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112 Cards in this Set
- Front
- Back
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Why does the plasma and cellular composition of blood change significantly during pregnancy?
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expansion of plasma volume proportionally greater than that of the red blood cell mass.
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Anemia isn pregnancy is genarlly defined as an Hct less than _______ or a hemoglobin of ________g/dL.
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-30%
-<10 |
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What is by far the most common type of anemia seen in pregnancy?
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iron deficiency anemia
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What are the classic findings of iron deficiency anemia in pregnancy?
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small, pale erythrocytes manifested on peripheral blood smears
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Futher lab tests for iron deficiency anemia show a decrease in __________ an increase in ________ and a decrease in ________.
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-decrease in serum iron
-increase in total iron-binding capacity -decrease in serum ferritin |
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For pts w/ iron deficiency anemia, what is the tx of choice?
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ferrous sulfate, 325 mg tablets BID
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The response to iron therapy for iron deficiency anemia is first seen as an increase in _________count about ___ week after the start.
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-reticulocyte count
-1 week |
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What is the second most common form of anemia in pregnancy?
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Folate deficiency anemia
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What is the demand of fetal and maternal folate during pregnancy?
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800mcg/day
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Folate deficiency is likely in what pts?
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-multiple gestations
-pts taking medications such as phenytoin (Dilantin), nitrfurantion, or trimethoprim |
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What is the tx of folate deficiency anemia?
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1mg folate PO QD
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What are some examples of hereditary anemias that may occur in pregnancy?
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-hereditary sherocytosis
-glucose 6-phosphate dehydrogenase deficiency -pyruvate kinase deficiency |
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________ trait may also present as microcytic, hypochromic anemia, but unlike iron deficiency anemia, what 2 things are normal and what is elevated?
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-Thalassemia Trait
-serum iron and total iron-biding capacity is normal -hemoglobin A2 (HbA2) is elevated |
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What are the consequences of anemia for the fetus?
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-minimal but may have an anemic neonate once born
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Hemoglobinopathies are disorders of what?
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polypeptide chains taht comprise the oxygen carrying hemoglobin molecule found in the blood cells
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Hemoglobin abnormalities usually involve an abnormality of what?
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B-globulins
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Pts with sickle cell trait (HbSA) have an increased risk of what?
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-urinary infections
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Pregnancies in patients with _______ are generally unaffected.
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HbS-B-thal
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Pts who are HbSS and HbSC suffer from what in pregnancy?
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vaso-occlusive episodes or cirses
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What is the most notable hormone that has an effect on glucose metabolism during pregnancy?
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human placental lactogen (hPL)
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hPL affects what two things?
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1-fatty acid metabolism
2-glucose metabolism |
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What is thought to be the anti-insulin?
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hPL
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Estrogen and progesteron interfere with what?
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insulin glucose relation
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Insulinase produced where and does what?
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produced in the placenta and degrades insulin to a limited extent
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What dangerous disease is more common in diabetic pregnant pts?
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DKA
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Increased renal blood flow resulting in diffusion of glucose in the glomerulus increases the ability of tubular reabsorption results in what?
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normal glucosuria of pregnancy (300 mg/day)
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Why are UTIs more common in pregnancy?
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because of the stasis of glucose rich urine
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During pregnancy, diabetics have an increase risk of what?
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-pregnancy induced HTN
-preeclampsia |
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Infants of mothers with diabetes are at an increased risk of what?
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congenital anomalies
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What are the most common anamalies of infants born to diabetic mothers?
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cardiac and limb deformities
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Macrosomia is more common in what pts?
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-obese
-diabetic |
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New borns w/diabetic mother are at an increased risk of hypoglycemia and what else/
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-hyperbilirubinemia
-hypocalcemia -polycythemia |
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Is there an increase of RDS in diabetes?
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YES
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What are some risk factors for gestational diabetes?
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-hx of giving birth to an infant > 4,000g
-hx of repeated spontaneous abortions -hx of unexplained stillbirth -strong family hx of diabetes, obesity, an or persistent glucosuria |
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What is the most commonly used screening test for gestationa diabetes?
