligohydramnios
Intrapartum - previa, abruption, MSAF
**Risk decreases w/ higher gestational age**
Neonatal Respiratory Distress
71
```
Risk Factors for __________:
Male gender
Maternal GDM
Perinatal asphyxia
Hypothermia
Multiple gestations
```
Respiratory Distress Syndrome
72
NB's most efficient way to temporarily increase ventilation and compensate for hypoxia and hypercarbia
tachypnea
73
sound created by exhaling against a partially closed glottis in an attempt to increase functional residual capacity in lungs and stabilize (stint) alveoli
**helps keep the lungs expanded and preserves oxygen**
grunting
74
attempt to decrease resistance to airflow by increasing the size of nostrils that results from increased inspiratory pressure
**this decrease in resistance will decrease total work of breathing**
nasal flaring
75
Attempt to increase lung compliance and assist the diaphragm as it mechanically expands the lung during inspiration
**occurs with airway obstruction**
retractions
76
apparent when 5 g/100 mL of hemoglobin is unsaturated and SpO2 decreases to 80-85%
central cyanosis
77
developmental deficiency in surfactant synthesis accompanied by lung immaturity and hypoperfusion
caused by prematurity and exacerbated by asphyxia
or impaired/delayed surfactant synthesis
neonatal respiratory distress
78
```
Risk Factors for ____________:
Fetal -
Male gender
Prematurity
Asphyxia
Anemia
Hypothermia
Multiple gestations
```
Maternal -
Poorly controlled diabetes
Pregnancy-
Polyhydramnios
Oligohydramnios
```
Intrapartum-
Previa
Abruption
MSAF
**Risk decreases w/ increased gestational age
```
neonatal respiratory distress
79
NB Respiratory Problem:
Begins early
and Increases in severity over the first 72 hours
neonatal respiratory distress
80
results in poor compliance, rapid, shallow breathing
surfactant deficiency
81
results in slower deep breathing
increased airway resistance
82
Symptoms of _________________:
Tachypnea
Grunting
Pitting edema
Cyanosis
Diminished breath sounds
Retractions
Isolated tachypnea w/ congenital heart disease
Temp instability (infection?)
Tachycardia (hypovolemia?)
Scaphoid abdomen (congenital diaphragmatic hernia?)
Asymmetric chest movement/ breath sounds
Tension pneumothorax possible
Stridor (possible subglottic stenosis in previously intubated)
neonatal respiratory distress
83
```
Diagnostics for _______________:
Follow NRP guidelines until infant is stable then...
-Chest x-ray
-ABG
-CBC w/diff
-Blood cultures
-Review maternal/fetal history
```
neonatal respiratory distress
84
Inadequate or delayed clearance of lung liquid leading to transient pulmonary edema
Transient Tachypnea of the Newborn
85
Caused by fluid in lungs increasing inspiratory activity, RR, and grunting
- Possibly from alteration in permeability of pulmonary capillary vessels, aspiration of amniotic fluid during in uterine gasping efforts or decreased vaginal thoracic squeeze
- Immaturity leads to slower lung fluid removal
- Delayed respiratory transition w/ increase in diffusion distance
- Increased risk of V/Q mismatching
Transient Tachypnea of the Newborn
86
```
Risk Factors for __________________:
Cesarean birth before labor onset
Perinatal hypoxic stress event
Precipitous labor
Male gender infant
Genetic change in alveoli 𝛃-adrenergic receptor expression
```
Transient Tachypnea of the Newborn
87
Uncommon in preterm infants born by C/S possibly due to increased interstitial tissue and smaller gas exchange areas that decrease movement of lung fluid from the interstitial space back into the airway
Transient Tachypnea of the Newborn
88
No transition after birth with symptoms resolving usually in 48-72 hours
Transient Tachypnea of the Newborn
89
```
Symptoms of _________________:
Tachypnea (up to 120-140 bpm)
Mild to moderate retractions
Grunting
Cyanosis (usually not prominent)
Breath sounds may be initially moist but clear quickly
```
Transient Tachypnea of the Newborn
90
Diagnostics for _______________:
CBC + blood cultures (Rule Out sepsis)
Chest X-ray (vascular engorgement, moderate cardiomegaly, occasional air bronchogram, hyperaeration)
ABG (may indicate respiratory acidosis)
Transient Tachypnea of the Newborn
