MATERNITY EXAM 2 (PREGNANCY COMPLICATIONS PART III), Exams of Obstetrics

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MATERNITY EXAM 2 (PREGNANCY COMPLICATIONS PART III) what is the most common medical condition in pregnant women and up to 15% of all pregnancies and is associated with higher rates of maternal, fetal and infant mortality, and severe morbidity? - ANS hypertensive disorders of pregnancy what type of pregnancy disorders are these: § Gestational hypertension § Preeclampsia § Eclampsia § Chronic hypertension § Chronic hypertension with superimposed preeclampsia? - ANS hypertensive disorders of pregnancy what are different hypertensive disorders of pregnancy? - ANS § Gestational hypertension § Preeclampsia § Eclampsia § Chronic hypertension § Chronic hypertension with superimposed preeclampsia what type of hypertension is onset of hypertension without proteinuria in a pregnant women who is at least 20 weeks gestation, systolic BP > 140 mmhg, and a diastolic BP > 90 mmhg? - ANS gestational hypertension what is a pregnancy specific syndrome where hypertension develops after 20 weeks of gestation in previously normotensive women, diseases of reduced organ perfusion with presence of hypertension and proteinuria, it complicates 5-6% of all pregnancies, and proteinuria present on urine dipstick on two random samples at least 6 hours apart OR > 300mg in a 24 hours period? - ANS preeclampsia what consists of proteinuria present on urine dipstick on two random samples at least 6 hours apart OR > 300mg in a 24 hours period? - ANS preeclampsia what is the only cure for preeclampsia? - ANS delivery is the only cure for preeclampsia delivery, and we wont force a delivery just because of this, but it doesnt go away until then? - ANS yes for preeclampsia, does protein have to be present in the urine? - ANS yes do we need to watch patients for preeclampsia for bleeding but also hypertension? - ANS yes what does decreased organ perfusion + hypertension + proteinuria indicate? - ANS preeclampsia is a random urine of 24 hour protein a huge indicator of preeclampsia? - ANS yes what is a seizure activity or coma in a woman that is diagnosed with preeclampsia, with no history of previous seizure disorder, and the presentation varies? - ANS eclampsia what is when the mother and fetus are deprived of oxygen when having a seizure? - ANS eclampsia once the mother delivers, can eclampsia still be developed after even if it was not present during pregnancy? - ANS yes can long term damage to CNS occur as well as hemorrhage risk and cortical blindness if we do not control preeclampsia? - ANS yes do headache and vision changes with preeclampsia require very intensive management? - ANS yes what are some fetal complications that can occur from decreased placental perfusion in preeclampsia? - ANS -IUGR -oligohydramnios -placental abruption what are these examples of for preeclampsia: -IUGR -oligohydramnios -placental abruption? - ANS high risk fetal complications is there slightly elevated creatinine or liver panel and edema/swelling to the face/hands with preeclampsia? - ANS yes how is preeclampsia without severe features managed? - ANS -oral medications to bring BP down -make sure baby is fine -BPP -ultrasound -make sure labs are stable -deliver if term what oral medications are used to bring down BP in preeclamspia? - ANS beta blockers (labetolol) hydralazine PO methyldopa (200-2,000 mg/day in divided doses) what are these oral medications used to bring down BP used to treat: beta blockers (labetolol) hydralazine PO methyldopa (200-2,000 mg/day in divided doses)? - ANS preeclampsia if preeclampsia without severe features, do we look at if they are term or not to deliver? - ANS yes if preeclampsia without severe features and they are term (36-37+ weeks), will we deliver ideally vaginal to avoid taking risks? - ANS yes is preeclampsia by itself a reason for a c section? - ANS no for preeclampsia, severe features or not are we delivering? - ANS yes with milder symptoms of preeclampsia are we going to do expected managemnt? - ANS yes at 34 weeks with milder symptoms of preeclampsia will we try to stabilize the BP, do