Other Medical Complications of pregnancy Flashcards
(49 cards)
what is hyperemesis gravidarium?
when pts’ N&V makes them dehydrated & they dvp electrolyte abnormalities.
what kind of metabolic abnormality dvps in hyperemesis gravidarium?
hypochloremic alkalosis
tx of hyperemesis gravidarium?
NS with 5% dextrose infusion
frequent small meals to maintain blood sugars
what anti-emetic meds are safe for pg’y?
Compazine Phenergan Tigan Reglan Droperidol Zofran
what route should anti-emetics be given?
IM, IV, or suppository (not PO)
tx of hyperemesis gravidarium that is rfr to rehydration & anti-emetics?
corticosteroids, acupuncture, acupressure, n. stim
rarely, feeding tubes or parenteral nutrition
what’s a concern with pregnant epileptic patients?
higher rates of fetal malformations, even higher rates if anti-epileptic meds used
what happens to the frequency of seizures during pregnancy?
increased
why does seizure freq increase?
increased ES => upregl’n of CYP450s => faster metab of anti-epileptic drugs. Plus ES itself decreases seizure thr.
rise in creatinine clearance => faster drug clearance
increased total bvol => decreased drug levels
increased stress, decreased sleep => lower seizure thr
decreased compliance w/anti-epileptic meds 2/2 concern for fetal effects
what congenital abnormalities are more common in epileptic moms?
cleft lip & palate
cardiac defects
NTDs (esp w/carbamazepine & valproic acid)
EEG abnormalities/dvp’l delay
mech of teratogenicity of phenytoin:
folate antagonist
mech of teratogenicity of primidone:
folate antagonist
mech of teratogenicity of phenobarbital:
folate antagonist
mgt of epileptic pts, pre-conception?
swtich to a single anti-epileptic drug and taper down to lowest possible dose before conception.
If seizure-free for past 2-5 years, can try complete withdrawal.
Supp’l folate.
how should valproate dosing change during pg’y?
don’t do higher-dose BID. Do smaller-dose TID or QID.
mgt of epileptic pg pt?
Get a level II fetal survey u/s at 20w to get good look at heart, face, CNS.
Get MSAFP level.
Check drug levels monthly.
mgt of epileptic pt on L&D:
check drug levels on admission. If low, give some.
give baby vit K after delivery. Check clotting studies on cord blood samples.
why check baby’s vit K level if born to an epileptic mom?
increased risk of spont hemorrhage in newborns b/c of increased vit K metab by anti-epil drugs.
mgt of seizures in an epileptic pt on L&D?
phenytoin
what CV meds need to be d/c’d during pg’y?
ACEi’s
Warfarin
diuretics
what to do for pts w/cardiac anomalies during labor?
endocarditis ppx
mgt of a pg pt w/mitral or aortic stenosis requiring surgery? During labor?
recommend termination of pregnancy so they c/h it repaired. If decline, prepare them & family for risk of morbidity & mortality.
During labor, give epidural early to decrease pain response. assisted vag delivery to diminish effects of Valsalva.
mgt of pts w/Eisenmenger physiology & pulm HTN?
recommended termination of pg’y. If decline, serial echocardiograms.
Assisted vaginal delivery.
mgt of pg pts w/Marfans syndrome?
avoid physical activity, beta blocker to decrease CO and decrease risk of aortic dissection.