91
```
Management of ______________:
Supportive based on symptoms
Rule out sepsis
O2 required (usually needs to be >40%)
**Not a severe respiratory problem
```
Transient Tachypnea of the Newborn
92
breathing alternating w/ a pause of up to 20 seconds which may be induced by hypoxemia and respiratory depression that is more common in preterm infants
*can be relieved by respiratory stimulants like caffiene
periodic breathing
93
lapse of 20 seconds or more in breathing that occurs w/ color changes or bradycardia (often < 80 bpm) that is common in preterm infants and more frequent for infants w/ chronic lung disease or other respiratory problems
*Abnormal finding in full-term infants - may indicate an underlying problem, like sepsis, hypoglycemia, CNS injury or abnormality, seizures, or maternal drug use
apnea
94
type of apnea with no airflow or breathing efforts
central apnea
95
type of apnea where there is no airflow WITH breathing efforts
obstructive apnea
96
apnea that begins as central and becomes obstructive
mixed apnea
97
this is caused, in theory, by vagal stimulation from common, transient umbilical corn entrapment resulting in bowel peristalsis
MSAF
98
```
Risks correlated with ____________:
C/S
Forceps
Intrapartum FHR abnormalities
Low APGARs
Need for assisted ventilation at delivery
```
Meconium aspiration
99
inactivates surfactant and activates complement cascade causing inflammation and vasoconstriciton of the pulmonary veins
Meconium Aspiration
100
Current belief is that this occurs when infant is compromised by a chronic event like chronic metabolic acidosis, infection, or other comorbidities rather than only an acute event in labor
Meconium Aspiration
101
```
Induces hypoxia via 4 major pulmonary effects:
Airway obstruction
Surfactant dysfunction
Chemical pneumonitis
Pulmonary hypertension
```
Meconium Aspiration
102
increases risk for intrauterine infection
MSAF
103
```
Symptoms of ____________:
Death (thick)
Long term neurological sequelae
Barrel chest
Crackles and Rhonchi on auscultation
Associated complication - Pulmonary Hypertension
```
MAS
104
Risk Factos for ____________:
Postterm
FGR
*due to decreased amniotic fluid + cord compression or uteroplacental insufficiency
MAS
105
```
Management of ____________:
Ventilatory support
Intubation as needed
CXR (varies w/ severity, areas of patchy atelectasis, areas of overinflation)
Surfactant replacement
Inhaled corticosteroids
```
MAS
106
```
M
R
S
O
P
A
```
```
Mask adjustment
Reposition airway
Suction (mouth + nose)
Open mouth
Pressure increase
Alternative airway
```
107
Start NRP with PIP of:
20-25
108
Start NRP with PEEP of:
5
109
chest compressions are necessary when the baby's HR is below ____ after at least ___ seconds of PPV
below 60 after at least 30 seconds of PPV
110
chest compression should be pressure applied to the _________ of the sternum
lower 1/3
111
```
Arterial:
Low pH
High PCO2
Normal HCO3
Normal Base Deficit
```
Respiratory Acidosis
112
```
Arterial:
Low pH
Normal PCO2
Low HCO3
High Base Deficit
```
Metabolic Acidosis
113
```
Arterial:
low pH
High PCO2
Low HCO3
High Base Deficit
```
Mixed Acidosis
114
Arterial Normal pH
7.26 +/- 0.07
115
Arterial Normal PCO2
53 +/- 10
116
Arterial Normal HCO3
22 +/- 3.6
117
Arterial Normal Base Deficit
4 +/- 3
118
```
Venous:
Low or Normal pH
High or Normal PCO2
Normal HCO3
Normal Base Deficit
```
Respiratory Acidosis
119
Venous:
Normal pH (short duration) or Low pH (long duration)
Normal PCO2
Normal HCO3 (short duration) or Low HCO3 (long duration)
Normal Base Deficit (short duration) or Low Base Deficit (long duration)
Metabolic Acidosis
120
```
Venous:
Low or Normal pH
High or Normal PCO2
Low or Normal HCO3
High or Normal Base Deficit
```
Mixed Acidosis
121
Arterial Normal PO2
18 +/- 6.2
122
Venous Normal pH
7.35 +/- 0.05
123
Venous Normal PCO2
38 +/- 5.6
124
Venous Normal PO2
29 +/- 5.9
125
Venous Normal HCO3
20 +/- 2.1
126
Venous Normal Base Deficit
4 +/- 2
127
Typically within a 20-30 minute period, if placental perfusion disruption is not corrected and anaerobic metabolism continues, the respiratory component will dissipate, and organic acid levels will continue to increase causing bicarbonate and serum pH levels to drop further. This is now a:
