Pregnancy

Question 1

A normal pregnancy is 40 weeks counted from…

Answer 1

the start of the last menstrual period

Question 2

Pregnancy is considered full term at

Answer 2

37 weeks

Question 3

What is preterm?

Answer 3

born before 37 weeks

Question 4

What is premature?

Answer 4

organ systems are not fully developed (usually lungs)

Question 5

of times a mother has been pregnant (regardless of results)

Answer 5

gravida

Question 6

of births > 20 weeks (multiples count as 1)

Answer 6

parity/para

Question 7

How do you notate a mother pregnant with her second child?

Answer 7

gravida 2, para 1

Question 8

Pre-eclapsia/eclampsia is more common in

Answer 8

primigravids aka first pregnancy

Question 9

T/F IOP commonly increases in late pregnancy

Answer 9

false, decreases

Question 10

19% in normal 24% in OHTN

Answer 10

decrease in IOP late pregnancy

Question 11

What vascular effects account for reduced IOP?

Answer 11

increased aqueous outflow, reduced episcleral venous pressure, decreased scleral rigidity, general acidosis during pregnancy

Question 12

What is a potential glaucoma tx for pregnant patients?

Answer 12

SLT

Question 13

What are pregnancy corneal changes?

Answer 13

decreased sensitivity, increased curvature, changes in thickness/index of refraction

Question 14

T/F OSD commonly leads to CL intolerance?

Answer 14

true

Question 15

How is tear film physiology altered?

Answer 15

immune reaction in lacrimal duct cells, destruction/disruption of acinar cells by prolactin, and other growth factors, general dehydration from vomiting and anti-emetics

Question 16

What are ocular physiologic changes?

Answer 16

pigmentation, ptosis, Graves

Question 17

What two pigment changes occur?

Answer 17

melasma or chloasma “pregnancy mask”

Question 18

Melasma

Answer 18

increased pigmentation of the skin

Question 19

Chloasma

Answer 19

specifically pigmentation to the face

Question 20

Who is at the highest risk for pregnancy mask

Answer 20

patients with light brown skin in areas with high sun exposure

Question 21

What causes increased pigmentation around the eyes?

Answer 21

increased estrogen, progesterone, and melanocytes-stimulating hormones

Question 22

When is eye pigmentation common other than pregnancy?

Answer 22

patch contraceptive and HRT

Question 23

When does pregnancy mask resolve?

Answer 23

after delivery or d/c of meds

Question 24

Why is ptosis common?

Answer 24

fluid retention and hormonal effect on levator aponeurosis– typically unilateral (resolves postpartum)

Question 25

T/F Graves orbitopathy may develop or worsen in those with Graves hyperthyroidism during pregnancy

Answer 25

true, tends to resolve postpartum

Question 26

Development of krukenberg spindles...

Answer 26

develop early in pregnancy and usually tend to decrease in size during the third trimester and postpartum

Question 27

T/F a decrease in autofluorescence is reported (lens?)

Answer 27

true

Question 28

Does pregnancy affect cataracts?

Answer 28

increased liquid volume during pregnancy might result in development or exacerbation of cataracts

Question 29

What lens refractive changes occur?

Answer 29

increasing in central and thinnest corneal thickness in the second and third trimesters of pregnancy which returns to the normal value with delivery

Question 30

When does pregnancy induced hypertension occur?

Answer 30

after the 20th week

Question 31

Pre-eclampsia

Answer 31

HTN systolic >140 or dialstolic >90 + peripheral edema, proteinuria (>300 mg/24 hours)

Question 32

Eclampsia

Answer 32

pre-eclampsia + seizures

Question 33

Risk factors of pre-eclampsia

Answer 33

having multiples, older or younger mom, vascular disease, fetal abnormalities

Question 34

Finland study on pre-eclampsia

Answer 34

mother's with first pregnancy over the age of 35 had higher rate of pre-eclampsia (9.4%) compared to those under 35 (6.4%)

Question 35

Ocular effects of pregnancy induced HTN

Answer 35

arterial narrowing, exudate and edema, RNFL infarct, neo or vit heme, serous RD, papillary edema, NA-AION, optic atrophy, cortical blindness from occipital lobe infarcts

Question 36

How often do serous RDs occur?

Answer 36

1% pre-eclampsia 10% eclampsia

Question 37

Article on pre-eclampsia and visual effects

Answer 37

Pre-eclampsia occurs in about 5% of pregnancies and visual/ocualar effects of pre-eclampsia occur in 1/3 of those cases

Question 38

HELLP syndrome

Answer 38

hemolysis, elevated liver enzyme, low platelets

Question 39

Retinal findings of HELLP syndrome

Answer 39

bilateral serous RD, sub-retinal opacities, vitreous hemes

Question 40

PEHPES

Answer 40

pre-eclampsia-eclampsia HTN posterior encephalopathy syndrome

Question 41

Ocular effects of PEHPES

Answer 41

HA, blurred vision, cortical blindness

Question 42

Central serous retinopathy

Answer 42

localized serous RD with white exudate and fibrin in pregnancy and resultant pigment mottling

Question 43

When does central serous develop?

Answer 43

3rd trimester

Question 44

T/F pregnancy increased risk of CSCR up to 9x

Answer 44

true

Question 45

Does CSR recur after delivery?

Answer 45

Yes, there is a higher chance

Question 46

What makes pregnancy CSR different?

Answer 46

90% of pts have fibrin layer within

Question 47

Is pregnancy a risk for diabetic retinopathy?

Answer 47

yes, duration of diabetes prior to pregnancy is important

Question 48

What factors increase risk of diabetic retinopathy?

Answer 48

presence of DR at conception, poor glycemic control, rapid normalization of glycemic levels, HTN/pre-eclampsia

Question 49

How do you treat diabetic retinopathy during pregnancy?

Answer 49

photocoagulation if severe

Question 50

Normal and diabetic FBG

Answer 50

normal: <100 mg/dL and diabetic >/=126

Question 51

Normal and diabetic RBG (same as 2 hr OGTT)

Answer 51

normal: <140 mg/dL and diabetic >/= 200

Question 52

Normal and diabetic HbA1c

Answer 52

normal: <5.7% and diabetic >/=6.5%

Question 53

Recommendations for pregnant diabetics

Answer 53

have eye exam prior to conceptions, and during 1st trimester

Question 54

What is DM follow up during pregnancy?

Answer 54

No ret to moderate NPDR 2-12 months and severe NPDR or worse 1-3 months

Question 55

Do gestational diabetics require an eye exam?

Answer 55

no

Question 56

Medication categories A-X

Answer 56

A: human studies no risk. B: animal no risk/no human evaluated. C: animal risk, no human study. D: risk to fetus in humans use caution. X: contraindicated

Question 57

New drug label system

Answer 57

pregnancy, lactation and male/female reproduction paragraphs