Duke PA Hypertension, Eclampsia, Low Birth Weight, Macrosomia, And GDM
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| If a young female patient is hypertensive and having a seizure she is __ until proven otherwise | Preeclamptic
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| Hypertension complicates __ of all pregnancies | 5-7%
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| Preeclampsia/eclampsia is responsible for __% of hypertension in pregnancy | 70
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| Hypertension with proteinuria and or pathologic edema | Preeclampsia
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| Hypertension without proteinuria or pathologic edema during pregnancy | Pregnancy induced hypertension
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| Hypertension with proteinuria and or pathologic edema with convulsions | Eclampsia
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| Signs and symptoms of preeclampsia | HA, hyperreflexia, visual changes, irritability, epigastric pain, edema of face/hands/abdomen, oliguria
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| What does HELLP stand for | Hemolysis, Elevated Liver enzymes, Low Platelets
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| Primary symptom of HELLP syndrome | Malaise, fatigue
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| Classic presentation of HELLP syndrome | Malaise/fatigue, N/V, HA, RUQ pain, severe elevated BP, 3+ protein/85% of the time
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| Partial or complete detachment of placenta from uterine wall, after 20 weeks gestation | Abruptio Placenta
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| What are some risk factors of abruptio placenta | Cocaine use, maternal hypertension, trauma
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| Placenta previa is __ bleeding | Painless/silent
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| Placenta abruption is __ bleeding | painful
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| When do you screen with 1 hour glucose | At 24-28 weeks in patients >25 or family history of DM or Ethnic risk
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| Risk factors for GDM | > 25 years, prior GDM/family hx, prior big baby/still birth, BMI greater than or equal to 27, chronic hypertension, glycosuria
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| What is the biggest complication of GDM | Big babies that don’t want to come out (macrosomia/shoulder dystocia)
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| What are the birth traumas associated with macrosomia | Brachial plexus injury, clavicular injury, facial nerve injury
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| Risk factors for fetal growth restriction | CVD (hypertension), smoking, fetal abnormalities, multifetal gestation, abnormal placentation, poor maternal wt gain or nutrition
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| __% of women are GBS vaginal/rectal colonized | 10-30%
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| What is the most common cause of neonatal sepsis | GBS
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| GBS bacteruria indicates | Heavy colonization
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| What is something you see in babies born to mothers on AZT for HIV | Lower white counts and macrocytic anemia (will resolve over time)
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| What is the average volume of amniotic fluid at term | 800mL
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| How is oligohydramnios determined | Identification of the largest pocket of fluid measuring less than 2cmx 2cm or the total of 4 quadrants less than 5 cm
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| What is oligohydramnios associated with | SGA fetus, renal tract abnormalities (renal agenesis), and urinary tract dysplasia
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| The clinical manifestation of oligohydramnios is a direct result of __ | The impairment of urine flow ot the amniotic fluid in the late part of the first half of pregnancy or during the second and third trimesters
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| Infants in the __ percentile are classified as having intrauterine growth restriction (IUGR) | < or =10th
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| Infants in the __ percentile are classified as large for gestational age (LGA) | > or = 90th
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| Both IUGR and LGA fetuses have increased risk for __ | Perinatal morbidity and mortality
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| A pregnancy cannot be described as IUGR unless what is known with certainty | Gestational age
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| What does symmetric IUGR refer to | Infants in which all organs are decreased proportionally
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| Symmetric IUGR infants are more likely to have __ | An endogenous defect that results in impairment of early fetal cellular hyperplasi
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| What does asymmetric IUGR refer to | Infants in which all organs are decreased disproportionately (abdominal circumference is affected to a greater degree than head circumference)
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| Asymmetric IUGR infants are more likely caused by __ | Intrauterine deprivation that results in redistribution of flow to the brain and heart at the expense of less important organs such as the liver and kidneys
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| An infant with an autosomal __ is more likely to be IUGR | Trisomal
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| What is the most common autosomal trisomy and what is the rate | Trisomy 21 (Down syndrome) 1 in 600 live births
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| What is the second most common autosomal trisomy and what is the rate | Trisomy 18 (Edward’s syndrome) 1 in 6000-8000 live births
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| Turner’s syndrome is associated with an average birthweight of approximately __ below average | 400g
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| Fetuses with neural tube defects are frequently | IUGR weighing approximately 250g less than controls
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| Chronic intrauterine infection is responsible for __% of IUGR pregnancies | 5-10
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| What is the most commonly identified pathogen responsible for IUGR | CMV
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| What is the most common protozoan, acquired by eating raw meat, that is responsible for IUGR | Toxoplasma gondii
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| Bacterial infections occur commonly in pregnancy and frequently are implicated in premature delivery, however they are not commonly associated with IUGR. The exception to this rule is chronic infection with __ | Listeria monocytogenes
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| What is the clinical picture of an infant born to a mother infected with chronic listeria monocytogenes | Critically ill, encephalitis, pneumonitis, myocarditis, hepatosplenomegaly, jaundice, and petechiae
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| Multiple gestation is associated with a __% increased incidence of IUGR fetuses | 20-30
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| What is the most common maternal complication causing IUGR | Hypertension
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| Women who stop smoking before __ weeks gestation are not at increased risk for having an IUGR infant | 16
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| Poor maternal wt gain is associated with an increased risk of having an IUGR infant. Daily intake must be reduced to less than __kcal/d before a measurable effect on birthweight becomes evident | 1500
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| What are some vascular diseases that are risk factors for having an IUGR infant | Collagen vascular disease, insulin-dependent diabetes mellitus associated with microvasculopathy and preeclampsia
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| What is the best parameter for early dating of pregnancy on ultra sound | Crown-rump length
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| What are the most accurate parameters for dating of pregnancy in the second trimester | Biparietal diameter, and HC