metabolic acidemia
128
Target rectal temp during HIE:
32.5-34 C
129
Requirements for ___________:
1. Greater than 35 weeks gestation
2. Birth weight >/= 1.8 kg
3. Less than 6 hours since insult
4. One or more of the following predictors:
pH = 7.0 + Base Deficit >/= 16 on arterial cord gases
pH 7.01--7.15 + Base Deficit 10--15.9 with acute perinatal event AND 10 min APGAR = 5 AND/OR Assisted ventilation at birth required for 10 or more minutes
```
5. Seizures OR 3 of the following:
Lethargy / Stupor / Coma
Decreased or NO Activity
Distal flexion/ Complete Extension/ Decerebrate Posturing
Hypotonia or Flaccid Tone
Weak/ Absent Suck
Incomplete/ Absent Moro Reflex
Constricted/ Dilated/ Deviated/ Non-reactive Pupils
Bradycardic or Variable HR
Periodic Breathing or Apnea
```
HIE
130
usually begins 6-12 hours or more after the initial insult and is characterized by hyperexcitability, cytotoxic edema, and damage from the release of free oxygen radicals and Nitrous Oxide, inflammatory changes and imbalances in inhibitory and excitatory neurotransmitters
Reperfusion Phase after HIE
131
cerebral palsy caused by HIW is more common in _______ infants
preterm
132
_____ infants with moderate to severe HIE have a higher mortality rate, as well as long term cognitive and motor problems
Term
133
in preparation for cooling, take rectal temp q ___ minutes
15
134
Causes for _____________:
```
Primary intracranial process:
Meningitis
Ischemic stroke
Encephalitis
Intracranial hemorrhage
Tumor
Malformation
```
```
Systemic problem:
Hypoxia-ischemia
Hypoglycemia
Hypocalcemia
Hyponatremia
Other disorders of metabolism
```
```
Electrolyte imbalances:
(calcium, potassium, magnesium, sodium)
Acidosis
Hyperbilirubinemia
Viruses (CMV)
Sepsis
```
NB Seizures
135
Symptoms of __________ Seizures:
Eyes: staring, deviation, blinking, fluttering, fixed open stare
Oral: chewing, sucking, lip-smacking, tongue thrusting
Limbs: cycling, swimming, rowing, boxing, pedalling
Systemic: apnea, tachycardia, blood pressure alterations
Subtle
136
```
Symptoms of __________ Seizures:
Usually, involve one limb or one side of the body jerking rhythmically at 1-4 times per second.
Consciousness usually preserved
Multifocal, simultaneous or sequential
Non-ordered/nonJacksonian migration
```
Clonic
137
Symptoms of ___________ Seizures:
Generalized and rapid isolated jerking of muscles
May be focal or multifocal
Usually Conscious.
Myoclonic
138
seizures that primarily occur in preterm infants
Clonic
139
seizures that primarily occur in term infants
Myoclonic
140
seizures that occur in preterm and term infants
Subtle
141
Symptoms of ___________ Seizures:
*Rare*
Sustained posturing of the limbs or trunk or deviation of the head
Generalized extensions of upper and lower limbs accompanied by pronation of arms and clenching of fists
Focal: sustained posturing of limb (rare)
May mimic decerebrate or decorticate posturing
Only 30% have EEG correlation
Difficult to treat with anticonvulsants
Tonic
142
type of seizure seen in drug withdrawal (especially opiates)
* If it occurs during sleep then it is probably ‘benign neonatal sleep myoclonus’
* Can also occur in a very severe form of encephalopathy
Myoclonic
143
type of seizure that may be due to an underlying focal neuropathology such as haemorrhage or cerebral infarction
Clonic
144
seizures that arise from the basal ganglia as a result of diminished cortical inhibition so further depression of the cortex with anticonvulsants may not alter these seizures
Subtle
145
% of NB that develop normally after hypoxia-ischemia seizures develop normally
50%
146
```
____________ causes for Seizures:
Prenatal:
Toxemia
Fetal distress
Abruptio placentae
Cord compression)
```
Perinatal:
Iatrogenic
Maternal haemorrhage
Fetal distress
Postnatal:
Cardio-respiratory (hyaline membrane disease)
Ccongenital heart disease
Pulmonary hypertension
Hypoxia-Ischemia
147
_________ causes for Seizures:
Intraventricular and Periventricular Infarction (mainly preterm neonates)
Intracerebral infarction (spontaneous, traumatic)
Subarachnoid hemorrhage
Subdural hematoma
