Medical Complications of Pregnancy

how does asthma change in pregnancy

1/3 worsen

1/3 get better

1/3 stays same

→ use same regimen as before

how often get titers for seizure meds

once a trimester and once more in last weeks of pregnancy (more if seizures are not controlled)

when would bowel obstruction need to be operated on

if no resolution after 48-96 hours

what to do if adnexal torsion in pregnant patient

remove infarcted organ, ovary or corpus luteal cyst

when do ovarian tumors need biopsy

if mass over 8 cm

when are pregnant patients screened for gestational pregnancy

24-28 weeks

abnormal value for 1hr glucose tolerance test

>140

glucose monitoring goals after diagnosis

Fasting blood sugar (FBS): <105 mg/dL

2-hour postprandial (PP): <120 mg/dL

what is best choice for tx of gestational DM

insulin

oral tx for gestational DM

glyburide

McRoberts maneuver

for shoulder dystocia, hyperflex patients legs and but pressure on lower abdomen while gently pulling on fetus’ head

describe hematocrit levels in pregnancy

Natural decrease in hematocrit during second half of pregnancy because newly formed hemoglobin and red cell mass do not keep pace with expansion of maternal blood volume

most common anemia in pregnancy

iron deficiency

how much additional iron should preg pt take

800 mg additional

megaloblastic anemia in pregnant pts usually caused by

folic acid deficiency

true or false: treat asymptomatic bacteriuria in pregnant pt

TRUE

most common bacteria causing pyelonephritis

e.coli

when are HIV pregnant pts REQUIRED to have cesearen

if >1000 copies of virus

T or F: warfarin for DTV tx

FALSE: teratogen → use heparin instead

when to give rhogam

1. 28 weeks

2. postpartum

3. ectopic, or abortion

how to differeniate preg induced vs chronic HTN

if preg induced → occurs after 20 week gestation

Preeclampsia RF

1. First pregnancy before age of 20yrs

2. Women with advanced maternal age

3. History of multiple pregnancies

4. Diabetes

preeclampsia triad

1. edema

2. gradual onset HTN

3. protein in urine

tx for preclamptic seizures

1st episode→ magnesium sulfate

or ativan or valium

HELLP syndrome

1. hemolysis

2. Elvated liver func

3. Low platelet

4. increased uric acid

definitive tx of hypetensive in pregnancy

delivery

Safest antihypertensive

methydopa

1st line for pregnancy HTN

labetalol

in preg pt always deliver regardless of gestational age if

1. Oliguria

2. Renal failure

3. HELLP syndrome

magnesium sulfate side effects

resp depression, hypotension, circulatory collapse