Week 7 pt 2 highlights Flashcards by Morgan Evans

What is an Intervention for Fetal Anemia? What does it do?

Transcranial Doppler; Looks at peak velocity of flow through middle cerebral artery

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What do you need to do if velocity is not high on transcranial doppler?

make decision about delivery based on gestational age

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Hypertension (HTN):
1) Affects ____% of pregnancies worldwide
2) Cause of _______% maternal deaths in US
3) Incidence of preeclampsia ___________ by 25% in the past 20 years

1) 10%
2) 12.3%
3) increased

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Predominant pathophysiologic finding in preeclampsia/gestational HTN is what?

Maternal vasospasm
-Placental size and function decreased

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Chronic HTN is a risk for what?

Preeclampsia + eclampsia

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Define gestational HTN

Hypertension that develops for the first time after 20 weeks gestation in the absence of proteinuria (and severe features)

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What is defined as Hypertension + proteinuria after 20 weeks gestation?

Preeclampsia

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What are the preeclampsia diagnostic criteria?

1) ≥140mmHg systolic or ≥90 mmHg diastolic blood pressure
2) Proteinuria
(0.3g or higher in a 24-hour urine specimen)
3) 1 or more severe features

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Eclampsia:
1) Define it
2) When do most cases occur?
3) Is it common?

1) Preeclampsia + tonic-clonic seizures
2) Within 24 hours of delivery
3) Uncommon

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List the 3 criteria for HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelet count)

1) Microangiopathic hemolysis
2) Thrombocytopenia
3) Hepatocellular dysfunction

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List 2 fetal studies that should be done for HTN

1) Ultrasound
2) Nonstress test +/- Biophysical profile (BPP)

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PO Labetalol and CCBs (nifedipine or amlodipine) considered 1st line for what?

Chronic HTN ≥160/105

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What is the Tx for preeclampsia with severe features?

Magnesium sulfate IM or IV

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What is the Tx for eclampsia?

Life threatening; Stabilize then deliver

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Pregnancy _______ recommended for patients with pulmonary hypertension, tetralogy of Fallot, Eisenmenger syndrome, Marfan syndrome (with aortic root dilation), dilated cardiomyopathy.

not

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When is GDM identified?

identified during pregnancy and usually subsides postpartum

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List the hormones that are involved in GDM. Which is are produced by the placenta?

1) hPL: Human placental lactogen (placenta)
2) Estrogen and Progesterone
3) Insulinase (placenta)

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Glucosuria of pregnancy: what is normal?

300mg/day

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DM:
1) What are the most common deformities?
2) Name a congenital anomaly
3) List 5 other things that can occur

1) Cardiac, CNS, renal and limb
2) Sacral agenesis
3) Spontaneous Abortion and Stillbirth
Macrosomia (>4000-4500g)
Polyhydramnios
Hypoglycemia (especially soon after delivery)
4) HgbA1c

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List 4 maternal complications of pregestational DM

1) DKA
2) Preeclampsia
3) Nephropathy (>1.5Cr or severe proteinuria)
4) Retinopathy

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1) How do you Dx pregestational DM?
2) What are the screening tests for gestational DM? (imporatant)

1) Hgb A1C obtained before conception that shows elevation
2) 24-28 weeks: 1 hour glucose tolerance test (50g drink)
-If “failed” (>140), 3-hour glucose tolerance test (100g drink)

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DM:
1) What is your first step in Tx?
2) If diet does not control BS, your next step is what?

1) Diet control
2) insulin

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What Screens women before they’re pregnant for “pregestational DM”?

A1C

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Estrogen stimulates thyroid binding globulin (TBG), which leads to what?

Elevation in total T3 and T4 but free T3 and T4 remain constant

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What test is done with 3 values, and is positive if 2 or more values are above the thresholds?

3 hour glucose test

Pregnancy= ____thyroid state

euthyroid

Hyperthyroidism/Grave’s disease: 1) What is the Tx in first trimester? 2) What abt 2nd and 3rd?