ultrasounds weekly, educate them on signs of worsening symptoms, give betamethasone, and try to get them as close to term as possible? - ANS yes do we check amniotic fluid volume in preeclampsia to make sure that expected management is working? - ANS yes what are some maternal indications for immediate delivery during expectant management of preeclampsia? - ANS -recurrent severe hypertension -recurrent symptoms -renal insufficiency -thrombocytopenia or HELLP syndrome -pulmonary edema -eclampsia -suspected placental abruption -labor or rupture of membranes what are these examples of for preeclampsia: -recurrent severe hypertension -recurrent symptoms -renal insufficiency -thrombocytopenia or HELLP syndrome -pulmonary edema -eclampsia -suspected placental abruption -labor or rupture of membranes? - ANS maternal indications for immediate delivery during expectant management of preeclampsia what are some fetal indications for immediate delivery during expectant management of preeclampsia? - ANS -gestational age of 34 weeks -growth restriction <5% -persistent oligohydramnios (greatest vertical pocket <2 cm) -BPP of 4/10 or less on at least 2 occasions 6 hours apart CNS symptoms -persistent headache not relieved by analgesics -visual changes pulmonary edema -clinically diagnosed thrombocytopenia -platelet count <100,000 renal insufficiency -serum creatinine > 1.1 mg/dL or -doubling of the serum creatinine when other renal diseases have been excluded liver dysfunction -increase in liver enzymes to > twice the upper limits of normal what are these examples of for preeclampsia: severe hypertension -SBP >160 mmhg or -DBP > 110 mmhg -taken on 2 occasions at least 4 hours apart while on bed rest (unless antihypertensives have been administered) CNS symptoms -persistent headache not relieved by analgesics -visual changes pulmonary edema -clinically diagnosed thrombocytopenia -platelet count <100,000 renal insufficiency -serum creatinine > 1.1 mg/dL or -doubling of the serum creatinine when other renal diseases have been excluded liver dysfunction -increase in liver enzymes to > twice the upper limits of normal? - ANS severe features of preeclampsia what is a life threatening obstetric complication that is a clinically progressive condition, occurs in 20% of women diagnosed with severe preeclampsia, and it involves hepatic dysfunction? - ANS HELLP syndrome alot of time does preeclampsia lead to HELLP syndrome? - ANS yes when is HELLP syndrome usually diagnosed in? - ANS severe preeclampsia does the liver have a lot to do with our clotting and management of clotting and due to the reduced perfusion to the liver, HELLP syndrome can occur? - ANS yes what does HELLP syndrome stand for? - ANS hemolysis (H) elevated liver enzymes (EL) low platelets/thrombocytopenia (LP) what does this stand for: hemolysis (H) elevated liver enzymes (EL) low platelets/thrombocytopenia (LP)? - ANS HELLP syndrome what part of HELLP syndrome is when the RBCs become fragmented as they pass through small damaged blood vessels? - ANS hemolysis what part of HELLP syndrome consists of reduced blood flow to the liver? - ANS elevated liver enzymes what part of HELLP syndrome occurs from vascular damage, vasospasm, and platelets aggregates at site of damage? - ANS low platelets/thrombocytopenia is there a very high risk for mortality with HELLP syndrome because you are dealing with a lot of things at one time such as potential bleeding, liver disorders, decreased perfusion to organs because of BP and vasospasms? - ANS yes what are you likely to end up in with HELLP syndrome? - ANS DIC what issue is associated with increased risk for: § Pulmonary edema what is diagnosed by a grand mal seizure in a preeclamptic patient that can occur before, during, or after delivery? - ANS eclampsia can eclampsia occur 2-3 weeks even after postpartum? - ANS yes is it considered high risk pregnancy if they have a history of preeclampsia/eclampsia? - ANS yes what are some complications of eclampsia? - ANS cerebral hemorrhage aspiration hypoxia encephalopathy is the first treatment for eclampsia to control the seizure? - ANS yes what should you think when managing eclampsia? - ANS