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Duke PA Hypertension, Eclampsia, Low Birth Weight, Macrosomia, And GDM

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