1) PTU 2) Methimazole.

Increase dose 25-30% during pregnancy (from the start)

1) Nausea and vomiting peaks in severity in weeks ______ 2) Affects 70-85% of women in ____ trimester

1) 7-12 2) 1st

What is the first line for n/v Tx in pregnancy?

Vit B6 (pyridoxime)

Most common indication for hosp admission in first ½ of pregnancy is what?

What are the main signs of HG?

Weight loss of more than 5% of pre-pregnancy weight and ketonuria

What should you do to Tx severe HG?

Corticosteroids (only if severe)

3rd trimester mom with pruritus (esp. hands and feet) is a sign of what?

Intrahepatic Cholestasis of Pregnancy (ICP)

ICP: What are 2 key parts of Dx? What are 2 key parts of Tx?

1) Elevated bile acid concentration No abnormality on imaging 2) ursodeoxycholic acid Deliver at 37wk

1) What is uncommon but most common cause of acute liver failure in pregnancy? Define this condition 2) What is a main Sx? 3) How do you manage it?

1) Acute fatty liver; Microvascular fatty infiltration of hepatocytes 2) persistent n/v 3) Intensive supportive care and prompt delivery

GERD: 1) You should avoid ___[procedure]______ in pregnancy 2) You should avoid what 3 things in diet?

1) endoscopy 2) Avoid milk products toward the end of the day Avoid fatty foods No eating 2-3 hours before bed

PUD: 1) How do you TX? 2) What if H. pylori?

1) : Acid suppression with PPI (omeprazole or pantoprazole) H.pylori: antimicrobial treatment deferred until after delivery if mild symptoms

True or false: If controlled, IBD does not affect fertility.

True

What are some important things you should do before pregnancy for pts with IBD?

1) 400 mcg folic acid supplementation 2) Sulfasalazine and mesalamine can be continued during pregnancy -In most cases, a flare during pregnancy is higher risk to baby than medication

Asymptomatic Bacteriuria and Acute Cystitis: Most common organism is what? List 3 treatments

1) E. coli 2) Fosfomycin Cefpodixime Augmentin

Pyelonephritis: 1) What is the main Sx? 2) What is it associated with? 3) What is the main Tx?

1) Acutely ill 2) Preterm birth 3) IV hydration and abx

What is the preferred initial imaging for Nephrolithiasis and Urinary Calculi in pregnant pts?

Kidney/pelvic U/S

Preexisting renal disease? 1) When is there little risk? 2) When is there likely deterioration of renal function? 3) When are there serious complications?

1) Cl/Cr <1.5mg/dL 2) Cl/Cr 1.5-3.0 3) Cl/Cr >3.0

You should wait at least _________ for pregnancy after kidney transplant

1 year

1) What is defined as occlusion of superficial veins? 2) What may you need to rule out? 3) What is the Tx in pregnant pts?

1) Superficial thrombosis 2) DVT (with US) 3) APAP/ Tylenol

True or false: Pregnancy is hypercoagulable, which can lead to DVTs

True

DVT: 1) How do you Dx? 2) How do you Tx? 3) What is contraindicated?

1) Doppler US 2) Low-molecular-weight heparin Enoxaparin 1mg/kg BID 3) Warfarin

Lamotrigine and Levetiracetam preferred to Tx what in pregnancy?

Seizures

Headache meds: Avoid ____________ in 1st trimester

triptans

True or false: There are fewer relapses of MS during pregnancy

True

Systemic Lupus Erythematosus (SLE): You should discontinue what 2 meds?

Cyclophosphamide and methotrexate

Neonatal Lupus: 1) What antibodies? 2) What do they do? 3) What should you screen for?

1) Anti-Ro (SSA) and Anti-La (SSB) antibodies 2) Damage fetal cardiac conduction system 3) Antibodies at 1st prenatal visit

How do you Tx Antiphospholipid Antibody Syndrome?

1) When attempting to conceive = Aspirin 2) With confirmation of pregnancy = LMWH

How do you Tx Bell's Palsy in pregnancy?

