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obs med total Flashcards

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1
Q

define htn in pregnancy

A

> 140/90 ( office)
135/85 (ambulatory)

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2
Q

severe htn and consequence

A

> 160/110
- stroke, placental abruption, ischemia

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3
Q

BP target in pregnancy per SGOC 2022

A

<85 mm hg ( diastolic)

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4
Q

SBP target in practice

A

130-140

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5
Q

CHIPS NEJM 2015 vs htn ( tight vs less tight)

A

those with less tight and would reach ad 160/110 had labs more in keeping with HELP

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6
Q

2nd line meds in BP in pregnancy

A
  • hydralazine
  • clonidine
  • thiazide
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7
Q

lactation safe ACEI

A
  • captopril
  • enalapril
  • quinapril
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8
Q

example of meds to avoid in pregnancy

A
  • atenolol
  • acei
  • prazosin
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9
Q

what type of issue acei in pregancy can cause

A
  • fetal renal agenesis
    -oligohydramnios
  • pulmo aplasia
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10
Q

Treatment non severe HTN

A
  • labetalol 100mg TID ( max 1200 mg DIE)
  • methyldopa 250 mg TID : max 750 TID
  • nifedipine XL 30 mg DIE ( max 120 mg IDE)
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11
Q

severe hypertension tx

A
  • nifedipine IR : 5-10
  • labetalol 10-20 push
  • hydralazine 5-10 mg IV q30min
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12
Q

name 7 high risk factors for preeclampsia

A
  1. chronic htn
  2. db
  3. obesity
  4. autoimmune conditons ( SLE/APA)
  5. renal issue
  6. IVF
  7. hx of preeclampsia
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13
Q

name moderate RF ( 3)

A
  1. age >40
  2. nullipartity /multiple gestation
  3. abruption, still birth, fetal growth restriction
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14
Q

preeclampsia dx

A
  1. htn
    and one of the following
  2. proteinuria ( 2+ dipstick, urine pcr >30, acr >8, >300 24H)

+/-
- mat sx : headache, cp, ruq pain, vision change, edema, anasarca, seizures, clonus
- lab abn : hb, plt, lft, ldh, bili, fibrinogen, coag , blood film
- fetal : iugr, oligohydramnios, abnormla doppler in placental ( reversed endd or absent in diastolic phase)

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15
Q

Does BP treatment prevent progression of preeclampsia ? yes no ?
what dodes it prevent the progression of

A
  1. no
  2. progression of severe htn and reduction in stroke risk
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16
Q

what does the MAGPIE TRIAL

A
  • in woman with preeclampsia : magnesium decrease elampsia risk and decreases maternal mortality ( trended towards)
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17
Q

magnesium toxicity risk

A
  • decrease bp, hr, gcs, urine output, reflex
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18
Q

magnesium tox antidote

A
  • calcium gluconate
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19
Q

what do you monitor for mg toxicity - 2

A
  • uo
  • reflex
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20
Q

plt level which epidural is safe ?

A

75

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21
Q

antenatal corticosteroid as of what week

A

<35 weeks

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22
Q

all women with hypertensive disorders of preg should have what measured in PP ?

A

lipids !

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23
Q

in htn prego, who should you consider vte ppx?

A

– C-section
- preeclampsia with IUGR
- postpartum hemorrhage >1L
- bedrest >7days antepartum
- assistant reproductive technology
- pre- pregnancy BMI >30
- age>35
- smoking
- placenta previa
- IUGR… and more

Two or more risks = suggest thromboprophylaxis

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24
Q

diagnostic OBS APS criteria

A

1) ≥ 3 consecutive unexplained prefetal deaths <10 weeks and/or early fetal deaths > 10 weeks - 16 weeks, or
2) Fetal death 16 weeks - 34 weeks, or
3) Pre-eclampsia with severe features and/or
placental insufficiency* with severe features (<34 weeks) with or without fetal death
+
Lupus anticoagulant, anti-cardiolipin, or beta-2- glycoprotein, if positive repeat in 12 weeks

