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DU PA HTN, LBW, GDM
Duke PA Hypertension, Eclampsia, Low Birth Weight, Macrosomia, And GDM
| Question | Answer |
|---|---|
| If a young female patient is hypertensive and having a seizure she is __ until proven otherwise | Preeclamptic |
| Hypertension complicates __ of all pregnancies | 5-7% |
| Preeclampsia/eclampsia is responsible for __% of hypertension in pregnancy | 70 |
| Hypertension with proteinuria and or pathologic edema | Preeclampsia |
| Hypertension without proteinuria or pathologic edema during pregnancy | Pregnancy induced hypertension |
| Hypertension with proteinuria and or pathologic edema with convulsions | Eclampsia |
| Signs and symptoms of preeclampsia | HA, hyperreflexia, visual changes, irritability, epigastric pain, edema of face/hands/abdomen, oliguria |
| What does HELLP stand for | Hemolysis, Elevated Liver enzymes, Low Platelets |
| Primary symptom of HELLP syndrome | Malaise, fatigue |
| Classic presentation of HELLP syndrome | Malaise/fatigue, N/V, HA, RUQ pain, severe elevated BP, 3+ protein/85% of the time |
| Partial or complete detachment of placenta from uterine wall, after 20 weeks gestation | Abruptio Placenta |
| What are some risk factors of abruptio placenta | Cocaine use, maternal hypertension, trauma |
| Placenta previa is __ bleeding | Painless/silent |
| Placenta abruption is __ bleeding | painful |
| When do you screen with 1 hour glucose | At 24-28 weeks in patients >25 or family history of DM or Ethnic risk |
| 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 |
| What is the biggest complication of GDM | Big babies that don’t want to come out (macrosomia/shoulder dystocia) |
| What are the birth traumas associated with macrosomia | Brachial plexus injury, clavicular injury, facial nerve injury |
| Risk factors for fetal growth restriction | CVD (hypertension), smoking, fetal abnormalities, multifetal gestation, abnormal placentation, poor maternal wt gain or nutrition |
| __% of women are GBS vaginal/rectal colonized | 10-30% |
| What is the most common cause of neonatal sepsis | GBS |
| GBS bacteruria indicates | Heavy colonization |
| What is something you see in babies born to mothers on AZT for HIV | Lower white counts and macrocytic anemia (will resolve over time) |
| What is the average volume of amniotic fluid at term | 800mL |
| 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 |
| What is oligohydramnios associated with | SGA fetus, renal tract abnormalities (renal agenesis), and urinary tract dysplasia |
| 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 |
| Infants in the __ percentile are classified as having intrauterine growth restriction (IUGR) | < or =10th |
| Infants in the __ percentile are classified as large for gestational age (LGA) | > or = 90th |
| Both IUGR and LGA fetuses have increased risk for __ | Perinatal morbidity and mortality |
| A pregnancy cannot be described as IUGR unless what is known with certainty | Gestational age |
| What does symmetric IUGR refer to | Infants in which all organs are decreased proportionally |
| Symmetric IUGR infants are more likely to have __ | An endogenous defect that results in impairment of early fetal cellular hyperplasi |
| 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) |
| 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 |
| An infant with an autosomal __ is more likely to be IUGR | Trisomal |
| What is the most common autosomal trisomy and what is the rate | Trisomy 21 (Down syndrome) 1 in 600 live births |
| What is the second most common autosomal trisomy and what is the rate | Trisomy 18 (Edward’s syndrome) 1 in 6000-8000 live births |
| Turner’s syndrome is associated with an average birthweight of approximately __ below average | 400g |
| Fetuses with neural tube defects are frequently | IUGR weighing approximately 250g less than controls |
| Chronic intrauterine infection is responsible for __% of IUGR pregnancies | 5-10 |
| What is the most commonly identified pathogen responsible for IUGR | CMV |
| What is the most common protozoan, acquired by eating raw meat, that is responsible for IUGR | Toxoplasma gondii |
| 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 |
| 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 |
| Multiple gestation is associated with a __% increased incidence of IUGR fetuses | 20-30 |
| What is the most common maternal complication causing IUGR | Hypertension |
| Women who stop smoking before __ weeks gestation are not at increased risk for having an IUGR infant | 16 |
| 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 |
| 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 |
| What is the best parameter for early dating of pregnancy on ultra sound | Crown-rump length |