Early treatment with steroids within 3 days of onset +/- valacyclovir depending on severity

How do you Tx depression and anxiety in pregnancy?

SSRIs No MAOIs

What are the first line treatments for bipolar disorder?

Lithium or Lamotrigine 1st line

How do you Tx postpartum psychosis?

Antipsychotics (risperidone), Lithium or ECT *Usually immediate inpatient treatment

Elective surgery should be __________ in pregnancy

avoided

___________ anesthesia is preferred to general anesthesia

Regional

What should you do for pregnant women before general anesthesia?

Pregnant women should be treated as if they have a full stomach; premedicate with **citrate and histamine blockers**

What is the most common surgical emergency of pregnancy?

Appendicitis

RLQ pain is still the most common presentation of what?

Appendicitis

What 2 imaging methods are used for appendicitis in pregnancy?

US is often initial; MRI

What are the 2 approaches to appendectomy? List a downside of one

1) Laparotomy 2) Laparoscopy: CO2 from insufflation can cross into placenta

What has a higher incidence in pregnancy due to increased cholesterol and lipid levels?

Acute Cholecystitis / Cholelithiasis

Acute Cholecystitis / Cholelithiasis: 1) What is a main symptom? 2) What imaging? 3) What are the 2 types of management?

1) RUQ pain 2) U/S 3) First line medical, second line surgical

What is less common in pregnancy, but has a significantly higher mortality rate?

Acute Pancreatitis

Acute Pancreatitis: 1) What is it? 2) What are the symptoms? 3) What are the 2 diagnostic tests?

1) Common bile duct obstruction, alcoholism, viral infections 2) Nausea, vomiting, and severe epigastric pain radiating to the back May be relieved somewhat by leaning forward 3) Elevated serum amylase and lipase

1) What is the main form of management? 2) Maternal and fetal risk is high with what management of acute pancreatitis?

1) Admission 2) Medical

What does the enlarged uterus in pregnancy increase the risk of?

Bowel obstruction

What are the 2 main options for managing bowel obstruction?

Medical & surgical

Why is adnexal torsion more common in pregnancy? Describe

More common in pregnancy due to elongation of ligaments Concern in IVF when preparing for retrieval of eggs

Adnexal/Ovarian Torsion: 1) What imaging? 2) What must you do if the ovary that's removed for Tx contains the corpus luteum?

1) Ultrasound: adnexal mass 2) Progesterone supplementation is necessary

Ovarian tumors are usually identified by ____________________ or ____________ during early pregnancy

pelvic examination; ultrasound

How do you manage ovarian tumors in pregnancy?

Wait until 2nd tri before surgical removal if needed/ safe to do so

Abdominal trauma is most commonly due to ________ (can cause placental abruption)

MVCs

List the TORCH infections

Toxoplasmosis Other (Syphilis) Rubella CMV HSV

Toxoplasmosis: 1) Who is at risk? 2) What is the classic triad?

1) Pregnant woman in contact with cat feces 2) Chorioretinitis + hydrocephalus + Intracranial calcifications

True or false: Routine screening not recommended for toxoplasmosis in the US

True

Describe toxoplasmosis treatment based on fetal age

1) <14 weeks Spiramycin 2) > 14 weeks add Pyrimethamine-Sulfadiazine and folinic acid

What are the poor prognosis signs with toxoplasmosis?

Ventricular dilation Large brain abscesses Brain necrosis Microcephaly Gyration disorders

List the 3 main stages of syphillis

1) Primary: chancre 2) Secondary: rash on palms and soles 3) Tertiary > 10 weeks

Primary and _____________ stages of syphilis are most infectious; baby gets it through placenta after ____ weeks

Secondary; 16

Congenital Syphilis may cause what condition in the fetus?

Hydrops fetalis

Hydrops fetalis: Differentiate between the two stages of signs

1) Early signs: first two years 2) Late Signs: after two years -Saddle nose -Hutchinson teeth -Saber shins

Is syphilis testing routine for pregnant women?