think airway, breathing, circulation what is the treatment for eclampsia? - ANS -control the seizure (usually a benzodiazepine) -O2 -BP control -start magneisum if they arent already on it -progress to vaginal or c section delivery what is this treatment for: -control the seizure (usually a benzodiazepine) -O2 -BP control -start magneisum if they arent already on it -progress to vaginal or c section delivery? - ANS eclampsia what medications are usually used to control seizures? - ANS benzodiazepines if mother is stable with eclampsia do we do a vaginal delivery and if they are unstable do we do a c section? - ANS yes what medication is used in severe preeclampsia to prevent eclampsia (convulsions), and HELLP syndrome? - ANS magnesium sulfate what medication is used in severe preeclampsia, HELLP syndrome, and eclampsia, and it is a secondary infusion (piggyback) to the main IV line, used using a volumetric infusion pump, initial loading dose of 4- 7 g is infused over 15-20 minutes, and the dose is followed by a maintenance dose diluted in 1,000 mL of lactated ringers solution adminstered by pump 1-2 g/hour? - ANS magnesium sulfate what is the initial loading dose of magnesium sulfate? - ANS 4-7 g infused over 15-20 minutes what medication are decreased respiratory drive, decreased deep tendon reflexes, and decreased urine output signs of toxicity? - ANS magnesium sulfate what are signs of toxicity of magnesium sulfate? - ANS decreased respiratory drive decreased deep tendon reflexes decreased urine output how often should you check magnesium levels to prevent toxicity? - ANS every 4-6 hours what level is considered toxic for magnesium? - ANS more than 8 mEq/L if over 10 for magnesium levels, what are you at risk for? - ANS cardiac arrest what is the antidote for magnesium toxicity and should be available at bedside? - ANS calcium gluconate (IV) what are these signs and symptoms of: § Hyporeflexia § Respiratory depression (<12) § Decreased urinary output (<30 ml/hr.) § Hypotension § CNS depression § Cardiac arrest? - ANS magnesium toxicity if a patient has a high risk factor or two moderate risk factors should they be on low dose aspirin throughout pregnancy? - ANS yes what are the high risk factors for indications for low dose aspirin throughout pregnancy? - ANS § Hx Preeclampsia, especially with adverse outcome § Multifetal Gestation § Chronic Hypertension § Pregestational Diabetes § Renal Disease § Autoimmune Disease methyldopa are most of the medications that we give to treat hypertension like ACEI or ARBS not safe in pregnancy and they will need to be switched? - ANS yes what is when type O mothers and fetuses with Type A or B blood occur and it is less severe than Rh incompatibility? - ANS ABO incompatibility what is when there is exposure of Rh negative mother to Rh positive fetal blood and there is sensitization, antibody production, and risk increases with each subsequent pregnancy and fetus with Rh positive blood? - ANS Rh incompatibility what is the management for Rh incompatibility? - ANS Rhogam at 26-28 weeks if spotting/bleeding and there is Rh incompatibility, do you give rhogam at 10 weeks and then when 28 weeks hit you give it again? - ANS yes what is when there is persistent uncontrolled vomiting during pregnancy, the patient has weight loss >5% of prepregnancy weight, there are ketones in the urine, it is way greater than normal pregnancy vomiting, they cannot tolerate anything so they are not eating or drinking, and it hurts fetal health? - ANS hyperemesis gravidarium what has a treatment goal to maintain adequate nutrition, correct electrolyte imbalance, and stop vomiting? - ANS hyperemesis gravidarium does hyperemesis gravidarium usually last long? - ANS no, maybe a week or so what medications can be used for hyperemesis gravidarium? - ANS zofran reglan compazine triperidol (extreme cases) corticosteroids normal saline with D5 for hydration what are these treatments for: zofran reglan compazine triperidol (extreme cases) corticosteroids normal saline with D5 for hydration? - ANS hyperemesis gravidarum what affects 5-8% of all pregnancies in the US and has a risk of 50-60% to develop