Cerebral artery and Vein infarction
Hemorrhage/Infarction
148
__________ causes for Seizures:
Intracranial haemorrhage
Cortical vein thrombosis
Trauma
149
```
___________ causes for Seizures:
Hypoglycemia (BG <20 in preterm or <30 in term infants)
GDM
Maternal Toxemia
Pancreatic disease
Glycogen storage disease (idiopathic)
Hypocalcaemia
Hypomagnesemia (may accompany or occur independently of Hypocalcemia)
Maternal Hyperparathyroidism
DiGeorge’s syndrome
Hyponatraemia
Hypernatraemia
Inborn errors of metabolism (amino acid and organic acid disorders, hyperammonemia; they usually manifest with peculiar odours, protein intolerance, acidosis, alkalosis, lethargy, or stupor)
Pyridoxine dependency
```
Metabolic
150
NB seizures caused by intraventricular hemorrhage have a:
high morbidity rate
151
Earlier onset of idiopathic or malformation seizures is associated with:
worse outcomes
152
```
Labs to order for ___________ HTN:
Baseline labs:
CBC
LFTs
CMP
24 hr urine
Serum creatinine
PCR (evaluate for kidney function)
EKG (screening purposes)
Platelets
Early GDM screening
```
Chronic HTN
153
Fetal Surveillance for ____________:
Anatomy/Growth scan 16-20 wks gestation (20 wks better)
Repeat growth US @ 30-32 wks, then every 3-4 wks
Biweekly NST & BPP (full or modified)
Chronic HTN
154
Chronic HTN BP should be kept within this range:
Systolic:
Diastolic:
120-160
| 80-105
155
```
Complications of ____________:
Abruption
Superimposed Pre-E
PTB
FGR
```
Chronic HTN
156
Chronic HTN patients should limit salt intake to:
2.4 g/day
157
Chronic HTN patients should be induced at _____ weeks but may be monitored until ____ weeks if low-risk
38 weeks; 40 weeks
158
```
Risk Factors for ___________:
African American race
Obesity
Smoking
AMA
HTN for 4 years or more
Diastolic BP > 100 mmHg at baseline
Hx Preeclampsia
Hx Diabetes
Hx Obesity
```
Superimposed Pre-E
159
```
Diagnostic Criteria for ___________:
Worsening HTN w/ new development of:
Proteinuria
Elevated liver enzymes
Thrombocytopenia
Pulmonary edema
Cerebral or visual disturbances
Renal insufficiency
```
Superimposed Pre-E
160
```
Medications for _____________:
low dose ASA 81 mg starting @ 12 weeks
Calcium if dietary intake < 600 mg/day
Anti-HTN medication:
labetalol, nifedipine, or methyldopa
```
Chronic HTN
161
```
Risk Factors for _______________:
1st pregnancy
Multiple gestation
Molar pregnancy
GDM
pregestational DM
Renal dx
CVD
Genetic predisposition to HTN developing in pregnancy
Hx PreE
cHTN
Thrombophilia
SLE
Prepregnancy BMI >30
Antiphospholipid antibody syndrome
AMA
Assisted reproductive technology
Obstructive sleep apnea
```
Gestational HTN
162
progression of gestational HTN to Pre-E is more likely if it occurs prior to ___ weeks
32
163
Management of ___________:
BP monitoring (home once/week, in-office once/week)
weekly or twice weekly visits
Decrease activity level (no working)
Lying left lateral multiple times per day
**IOL usually @ 37-38 weeks
Gestational HTN
164
Fetal Surveillance for ____________:
NST or modified BPP 2 x/week switching between full BPP
Growth US every 3-4 wks
Fetal kick counts daily @ home
Gestational HTN
165
```
Risk Factors for _____________:
High Risk:
Autoimmune disease (SLE, APA)
Chronic HTN
Hx of Pre-e (especially if adverse outcome)
Multifetal gestation
Renal disease
Type 1 or 2 DM
```
```
Moderate Risk:
AMA
BMI >/= 30
Family Hx of Pre-e in mother or sister
Nulliparity
Hx LBW, SGA, previous adverse pregnancy outcome, >10 yr pregnancy interval
African American race
Low SES
```
Preeclampsia
166
A multisystem disorder that begins early in pregnancy
where placental tissue is key (placental tissue must be present but fetus doesn’t need to be)
Characterized by abnormal placentation and failed remodeling of the spiral arteries, which usually occurs early in gestation in two distinct phases
Preeclampsia
167
Phase 1 of ____________:
failure of the process of spiral placental arteries becoming larger to accomodate increased blood flow causing hypoperfusion, hypoxia, and ischemia within the developing placenta
Preeclampsia
168
Phase 2 of _____________:
