Flashcards in Pregnancy Complications - Wootton Deck (23)
Risk factors for GDM
Obesity, previous history, strong family history, known glucose intolerance
Complications (mom) of GDM
- DM later
Complications (fetus) of GDM
- Hypoglycemia @ birth
- Operative delivery
- Shoulder dystocia
- Birth trauma
Pre-gestational DM is most crucial in what time period?
Embryogenesis - birth defects (6x increase)
How to screen for GDM?
When do you screen? Why?
Negative value (1 hr)?
Glucose tolerance test
26-28 weeks (hPL is at highest, will make you glucose intolerant if it's gonna happen at all)
Less than 135
When are you diagnosed w/ GDM?
2+ abnormal GTT values (1 hr + 3 hr tests)
Diet counseling, oral hypoglycemic meds (glyburide), insulin
Normal blood glucose fasting level (w/ treatment)
Normal post-prandial (2 hr) glucose level (w/ treatment)
Less than 90
Less than 120
Maternal complications of GDM?
Main fetal complication? Requires what? Risk for what?
Other important complications?
DM later, birth trauma, HTN, preeclampsia
Macrosomia (large abdomen)
- Risk for shoulder dystocia (can't get belly out at birth)
Intrauterine death, hyperbilirubinemia, operative delivery, birth trauma
A baby greater than ____ must be delivered via C-section
32 G2P1 at 14 weeks, has had DM for 7 years, takes Metformin and Glyburide. High HbA1c
Maternal complications? (3)
Baby defects? (4)
- Worsening retinopathy or nephropathy
- ***Fetal cardiac defects
- Spontaneous aboriton
- Growth restrictions
Studies to evaluate maternal health in DM pregnancy? (5)
- Kidney function
- EKG (vascular dz)
- Thyroid studies
- Glycemic control
Studies to evaluate fetal health in DM pregnancy? (5)
- Ultrasound for dating, etc
- Biochemical testing/nuchal translucency
- Detailed ultrasound for fetal anatomy (EKG, etc.)
- Growth ultrasounds
- Antenatal testing
How to deliver DM pregnancy? When?
Vaginal - try to get to wk 39 (lungs mature slower than normal)
25 G3P1 at 30 weeks, has fever and tachycardia. Diaphoretic. Overactive thyroid and can't remember what drugs she takes...
- Beta blockers
- IV fluids
Fetal effects w/ hyperthyroidism
- Fetal goiter (can't deliver)
- Fetal hypothyroidism
How to treat hyperthyroidism in pregnancy?
PTU - 1st trimester (hepatotoxicity after)
Methimazole - 2nd/3rd (aplasia cutis before)
How to treat hypothyroidism in pregnancy?
Monitor? Like in what else?
Thyroid replacement (levothyroxine)
TSH and free T4 (just like in hyperthyroidism)
Fetal effects from untreated hypothyroidism
- Spontaneous abortion
- Low birth weight
- Lower intelligence
28, G2P1 at 28 weeks, pain in calf that is red, swollen and tender. Obese. Palpates a cord on palpation.
Most important test?
Risk factors? (2)
LE venous doppler
Superficial thrombophlebitis (NOT DVT)
Tylenol, ice, heat, etc.
35, G1P1, 6 weeks post-partum. Pain in R calf worse with walking. Edema and tenderness, bigger than L calf. Pain w/ dorsiflexion...
Med monitoring? (3)
Long-term management? (3)
LE venous doppler
DVT - from pregnancy
Anticoagulation (Lovenox, then Warfarin)
INR (once on Warfarin)
Factor Xa (Lovenox)
3-6 months post-partum, prophylax future pregnancies, NO combo OCPs
Treating DVT DURING pregnancy? Why?
Lovenox, then Heparin at 36 weeks until birth (can be reversed before birth)
29, G1 at 30 weeks w/ pleuritic chest pain, shortness of air and palpitations. 2 months ago complained of back pain, pelvic pain, leg pain, and headaches. Coughing up blood now.
Findings on PE?
How to evaluate? (5)
Tachypnea, tachycardia, fever, pleural friction rub, chest splinting, pulmonary rales, accentuated pulmonic valve S2
V/Q scan or CT angiography, ABG, EKG, CXR
Anticoagulation (Lovenox, then Heparin at 36 wks)
Thrombophilia workup (LAC, Factor V Leiden, Protein C and S, AT3, Prothrombin mutation)