type 2 DM later in life, and is the inability to meet the demand of pregnancy induced insulin resistance, there is not enough beta cell production? - ANS gestational diabetes what are risk factors for gestational diabetes? - ANS § Race: Hispanic/Latina, Asian/Pacific Islander, Native American § AMA § Obesity § Family Hx § Excessive gestational weight gain what are these risk factors for: § Race: Hispanic/Latina, Asian/Pacific Islander, Native American § AMA § Obesity § Family Hx § Excessive gestational weight gain? - ANS gestational diabetes what is when there is inability to meet the demand of pregnancy induced insulin resistance, there is not enough beta cell production, HPL is involved, it gets higher and higher as pregnancy progresses, insulin secretion is not enough to respond to increase in insulin resistance by placental hormones, and glucose levels increase? - ANS gestational diabetes when do we usually test for gestational diabetes? - ANS 2nd trimester during what trimester is there a decrease in the need for insulin? - ANS 1st trimester during what trimesters are there an increase for insulin requirements? - ANS 2nd and 3rd trimester what trimester is there a decrease in the need for insulin, fetal needs are minimal, women consume less food because of n/v, placental hormones are how (HPL low), and there is risk of hypoglycemia secondary to nausea and vomiting? - ANS 1st trimester what trimesters are there increase in insulin requirements, increase in glucose use and storage by the women and fetus, and insulin requirements may double or quadruple by the end of pregnancy as a result of the placental maturation and HPL production? - ANS 2nd and 3rd trimesters do increased energy needs during labor require increased insulin to balance intravenous glucose? - ANS yes is there an abrupt decrease in insulin requirements postpartum? - ANS yes what type of insulin is given at dinner? - ANS short acting insulin what is the main treatment regimen for gestational diabetes? - ANS insulin what is the second line treatment for gestational diabetes? - ANS oral hypoglycemics is blood sugar for gestational diabetes managed with insulin for the first line and some oral antihyperglycemics are used, but 99% of the time they have to be on insulin until they deliver? - ANS yes what are these examples of from diabetes in pregnancy: § Dystocia or difficult labor § Stillbirth § Preterm labor § C-section § Increased risk of developing preeclampsia § More frequent UTIs § Hydramnios § Chronic monilial vaginitis § Ketoacidosis? - ANS maternal complications from diabetes in pregnancy what are the maternal complications from diabetes in pregnancy? - ANS § Dystocia or difficult labor § Stillbirth § Preterm labor § C-section § Increased risk of developing preeclampsia § More frequent UTIs § Hydramnios § Chronic monilial vaginitis § Ketoacidosis what are the fetal/newborn complications from diabetes in pregnancy? - ANS § Birth Defects § Large for Gestational Age (LGA) infants / Macrosomia (25 to 42%) § Stillborn § Fetal birth trauma § Hypoglycemia § Fetal asphyxia § Respiratory distress syndrome § Polycythemia § Jaundice what are these examples of for diabetes in pregnancy: § Birth Defects § Large for Gestational Age (LGA) infants / Macrosomia (25 to 42%) § Stillborn § Fetal birth trauma § Hypoglycemia § Fetal asphyxia § Respiratory distress syndrome § Polycythemia § Jaundice? - ANS fetal/newborn complications from diabetes in pregnancy what are signs of hypoglycemia in the newborn? - ANS · Poor feedings · Jitteriness · Lethargy · High pitched or weak cry · Apnea · Cyanosis and seizures what are these signs of: · Poor feedings · Jitteriness · Lethargy · High pitched or weak cry · Apnea · Cyanosis and seizures? - ANS hypoglycemia in the newborn what glucose level is considered hypoglycemia? - ANS glucose < 40 (50) mg/dL does fetal islet cells hypertrophy and beta cell hyperplasia (over production of insulin continues after the mother glucose is no longer there), leading to hypoglycemia, hypocalcemia/hypomagnesium? - ANS yes what is the management of gestational diabetes? - ANS § Preconception Counseling § Blood Glucose level Control