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25
3 crtieria of YEARS algorithm for PE . what else do you add to this ? this is based on which study ?
Assess for 3 criteria of YEARS algorithm + D- Dimer. 1. S&S dvt 2. hemoptysis 3. PE felt like most likely diagnosis d dimmer artemis study ( NEJM 2019 ) * 3 negative clinical criteria + d-dimer <1000 ng/mL: PE ruled out * 1 or more clinical criteria + d-dimer <500 ng/mL: PE ruled out
26
can d dimer rule out vte safely in those with low/intermediate or unlikely pretest probability ?
yes
27
does tpa cross placenta
no
28
Noacs in pregnancy? bf ?
no and no
29
in what cases do you give VTE with at3 deficiency ( antepartum & PP)
in the case of + family history
30
do you give vte ppx in contex tpof protein c or S deficiency
usually no, but could consider in PP if + fam hx
31
heterozygous VFL, do you given vte ppx ?
no
32
APLA , do you give vte ppx
yes - antepartum with ASA - PP continued
33
if on therapeutic anticoagulation, how long before epidural do you hold LMWH and UFH
1. 24h pre 2. 6h pre
34
how long after delivery do you resume anticoagulation
- ppx 4hrs post neuraxial anesthesia removal - 4-6h post vag delivery - 6-8h post c section
35
antiocagulation not safe in breastfeading ?
DOAC
36
when is gestational thrombocytopenia the worst ?
t3
37
gest thromobcytopenia, how low dod you usually go and do you need to tx?
- around 70-100 - no tx , resolves 6 weeks PP
38
when do you transfuse in itp
1. plt <30 2. bleeding 3. for delivery <50 near delivery
39
itp tx in pregnancy
prednisone IVIG
40
IDA associated w/ ?
1. PPH 2. Depression/anxiety 3. fatigue/SOB
41
what can you do to reduce PPH` ?
1. iron tranfusion 2. transexamic acid
42
"SEUIL" to dx anemia in pregnancy ?
<110
43
only AHA to use in pregnancy ?
mtf, glyburide
44
what did the conceptt trial in type 1 db pregnant woman say ?
cgm kept hba1c in target, less LGA, fetal hypoglycemia andd NICU admission
45
mity trial stated what about t2d
type 2 diabetes of Metformin vs placebo: - No difference in composite neonatal morbidity and mortality - Mothers had better glycemic control, less weight gain, and less requirement for insulin. - Lower infant weight noted in secondary outcome. - Long term effects on infants/children weren’t studied, paucity of data in literature.
46
2nd step 75g OGTT test values
5.3, 10.6, 9
47
1st step if 75g OGTT
5.1, 10, 8.5
48
BG targets in pregnancy - fasting -1h post - 2h post - hba1c -intrapartum BG
- 5.3 - 7.8 - 6.7 -6.5% - 4-7
49
who do you screen for PP thyroiditis? and how long after ?
- those with t1dm -3M post
50
do you repeat 75G ogtt postpartum ? when ?
yes - 6w - 6M
51
morning sickness or hyperemesis gravidarium is associated with transaminitis?
HG
52
what are you first line treatment for HG ?
metoclopramide + gravol + ppi + e+ replacement
53
1st line gerd tx in prego, followed with what ?
calcium carbo --> h2i -->ppi
54
HG is highest at what time during pregnancy
t1
55
budchiari when in pregnancy ?
pp
56
ALFP when in pregnancy
end t3, PP
57
IH cholestasis when in pregnancy
t2-t3
58
help/preeclampsia when ?
t2-pp
59
bile acid level assocaited with still birth
100
60
tenofovir started when in mothers
28-32
61
do you treat hep c during pregnancy ?
no
62
hypoxia vs dyspnea, which is abN in pregnancy
hypoxia
63
prominent/mildly elev ated jvp normal in pregnancy ?
yes
64
definition of peripartum cardiomyopathy and timing ?
systolic with EF <45% . timing is last month of pregnancy ad 5M PP
65
treatment of peripartum cardiomyopathy
1. lasix 2. mtp 3. nitro vs hydralazine vs digoxin ( if refractory)
66
number one unstable syncopal reason in pregnacy ?
embolism ( PE/amniotic fluid)
67
VT/VF in pregnancy - meds to give - meds to avoid + why
- bb - amiodarone -- fetal hypot4
68
dose of warfarin considered safe in pregnant woman if really have no choice ? sinon..
5 mg sinon - switch to lmwh
69
which valve lesions better tolerated in pregnancy ?
regurgitant
70
antibio CAP pregnancy
macolide and beta lactam
71
CAP risk in pregnancy
preeclampsia, preterm bb, low birth weight
72
risk if give fq in cap prego
cartilage prob
73
risk if give tetracycline in prego
- teeth staining and bone growth suppression
74
risk if give sulfa in pregnancy
having kernicterus
75
IBD - when to stop mtx ?
3 months pre conception
76
what meds can continue during pregnacy with IBD
- aza - anti tnf - 5 ASA ( ensure phthalate free)
77
if bb exposed to tnf, what's precaution to take
don't give them live vaccine x >6 months ( i.e. rotavirus)
78

obstetrical medicine (1 decks)

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