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1 hr glucose test after eating 50 g of glucose solution
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Pts who glucose exceeds 140 require what next step?
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standard 3 hr glucose tolerance test using 100 g of glucose
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How many abnormal values on a 3 hr test are needed to make the dx of gestational diabetes?
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2 or more
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If a pt doesn't have any risk factors, the 1 hr glucose screening is done when?
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24-48 weeks
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What is the recommened diet for pregnant women?
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35 Kcal/kg of ideal body weight
-45% carbs -35% fat -20% protein |
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THe goal for glucose control is a fasting plasma glucose of what?
non-fasting |
90-100
120-140 |
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Does insulin cross the placenta?
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no
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Does glucose cross the placenta?
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yes
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Pts with diabetes are followed closely through pregnancy at how many week intervals?
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1-2 weeks
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HA1c reflects glucose values over the past how many weeks?
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6-8 weeks
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Why do pts with diabetes have to have an ophthalmologic exam?
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because an increase risk of progressive retinopathy
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Because of the risk of renal disease and preeclampsia later in pregnancy, what test should be done in diabetic pts?
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24 hr urine collection
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If a pts is hospitalized due to diabetes, what can be used to control their blood sugar?
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-5% dextrose solution at 100mL/hr with frequent plasma glucose assessments
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Do pts usually require insulin post partum?
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no
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Glucose tolerance screening is advocated for how long post partum?
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2-4 month postpartum
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What therapy is indicated if there are repetitive urinary tract infections during pregnancy or following pyelonephritis during pregnancy?
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nitrofurantion
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What is one of the most common medical complication of pregnancy requiring hospitalization?
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pyelonephritis
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How does an infection w/ E/coli result in increased uterine activity?
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E.coli produces phospholipase A, which in turn can promote prostaglandin sythesis
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Can fever induce contractions?
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YES
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Pregnancy outcome is related to the degree of what?
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serum creatinine elevation adn the presence of hypertension
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Does pregnancy have a negative impact on chronic renal disease?
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no
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Pts with mild renal impairment have what kind of pregnancy?
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-relatively uneventful
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Moderate renal impairment mothers have what kind of pregnancy?
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more serious with an icrease incidence of deterioration of renal function
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In addition to HTN, there is an increase incidence of what in pts wth chronic renal disease?
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intrauterine growth restiction
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What are the 3 categories of HSV in pregnancy?
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-first episode primary
-first episode non primary -recurrent disease |
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If a pt has No HSV-1 or HSV-2 antibodies they are categorized as what?
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first episode primary
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IF a pts has circulating antibodies of HSV, then they are categorized as what?
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first episode non primary
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Does primary or non primary HSV carry a greater risk?
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primary
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What kind of delivery is recommended in HSV?
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C/S
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What are some common defects associated with rubella in pregnancy?
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-congenital heart disease
-mental retardation -deafness -cataracts |
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Primary infection of Rubella can be diagnosed by what?
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acute and convalescetn sera for IgM and IgG antibodies
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It is recommended that pregnancy is delayed how long after rubella vaccine?
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3 months
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Group B strep is an important cause of what?
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perinatal infections
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Early onset infection of Group B strep is manifested by what?
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-septic shock
-septicemia -pneumonia -menignitis |
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Late onset infection of Group B strep occurs up to how long after delivery?
What is the most common specific infection associated with it? |
-4 weeks after delivery
-menigitis is most common, but bone and joint infections can also occur |
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In the mother, what can be caused by an infection with group B strep?
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postpartum endometritis
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What type of Hepatitis has no specific effects on pregnancy?
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Hep A
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What is the carrier rate for Hep B?
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1:1,000 US adults
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For Hep B, if the mother is positive for the "e" antigen her fetus has what percent chance of becoming infected?
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90%
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If the mother is negative for the "e" antigen of Hep B, her fetus has what percent chance of becoming infected?
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10%
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Fetal/neonatal infection of Hep B is more common when during the pregnancy?
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if the infection occurs in the 3rd trimester or the several months following delivery when the baby is receiving breast milk
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What is the rate of HIV transmission from mother to fetus w/out prophylactic therapy?
