Pregnancy and Chronic Conditions Flashcards
Risks of pregnancy with diabetes
Fetal growth restriction
Spontaneous abortion
Major congenital malformations (congenital heart, neural tube, limb) - related to metabolic control in 1st trimester
Complications of ACEi use during pregnancy
2nd trimester: impaired fetal renal function
Oligohydramnios
Fetal growth restriction
Anuria
Renal failure
Hypotension
Pulmonary hypoplasia
Joint contractures
Death
When should zidovidine be administered for pregnant HIV patient?
IV in labor and for neonate
When is cesarian indicated for HIV patient?
Viral loads >1,000 copies/mL and prior to labor
Less benefit after onset of labor or ruptured membranes
Acute treatment of thyroid storm in pregnancy
Propylthiouracil (decreases thyroid hormone synthesis)
Propranolol
Sodium iodide
IV fluid replacement
Dexamethasone
DO NOT give radioactive iodine
Note: propylthiouracil also given for Graves disease management during pregnancy
Homeless women are at highest risk for what pregnancy complication?
Preterm birth (even after controlling for smoking)
Low birth weight
When should patients be screened for gestational diabetes, and how?
24-28 weeks for those without risk factors
First visit for those who do
1-hr 50-g oral glucose challenge test, followed by diagnostic 3-hr 100-g oral glucose tolerance test if initial results exceed
2-hr 75-g OGTT omits screening test
If early test normal, repeat between 24-28 weeks
Treatment for bacterial vaginosis
Metronidazole or clindamycin
What maternal heart diseases can be acquired during pregnancy?
Heart failure, arrhythmia, MI, aortic dissection
What to do for symptomatic mitral valve prolapse?
Beta-blocker
Symptoms include anxiety, chest pain, palpitations, syncope
Which thalassemias are most severe?
Beta thalassemia
HbH disease (Alpha thalassemia with 3 nonfunctioning genes)
Obesity increases risk of…?
cHTN, GDM, preeclampsia, fetal macrosomia, C-section, postpartum complications
NOT preterm labor, post-term pregnancy, small for gestational age, or malpresentation
When should anticoagulation be given if history of VTE?
When pregnancy is diagnosed and inclusive of postpartum period; risk is highest in 3rd trimester and then even higher postpartum
Unfractionated heparin and LMWH
VTE more likely to occur with C-section compared to vaginal
Pruritis during pregnancy
Intrahepatic cholestasis of pregnancy –> bile salt retention –> pruritis
Treat with ursodeoxycholic acid if resistant to antihistamines, topical steroids, topical emollients, or opioid antagonist naltrexone
Challenge of appendicitis during pregnancy
Uterus may shift appendix up and out toward the flank
Symptoms similar to normal pregnancy symptoms
