Hypertension
Which type of hypertension does the following indicate?
-at or >20 wga
-w/out proteinuria
-BP >140/90
-lasts <12 weeks postpartum
-25% will develop PEC
-the treatment is BP medications
Management includes:
-monitor labs
-US
-NST
-AFI
-iOL(37-38 weeks)
Gestational Hypertension
What are some maternal risks due to preexisting diabetes and gestational diabetes?
-lacerations during labor
-c-section
-hemorrhage due to distended distended uterus because of bigger baby
Name the type of miscarriage
There is a closed cervix, BOW is intact, vaginal bleeding early in pregnancy.
Management: wait and see, transvaginal US, hCG
Threatened miscarriage
When is the fetus most susceptible to teratogens?
The first 8 weeks in the first trimester
Ectopic pregnancy
Risks?
Signs/symptoms?
Management?
Risks
-internal bleeding if tube ruptures
-Rh mixing
Signs/symptoms
-classic triad(abdominal pain, delayed menses, vaginal bleeding or spotting 6 weeks after LMP)
Management
-removal
-methotrexate
-salpingectomy
-RhoGAM
Which type of hypertension does the following indicate?
-after 20 wga or in early PP period
-with proteinuria
-BP >140/90 x2
-can be w/ severe features
-treatment w/ BP meds, magnesium sulfate
Management includes:
-foley(strict I/O's)
-VS q15-30 mins
-platelets, liver enzymes
-assess edema, clonus, DTRs
-assess for HA, visual changes, epigastric pain
Preeclampsia(PEC)
What are some fetal risks associated with maternal preexisting and gestational diabetes?
-fetal macrosomia
-shoulder dystocia
-fetal hypoxia due to shoulder dystocia
Name the type of miscarriage
The cervix is open, ruptured BOW, heavy bleeding
Management: D&C
Inevitable miscarriage
What are some effects of alcohol on a fetus and a newborn?
Fetus
-NAS
-CNS malfunctions
-cognitive impairment
-growth restrictions
-microcephaly
-small eyes
-thin lips
Newborn
-jitteriness
-hyperreflexia
-irritability
-seizures
Hydatidiform Mole/Molar Pregnancy
What is it?
Expected lab values?
Long term risks?
What it is
-proliferation of placental trophoblastic tissues
Expected lab values
-hCG persistently high beyong 10-12 weeks of gestation
Long term risks
-prior molar pregnancy
-early teens
-older than 40 years old
Which type of hypertension does the following indicate?
-before pregnancy or before 20 wga
-HTN initially diagnosed during pregnancy that lasts longer than 12 weeks postpartum
Chronic Hypertension
How do insulin needs change during and after pregnancy?
1st, 2nd, 3rd trimesters, after delivery, and if mother breastfeeds or not
1st trimester: insulin needs decrease(risk of hypoglycemia in diabetic mother)
2nd and 3rd trimesters: insulin needs increase because placental hormones act as insulin antagonists
Postpartum: insulin doses drop by 50% after birth of the placenta-->insulin needs decrease due to expulsion of the placenta
Breastfeeding mother: insulin needs are lower than normal(needs less insulin than non-breastfeeding mom)
Non-breastfeeding mother: insulin needs return to normal
Name the type of miscarriage
Something is left behind(BOW, placenta)
Management: D&C, suction curettage
Incomplete miscarriage
What are some effects of heroin on a fetus and newborn?
Fetus
-IUGR
-stillbirth
-meconium aspiration
-neonatal death
-prematurity
Newborn
-SIDS
-fetal withdrawal
-jittery/hyperactive
-apnea
-convulsions
-poor feedings and poor sucking
-dehydration
-shrill, persistent cry
Methadone is not contraindicated in pregnancy
What is the difference between hyperthyroidism and hypothyroidism?
Hyperthyroidism: elevated T4
Hypothyroidism: elevated TSH
What does it mean when a patient has Preeclampsia with severe features?
This means the patient has hypertension with at least 1 of the following symptoms in addition to it
-thrombocytopenia
-impaired liver function
-renal insufficiency
-pulmonary edema
-new onset cerebral or visual disturbances
-BP >160/110
How do you manage diabetes in pregancy?
Preexisting DM Type 1 and 2: early screening, balanced diet, exercise
GDMA 1: control with diet
GDMA 2: control with meds(metformin, glyburide, insulin)
Name the type of miscarriage
All products of contraception left the body
Management: none or suction curettage to ensure nothing retained
Complete miscarriage
What are some effects of cocaine on a fetus and newborn?
Fetus
-placental abruption
-preterm birth
-low birth weight
Newborn
-cerebral infarction
-no withdrawal, but neurotoxicity(irritability, tremors, seizures, abnormal EEG, abnormal sleep, hypertonicity)
-SIDS
-cognitive disability
-high pitched cry
Maternal PKU
Pathophysiology?
Management?
Risks?
Pathophysiology
-inborn error of metabolism caused by autosomal recessive trait that creates a deficiency in phenylamine hydrolase which impairs body’s ability to metabolize protein in foods
Management
-women advised against breastfeeding bc their milk contains high levels of phenylamine hydrolase, phenylamine hydrolase restricted diet
Risks
-cognitive impairment
What is HELLP Syndrome?
This is severe PEC with Hemolysis, Elevated Liver Enzymes, and Low Platelets.
When and how do you test for gestational diabetes in pregnancy?
Glucose screen(GTT) done in the 2nd trimester at 24-28 weeks if mother does not have risk factors or done at 20-24 weeks if mother has risk factors.
1 hour vs 3 hour GTT test
1 hour BS of 130-140= + screen
3 hour BS of 130-140 x2= + screen
Name the type of miscarriage
No signs of miscarriage but fetus passed away at some point
Management: monitor clotting factors, D&C, or misoprostol
Missed miscarriage
What are some effects of meth on a fetus and newborn?
Fetus
-placental abruption
-preterm birth
-IUGR
Newborn
-behavioral issues
-neonatal bradycardia
-neonatal tachycardia
-lethargy
What are some conditions where DIC poses a high risk?
-abruption
-severe PEC
-HELLP syndrome
-infections/sepsis
-stillbirth