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| what is the most accurate parameter for dating of pregnancy in the third trimester | Head circumference
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| What is the single most common preventable cause of IUGR in infants in the US | Smoking
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| Data shows that IUGR infants appear to catch up in weight in the first __ of life | 6 months
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| Taken as a group IUGR infants have more __ than do their AGA peers | Neurologic and intellectual deficits
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| The incidence of __ is increased in IUGR infants | Sudden infant death syndrome
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| In the second half of pregnancy, increased concentrations of __ combine to produce modest maternal insulin resistance which is countered by postprandial hyperinsulinemia | Human placental lactogen, free and total cortisol, and prolactin
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| Maternal obesity is associated with a __ increased likelihood of fetal macrosomia | 3-4 fold
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| Male fetuses are __g heavier on average than female fetuses | 150
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| What is the best single measure in evaluating macrosomia by ultrasound in diabetic mothers | Abdominal circumference
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| Estimated fetal wt. by __ is not very accurate | Ultrasound
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| What is the most common medical complication of pregnancy | Diabetes mellitus
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| Preexisting diabetes mellitus affects approximately __ per 1000 pregnancies | 1-3
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| Defined as any degree of glucose intolerance with first recognition during pregnancy | Gestational diabetes
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| GDM complicates __% of pregnancies | 4
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| Women with GDM have an approximately __% risk of developing type 2 diabetes over the next 10 years | 50
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| __ is the hormone mainly responsible for insulin resistance and lipolysis. It is similar in structure to growth hormone and acts by reducing the insulin affinity to insulin receptors | Human placental lactogen
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| H A1C can predict the risk for __ when measured in the first trimester | Malformation
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| Higher glucose level in mothers lead to higher glucose levels in the fetus. This leads to higher levels of insulin which can cause __ in the fetus | Macrosomia, central fat deposition, enlargement of internal organs such as the heart
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| What are risk factors for developing GDM | Obesity, prior hx of GDM, heavy glycosuria, unexplained stillbirth, prior infant with major malformation, family hx of DM in first degree relative
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| When should at risk pregnant women be screened for GDM | As soon as feasible and again between 24 and 28 weeks
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| Which women can be omitted for GDM screening | Age <25, normal body wt, no family hx, no hx of abnormal glucose metabolism/poor OB outcome, and not a member of an ethnic or racial group at high risk
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| What are the ethnic or racial groups with a high prevalence of diabetes | Hispanic Americans, Native Americans, Asian Americans, African Americans, Pacific Islanders
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| What is the mainstay of treatment in the pregnant women with pregestational diabetes | Rigorous control of blood glucose
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| What is an optimal fasting glucose in pregnancy | 70-95
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| What is an optimal 1-hr postprandial glucose value during pregnancy | Less than 140
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| What is an optimal 2-hr postprandial glucose value during pregnancy | Less than 120
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| Characterized by the onset of hypertension and proteinuria, usually during the third trimester of pregnancy | Preeclampsia
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| Characterized by a history of high blood pressure before pregnancy, elevation of BP during the first half of pregnancy, or high blood pressure that lasts for longer than 12 weeks after delivery | Chronic hypertension
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| An ECG may reveal __ in the patient with long-standing hypertension | Left ventricular hypertrophy
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| What is mild hypertension | Systolic >/= 140, diastolic >/=90
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| What is severe hypertension | Diastolic >/= 180, diastolic >/=110
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| what is proteinuria as defined for preeclampsia | Urinary excretion of >/= 0.3g protein in a 24 hour urine specimen, usually correlates with a finding of 1+ or greater on dipstick
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| new onset of grand mal seizures in a woman with preeclampsia that cannot be attributed to other causes | Eclampsia
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| how is preeclampsia distinguished from gestational hypertension | There is no proteinuria in gestational hypertension
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| what are the mainline antihypertensives used during pregnancy | Methyldopa, labetalol, nifedipine
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| preeclampsia complicates __% of all pregnancies | 5-7
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| normal pregnancy is associated with decreased maternal sensitivity to __. This effect leads to expansion of the intravascular space | Endogenous vasopressors
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| women destined to develop preeclampsia do not exhibit normal refractoriness to __. As a result normal expansion of the intravascular space does not occur | Endogenous vasopressors
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| in addition to the classic findings of hypertension and proteinuria, women with preeclampsia may complain of what other symptoms | Scotomata, blurred vision, or pain in the epigastrium or right upper quadrant
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| lab work of patients with preeclampsia will reveal __ | Elevated levels of hematocrit, lactate dehydrogenase, serum transaminase, and uric acid, and thrombocytopenia
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| in the management of preeclampsia, with few exceptions, maternal interests are best served by __ | Immediate delivery
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| how are women with mild preeclampsia before 37 weeks managed | Expectantly with bed rest, twice-weekly antepartum testing, and maternal evaluation
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| severe preeclampsia mandates __ | Hospitalization
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| in the case of severe preeclampsia delivery is indicated it the gestational age is __ weeks or greater, fetal pulmonary is confirmed, or evidence of deteriorating maternal or fetal status is seen | 34
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| in the case of severe hypertension what is the goal of antihypertensives | Systolic <160 and diastolic <105
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| in the case of severe preeclampsia acute blood pressure control may be achieved with what drugs | Hydralazine, labetalol, or nifedipine
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| in severe preeclampsia between 33 and 35 weeks consideration should be given to __ for pulmonary maturity studies | Amniocentesis
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| loss of patellar reflexes is observed at magnesium levels of __mg/dL or higher | 10
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| respiratory paralysis may occur at magnesium levels of __ or higher | 15
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