Normal Pregnancy & Complications Flashcards
(36 cards)
how should anemia in pregnancy be treated?
- treatment is with 60-120mg of elemental iron/day (with vitamin C or with meals)
- if intolerant or no improvement with oral iron, may require IV iron
Anemia in pregnancy is catergorized as what specific to gestation?
1st trimester: <11g/dL
2nd trimester: <10g/dL
3rd trimester: 11g/dL
postpartum: <10g/dL
- screening performed as part of early prenatal labs
- always treat when >100k (increased risk of cystitis, and pyelonephritis)
- GBS bacteria at any point is indication for antibiotics during labor
- urinary frequency is common in pregnancy, but should have not dysuria, urgerncy, hematuria, foul smell, fever or flank pain
- pyelonephritis can develop, often requires inpatient treatment
Asymptomatic bacteriuria
- flank pain with hematuria (+/-) but no fever (unless secondarily infected)
- diagnosis: labs: UA+ culture, BMP; imaging: ultrasound to evaluate renal and ureteral dilation
- treatment: hydration and pain management
renal stones in pregnancy
how should genital herpes be treated in pregnancy?
treat outbreak with acyclovir
AND
prophylaxis (from 36 weeks until delivery (3x/day until delivery)
* any active lesions at delivery—> C-section recommended
treatment of yeast infection in pregnancy
topical clotrimazole or miconazole
NO oral medication in pregnancy
what should be done for obesity in pregnancy with a BMI over 40?
EKG at baseline
Sleep apnea evaluation
anesthesia consult
growth ultrasounds
what are the 4 categories of hypertensive disorders of pregnancy?
- chronic hypertension
- chronic hypertension with superimposed preeclampsia
- preeclampsia/Eclampsia
- gestational hypertension
- Two BP readings >140/90 at least 4 hours apart
- prior to pregnancy or before 20 weeks’ genstation
- associated with adverse perinatal outcomes (preeclampsia, fetal growth restriction, placental abruption)
Chronic hypertension in pregnancy
treatment of chronic hypertension in pregnancy?
medication
* nifedipine, labetalol, methylopa
* ACE/ARB are contraindicated
increased monitoring required later in pregnancy to indentify complications (poor fetal growth, preterm birth, placental abruption, preeclampsia an eclampsia)
risk of having diabetes in pregnancy?
- large babies (increased risk of operative delivery, shoulder dystocia, brachial plexus injury, fracture, neonatal depression)
- preeclampsia and gestational hypertension (related to insulin resistance
- polyhydraminos
- stillbirth
- other morbidity (hypoglycemia, hyperbilirubinemia, low calcium, low magnesium, polycythemia, respiratory distress, cardiomyopathy
- previously diagnosed chronic hypertension PLUS the addition of the following
- proteinuria
- sudden increase in BP previously well controlled
- s/sx preeclampsia (RUQ pain, headache, vision change, pulmonary edema, change in creatinine/transaminases, thrombocytopenia)
chronic hypertension with preeclampsia
treatment hypertension with preeclampsia
- may include need for urgent delivery
- growth ultrasounds throughout remainder of pregnancy
- antenatal testing
- Two BP readings > 140/90 at least 4 hours apart
- after 20 weeks’ gestation (no prior elevation in blood pressure to suggest chronic hypertension)
- evaluation negative preeclampsia (no signs of preeclampsia (HA, vision change, RUQ pain, edema) no proteinuria or other concerning lab findings
gestational hypertension
treatment of gestation hypertension?
- expectant management
- increased monitoring (women may still go on to develop preeclampsia)
- delivery by 37 week gestation
Disorder of placental function which results in
* endothelial damage
* vasospasm
* placental insufficiency
* affects all maternal organs
* affects fetus due to decreased placental flow
preeclampsia
risk factors of preeclampsia?
- first pregnancy
- new paternity
- age <18 years or >35 years
- history of preeclampsia
- family hx preeclampsia in first degree relative
- black race
- BMI >3o
- interpregnancy interval <2 years or >10 years
what are potential complications of preeclampsia?
- placental abruption
- acute kidney injury
- cerebral hemorrhage (mom or baby or both)
- liver failure/liver rupture
- pulmonary edema
- DIC
- eclampsia
what is preeclampsia without severe features?
- new-onset hypertension and proteinuria after 20 weeks gestation
- proteinuria (urine protein/creatinine > 0.3; proteinuria > 300mg in 24 hour period)
- other laboratory features
preeclampsia with severe features
New onset hypertension after 20 weeks gestation along with any of the following signs of end organ dysfunction
* BP >160/110
* elevation in serum creatinine > 1.1 or doubling of previously normal creatinine
* liver enzyme elevation 2x greater than normal
* severe RUQ pain
* severe headache or visual distrubance
* pulomary edema
management of preeclampsia and hypertension at less than 37 weeks, without severe features?
- increased fetal and maternal monitoring
- maternal BP monitoring at home
- twice weekly nonstress tests
some debate about managment between 34-36 weeks
after weeks or with worsening condition= delivery
management of preeclampsia with severe features
- may require IV or oral medications to lowere BP
- seizure prophylaxis with magnesium sulfate
- 4-6mg IV loading dose followed by a drip
- monitor for hypermagnesemia (loss of DTRs, decreased respiratory drive, decreased cardiac conduction)
management of eclampsia (seizures)
- call in back up
- seizure precautions
- supplemental O2
- magnesium bolus (IV vesus IM)
- characterized by pruritis (itching) no rash and an elevation in serum bile acid concentrations, typically developing in the late second and/ or the third trimester and rapidly resolving after delivery
- risks for the fetus are significant (stillbirth, meconium, preterm delivery, respiratory distress syndrome)
- treatment: ursodiol to decrease itching
- antenatal testing indicated until delivery
- timing of delivery: induction of labory by 37 weeks `
cholestasis of pregnancy