| What are the most accurate parameters for dating of pregnancy in the second trimester | Biparietal diameter, and HC |
| what is the most accurate parameter for dating of pregnancy in the third trimester | Head circumference |
| What is the single most common preventable cause of IUGR in infants in the US | Smoking |
| Data shows that IUGR infants appear to catch up in weight in the first __ of life | 6 months |
| Taken as a group IUGR infants have more __ than do their AGA peers | Neurologic and intellectual deficits |
| The incidence of __ is increased in IUGR infants | Sudden infant death syndrome |
| 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 |
| Maternal obesity is associated with a __ increased likelihood of fetal macrosomia | 3-4 fold |
| Male fetuses are __g heavier on average than female fetuses | 150 |
| What is the best single measure in evaluating macrosomia by ultrasound in diabetic mothers | Abdominal circumference |
| Estimated fetal wt. by __ is not very accurate | Ultrasound |
| What is the most common medical complication of pregnancy | Diabetes mellitus |
| Preexisting diabetes mellitus affects approximately __ per 1000 pregnancies | 1-3 |
| Defined as any degree of glucose intolerance with first recognition during pregnancy | Gestational diabetes |
| GDM complicates __% of pregnancies | 4 |
| Women with GDM have an approximately __% risk of developing type 2 diabetes over the next 10 years | 50 |
| __ 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 |
| H A1C can predict the risk for __ when measured in the first trimester | Malformation |
| 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 |
| 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 |
| When should at risk pregnant women be screened for GDM | As soon as feasible and again between 24 and 28 weeks |
| 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 |
| What are the ethnic or racial groups with a high prevalence of diabetes | Hispanic Americans, Native Americans, Asian Americans, African Americans, Pacific Islanders |
| What is the mainstay of treatment in the pregnant women with pregestational diabetes | Rigorous control of blood glucose |
| What is an optimal fasting glucose in pregnancy | 70-95 |
| What is an optimal 1-hr postprandial glucose value during pregnancy | Less than 140 |
| What is an optimal 2-hr postprandial glucose value during pregnancy | Less than 120 |
| Characterized by the onset of hypertension and proteinuria, usually during the third trimester of pregnancy | Preeclampsia |
| 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 |
| An ECG may reveal __ in the patient with long-standing hypertension | Left ventricular hypertrophy |
| What is mild hypertension | Systolic >/= 140, diastolic >/=90 |
| What is severe hypertension | Diastolic >/= 180, diastolic >/=110 |
| 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 |
| new onset of grand mal seizures in a woman with preeclampsia that cannot be attributed to other causes | Eclampsia |
| how is preeclampsia distinguished from gestational hypertension | There is no proteinuria in gestational hypertension |
| what are the mainline antihypertensives used during pregnancy | Methyldopa, labetalol, nifedipine |
| preeclampsia complicates __% of all pregnancies | 5-7 |
| normal pregnancy is associated with decreased maternal sensitivity to __. This effect leads to expansion of the intravascular space | Endogenous vasopressors |
| 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 |
| 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 |
| lab work of patients with preeclampsia will reveal __ | Elevated levels of hematocrit, lactate dehydrogenase, serum transaminase, and uric acid, and thrombocytopenia |
| in the management of preeclampsia, with few exceptions, maternal interests are best served by __ | Immediate delivery |
| how are women with mild preeclampsia before 37 weeks managed | Expectantly with bed rest, twice-weekly antepartum testing, and maternal evaluation |
| severe preeclampsia mandates __ | Hospitalization |
| 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 |
| in the case of severe hypertension what is the goal of antihypertensives | Systolic <160 and diastolic <105 |
| in the case of severe preeclampsia acute blood pressure control may be achieved with what drugs | Hydralazine, labetalol, or nifedipine |
| in severe preeclampsia between 33 and 35 weeks consideration should be given to __ for pulmonary maturity studies | Amniocentesis |
| loss of patellar reflexes is observed at magnesium levels of __mg/dL or higher | 10 |
| respiratory paralysis may occur at magnesium levels of __ or higher | 15 |
Created by:
bwyche
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