Part of routine screening with serologic testing

Congenital rubella risk is highest in first ____ weeks

If you discover infection of CMV in mom early, you can treat with _____________ or _________________ to prevent fetal disease

valacyclovir; hyperimmune globulin

Is primary or recurrent herpes a greater risk to the fetus?

Primary

1) What is a key part of the pathogenesis of varicella zoster? 2) When does a congenital syndrome occur?

1) Mom is unvaccinated with no history of infection 2) 13-20 wks = congenital syndrome

Describe the Sx of varicella zoster

1) Mom: fever, weakness, popular pruritic rash 2) Baby: congenital varicella syndrome Often fatal before 13 weeks; 13-20 wks = congenital syndrome; after 20 weeks, less serious Limb hypoplasia Ciatriccal limb lesion Low birth weight Microcephaly Eye defect: cataract Neurological: cortical atrophy  intellectual disability

List the main parts of the 4 modalities of varicella treatment

1) Oral acyclovir; not been shown to decrease rate of fetal transmission 2) Varicella zoster Ig (VZIG) 3) IV acyclovir; admission 4) For neonate: IV acyclovir

Varicella: The live attenuated vaccine is ________ given to pregnant women or to any woman 4 weeks before conception

never

Gonorrhea and Chlamydia commonly __________

coexist

Ophthalmia neonatorum may be caused by what?

Gonorrhea and Chlamydia in vaginal delivery

For Gonorrhea and chlamydia, what is a main part of Tx?

Azithromycin 2gm PO x1

Hepatitis A: 1) How do you prevent? 2) Is there a chronic infection? 3) Can you breastfeed?

1) Vaccine available 2) No 3) Not contraindicated

Describe the transmission of Hep A and prevention

1) Fecal-oral 2) Vaccine available -HAV or HAV/HBV combo -Can be used during pregnancy 3) No chronic infection

Hep A: 1) Describe Dx 2) Describe Tx

1) Anti-HAV IgM antibodies 2) Supportive care IgG for pre- and post-exposure prophylaxis Breastfeeding: not contraindicated

Hepatitis B 1) Testing for HBsAg is ____________ 2) Is breastfeeding contraindicated? 3) Can you vax during pregnancy?

1) routine 2) not contraindicated 3) Can vaccinate during pregnancy

Hep B: Treat with _____________ if chronic carrier and high viral load to decreased risk of intrauterine fetal infection

tenofovir

Is breastfeeding contraindicated with Hep C?

No, not unless cracked or bleeding nipples

What type of hepatitis needs Needs HBV present for transmission?

Hepatitis D

1) Do you screen for HIV in pregnancy? 2) Can you breastfeed?

1) Routine screen at first neonatal visit 2) No; contraindicated

List RIPE Tx for TB

1) Rifampin 2) Isoniazid 3) Pyrazinamide is not given as a part of first line treatment in pregnant patients 4) Ethambutol

Latent TB is treated __________ delivery

AFTER

Which strains of HPV are assoc with warts?

6 + 11

HPV typically __________ with pregnancy

worsens

List 2 important points abt HPV in pregnancy

1) Podophyllin, podophyllotoxin, interferon, FU all contraindicated 2) Can give topical imiquimod

Name a foodborne illness from deli meat and unpasteurized milk (including soft cheese)

Listeria monocytogenes

Define Granulomatosis infantiseptica and where it can come from

Miliary micro abscesses and granulomas, most often in the skin, liver, and spleen. -Can come from listeria

TDAP should be given during the what weeks of pregnancy?

27-36th wk

Zika: 1) How is it transmitted? 2) What is the main Sx?

1) Mosquitoes or sexual contact 2) Microcephaly

Group B Streptococcus: 1) What is it also called? 2) How common is it? 3) When should you screen for it? 4) What should you do during delivery?

1) Streptococcus agalactaie 2) up to 30% of pregnant women 3) 35-37 weeks 4) Give Penicillin G

Week 7 pt 2 highlights Flashcards

(116 cards)