the maternal inflammatory response to the initial abnormal placentation and subsequent placental hypoxia that causes endothelial cell dysfunction in the maternal arteries, the release of cytokines which leads to systemic inflammation, vascular endothelial dysfunction, and prothrombotic condition
*Manifests at HTN and in severe cases, liver, kidney and brain damage
Preeclampsia
169
symptom of Pre-E that is thought to be due to periportal and focal parenchymal necrosis, hepatic cell edema, or Glisson’s capsule distension, or a combination
RUQ or epigastric pain
170
FGR or new-onset proteinuria in the 2nd half of pregnancy without ___________ may precede development of diagnostic criteria for Pre-E
HTN
171
```
Labs for ___________:
UA
Urine dipstick
LFTs
CBC with diff (PLTs)
```
Preeclampsia
172
PLT count less than 100K
Thrombocytopenia
173
```
Diagnostic Criteria for ____________:
New onset HTN + proteinuria
*If no proteinuria, must have:
-Thrombocytopenia
-Impaired Liver function
-Renal insufficiency
-Pulmonary edema
-Cerebral or visual disturbances
```
Preeclampsia
174
```
Proteinuria:
Protein >_____ mg/ per 24 hr urine collection
or
PCR > ______ mg/dL
or
Urine dipstick > _____ protein
```
300 mg/ 24 hr urine
PCR > 0.3 mg/dL
dipstick > 1+
175
Renal insufficiency: > ____ mg/dL creatinine
| or doubling creatinine
1.1
176
Impaired Liver Function: Elevated ___________ to twice normal
Liver Enzymes (transaminases)
177
```
Complications of ____________:
Abruption
Pregnancy loss
Stroke
Organ failure
Maternal death
Preterm birth
FGR
Stillbirth
Neonatal death
Twice the risk for cardiovascular disease and mortality from ischemic heart disease, HF or stroke
HTN after perinatal period
```
Preeclampsia
178
______________ medication not recommended for Pre-E unless severe features present
Antihypertensive
179
Mild Preeclampsia: IOL by ____ weeks
37
180
Severe Preeclampsia: IOL by ____ weeks
34
181
first line agents to keep BP after Mag
Hydralazine, labetalol, and nifedipine
182
H
EL
LP Syndrome
Hemolysis
Elevated Liver enzymes
Low Plateletss
183
Rapid progression to HELLP or eclampsia is more likely to occur when onset of preeclampsia is prior to ___ weeks gestation
34
184
```
Symptoms of __________:
Triad:
Platelets < 100K
Serum AST ≥ 70 or 2 x baseline levels
Elevated LDH > 600
+
Elevated indirect bili (usually just use total bili)
```
HELLP
185
Treating thrombocytopenia in HELLP syndrome with _______________is not supported by evidence
corticosteroids
186
Type of seizure in eclampsia
Grand mal/ tonic-clonic
187
```
Risk Factors for ___________:
chronic HTN
Uteroplacental insufficiency without definitive cause, PP hemorrhage
NSAID use? (possible in ACOG statement)
Cardiovascular disease
Gestational HTN
```
PP Preeclampsia
188
immune maladaptation, very low-density lipoprotein toxicity, genetic imprinting, increased trophoblast apoptosis or necrosis, and an exaggerated maternal inflammatory response to deported trophoblasts
PP Preeclampsia
189
AST and ALT ________ in Pre-E
elevated
190
H+H ________ in Pre-E
elevated or decreased
191
LDH ________ in Pre-E indicating tissue damage and hemolysis
elevated
192
Bili ________ in Pre-E
elevated
193
Fibrinogen __________ in Pre-E
decreased
194
PT/PTT ____________ in Pre-E
decreased
195
Risk for Mag toxicity is greater with a ____ GFR
low
196
```
Signs of ___________:
Hypotension
Resp depression
Decreased DTRs
EKG changes
Oliguria
SOB/chest pain
```
Mag toxicity
197
Antidote for Mag toxicity
Calcium Gluconate Calcium Chloride IV
198
SE of ___________:
flushing
decreased FHR variability
Mag
199
_________ IV drops BP quickly while ____________ IV drops BP more slowly
Hydralazine fast
| Labetolol slow
200
a combined alpha & beta-blocking agent that decreases BP by dilating arterioles and decreasing HR
***Should not be given to those with
Asthma, Cocaine or Amphetamine Use***
Labetolol
201
reduces BP by dilating arteries
| S/E - tachycardia, HA, delayed maternal hypotension, fetal bradycardia, rarely upper abdominal pain
Hydralazine
202
PP women with persistent BPs over ___/___ on 2 occasions at least __-__ hours apart should receive anti-hypertensive meds
150/100
| 4-6 hours apart
203
In Pre-E with BP over 160/110, anti-hypertensive meds should be started with ___ minutes