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25% related to higher viral loads and lower CD4 count
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What is the HIV transmission rate from mother to fetus w/ zidovudine monotherapy?
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8%
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What is the HIV transmission rate from mother to fetus with vigorus antiretroviral therapy and a viral load of < 1,000 copies?
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1-2%
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What plays a significant reol in perinatal HIV transmission?
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breast feeding (50% of new infections)
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Syphilis corsses the placenta to the fetus after how many weeks of gestation?
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16 weeks
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Most infants infected with syphilis don't develop signs until how long after delivery?
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10 to 14 days
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What are some early signs of syphilis infection in newborns?
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-macolupapular rash
-snuffles -mucous pateches on oropharynx -hepatoslpenomegaly -jaundice -lymphadenopathy -chorioretinitis |
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What are some later signs of syphilis infection in newborns?
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-Hutchinson teeth
-mulberry molars -saddle nose -saber shins |
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What is the treatment for syphilis for primary or secondary infection or latend infection of < 1 year duration?
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2.4 MIU IM benzathine penicillin injection
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What is the tx fo gonorrhea in pregnancy?
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ceftriaxone
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What is a major complication of gonorrhea infection in newborns?
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-gonococcal ophthalmia
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What is the most common congenital infection in the US?
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CMV
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Primary maternal infectin of CMV is associated with a what percent risk of intrauterine infection?
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50%
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What can be seen on a newborn that is suggestive of CMV infection?
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-petechiae
-hepatosplenomegaly -thrombocytopenia -microcephaly -chorioretinitis -hearing loss -mental retardation |
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About how many reproductive aged women have antibodies to toxoplasmosis?
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1/3rd
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Risk of congenital infection of toxoplasmosis is limited to pregnant women with what?
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primary infection
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Infection in what trimester leads to more serous disease of toxoplasmosis?
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first trimester
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Dx of toxoplasmosis usually is made how? Why?
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serologic testing because it is usually asymptomatic
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What is the tx of toxoplasmosis in pregnancy?
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pyrimethamine and sufladiazine
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Congenital varicella almost always occurs when maternal infection occurs when?
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first half of pregnancy
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If Clinical infection of varicella occurs in a patient btw ____ days prior to deliver and _____ days after deliver, infectin can be severe.
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-5 days before
-2 days after |
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Why does parvovirus have particular ramifications during pregnancy?
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because it can cause abortion, fetal monimmune hydrops fetalis and even death
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For parvovirus, what reflects recent infection and what reflects past infection?
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-IgM recent
-IgG past |
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Why should women with parvoviris get weekly ultrasounds?
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to check for fetal hydrops (ascites, edema)
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Why is risk of mother and fetus elevated for women with preexisting cardiac disease?
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because cardiac output increases by about 40% in pregnancy
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Functional classification of Heart disease in pregnancy. What does each classification mean?
I II III IV |
I-no cardiac decompensation
II-no symtoms at rest, & minor limitation of physical activity III-no symptoms at rest, & marked limitation of pysical activity IV-symptoms at rest and increased discomfort on physical activity |
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What is some general management for women with cardiac disease in pregnancy?
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-rest
-avoiding |
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Labor in what position is done to facilitate cardiac function?
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lateral position
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For cardiac disease, is vaginal or c-section better?
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vaginal bc of increased cardiac stress by c-section
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What stage of labor do you want to shorted for pts with cardiac disease?
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2nd stage
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What heart disease is common in pregnancy?
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Rheumatic Heart disease
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Pregnant women with rheumatic heart disease have an increase risk of what?
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-thromboembolism
-subacute bacterial endocarditis -cardiac failure -pulmonary edema |
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A high rate of fetal loss is seen in women with what cardiac condition?
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rheumatic heart disease
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Mitral stenosis associated with atrial fib has an especially high likely hood of what?
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congestive failure
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What is the most common maternal arrhythmia?
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paroxysmal atrial tach
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What risk do women w/asthma have in pregnancy?
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-pulmonary complications
-HTN -gestational diabetes -preterm labor and delivery -low birth weight |
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Later in pregnancy, what can be causes of acute abdomen pain?
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placental abruption and uterine rupture
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