30
204
LR fluid should be given to Pre-E patients @ __-__ mL/hr
SLOW 60-125
205
__________ is a risk in Pre-E due to renal/HTN sequelae oliguria w/ severe pre-e.
ARDS and pulmonary edema
206
In Preeclampsia w/o severe features and severe Pre-e: Sum of oral and IV fluid should be ≤ _____ ml/hr unless there are other clinical circumstances that dictate a different management plan
125
207
Eclamptic seizure meds that are justified only in the context of antiepileptic treatment or when mag is contraindicated or unavailable.
Benzos and phenytoin
208
Immediate Management of Eclamptic Seizure:
| ___-___ grams Mag over 15-20 min (loading dose)
4-6 grams
209
If seizure continues despite Mag:
| Give additional loading dose of ___ mg IV over 5 min
2 grams
210
Second-line anti-seizure medications for uncontrolled eclamptic seizures
IV barbituates, Clonazepam, Diazepam, Midazolam or Lorazepam
211
```
Symptoms of ______________:
Most are asymptomatic
Anxiety
Palpitations
Atypical chest pain
Syncope
Dyspnea w/ exertion
INCREASED risk of sudden death
Infective endocarditis
```
Mitral Valve Prolapse
212
Mitral Valve Prolapse Antibiotics?
No longer recommended for dental work or childbirth
213
If MVP patient develops infective endocarditis, give:
Pen G IV with Gentamycin x 2 weeks
214
Increases risk for congenital complete AV block
Maternal Lupus
215
Drugs. Alcohol, anticonvulsants, lithium, retinoic acid, thalidomide, warfarin, amphetamines increase risk of NB heart:
murmur
216
```
___________ CHD:
PDA
Atrial Septic Defect
Ventricular Septal Defect (most common)
Pulmonary Stenosis
Aortic Stenosis
Coarctation of the Aorta
```
Acyanotic
217
should be used to maintain patency of the ductus arteriosus once it is established that a ductal dependent lesion exists.
Prostaglandin E1
218
```
Symptoms of ____________:
Many asymptomatic
Frequent respiratory or lung infections
Difficulty breathing
Tiring when feeding (infants)
Shortness of breath when being active or exercising
Skipped heartbeats
Palpitations
Heart murmur
Swelling of legs, feet, or stomach area
Stroke
```
Atrial Septal Defect
219
```
Symptoms of _______________:
Some Asymptomatic
Shortness of breath,
Fast or heavy breathing,
Sweating,
Tiredness while feeding, or
Poor weight gain.
Heart murmur
```
Ventral Septal Defect
220
PDA normally functionally closes at ____-____
24-48 hours
221
PDA patency is abnormal at ____-____
2-3 months
222
PDA, VSD, ASD causes ____ to _____ shunting
left to right
223
Symptoms of _______________:
Typically Asymptomatic
May report decrased exercise tolerance or pulmonary congestion in conjunction with a murmur.
3-6-week-old infants can present with:
Tachypnea
Diaphoresis
Inability or difficulty with feeding
Weight loss or no weight gain.
With a moderate-to-large left-to-right shunt may be associated with a hoarse cry, cough, lower respiratory tract infections, atelectasis, or pneumonia
With large defects, may have a history of feeding difficulties and poor growth during infancy, described as failure to thrive (FTT).
Frank symptoms of congestive heart failure (CHF) are rare.
Adults who go undiagnosed may present with s/s of heart failure, atrial arrhythmia, or even differential cyanosis limited to the lower extremities
PDA
224
pumonary stenosis, aortic stenosis, and coarctation of the aorta cause ___________ obstruction
outflow
