How should aortic stenosis in pregnancy be managed?
- Similar problems with mitral stenosis
- Avoid tachycardia and fluid overload
- Give antibiotic prophylaxis
How can one remember the difference between mitral valve prolapse and mitral stenosis in pregnancy?
- Prolapse=okay to be pregnant
- Stenosis=sick in pregnancy
What happens to mothers with mitral stenosis in pregnancy?
- Increased preload due to normal increase in blood volume results in left atrial overload and backup into lungs resulting in pulmonary HTN.
- Sequelae: tachycardia associated with labor and delivery exacerbates pulmonary HTN, b/c decreased filling time. May lead to pulmonary edema.
Tx: antibiotic prophylaxis.
How should vertical transmission of HIV be prevented?
- Reduce maternal viral load: give Zidovudine (ZDV) beginning at 14 weeks.
- Monitor CD4 count and viral load regularly and monitor blood count and liver functions monthly.
- Reduce vertical transmission: give IV ZDV, reduce duration of ruptured membranes, offer elective c-section to mother, avoid breast feeding,
- Administer prophylaxis to newborn: give ZDV syrup to newborn for 6 wks.
- *Combo of ZDV and c-section decreases vertical trans of HIV by up to 85%.
What is the link between type 1 DM in pregnancy and post-partum thyroid dysfunction?
25% of women with type 1 DM will develop postpartum thyroid dysfunction.
How is hyperthyroidism (thryrotoxicosis) treated in pregnancy?
Prophythiouracil is DOC, methimazole may be used.
How is thyroid storm treated in pregnancy?
- Sodium iodide
- Parathyroid hormone
At what fetal weight should elective c-section be considered?
what fetal monitoring should be done in a patient with DM?
- Starting at 32-34 weeks
- 1. Ultrasound to eval fetal growth, estimated weight, amniotic fluid volume, fetal anatomy.
- 2. Nonstress test and amniotic fluid index testing weekly to biweekly depending on disease severity.
- 3. Biophysical profile
- 4. Contraction stress test
What is the CNS anomaly most specific to DM?
What probably causes gestational diabetes?
Placental lactogen, which has large glucagon-like effects.
When is a 3 hour glucose tolerance test done and what are the criteria?
- It is done when the glucose challenge test is >140 and <200
- Draw glucose levels at 1 hour (normal <180), 2 hrs (<155), and at 3 hrs (<140)
- Positive test: 2/4 high values.
What is a glucose challenge test and when and how is it done?
- What: It is a screen for gestational diabetes
- When: Done at 26-28 weeks.
- How: Give 50g glucose load (nonfasting), draw glucose blood level 1 hour later.
- If >140--> do 3 hr glcuose tolerance test.
- If >200, pt is diagnosed with GDM type A1 and a diabetic diet is initiated.
Cardiovascular drugs in pregnancy
- Propranolol (Inderal): no evidence of teratogenecity
- Fetal bradycardia has been seen as a direct dose effect when given to mother 2 hrs prior to delivery.
- Increased risk of IUGR
What anti-asthmatics may be used in pregnancy?
- Epinephrine: exposure after T1 associ with minor malformations
- Terbutaline: not assoc with birth defects.
- Isoproterenol (Isuprel) and albuterol (Ventolin) not teratogenic
- Corticosteroids are inactivated by placenta when maternally administered; <10% of maternal dose is in fetus
What antibiotics may be used in pregnancy?
- Penicillins, cephalosporins and erythromycin are safe in pregnancy.
- Bactrim use in T1 associated with increase birth defects.
- Doxy-no teratogenic risk in T1
What may chronic use of NSAIDs lead to?
oligohydramnios, constriction of fetal ductus arteriosus.
Does heparin cross the placenta?
NO! It is the DOC in pregnant patients needing anticoagulation.
What stage of fetal development is the maximum susceptibility to teratogen-induced malformation?
3-8 weeks: organogenesis phase
What dose of folic acid should be taken normally? In high risk for neural tube defect patient?
- Normal: 0.4 mg/day
- High risk: 4 mg/day
When is the neural tube formed?
It is nearly formed by the time of the first missed period, thus starting folic acid supplementation upon diagnosis of pregnancy is too late!
What are contraindications to pregnancy?
Pulmonary HTN: Associated with 50% maternal mortality rate and a >40% Fetal mortality rate.
Eisenmenger Syndrome: maternal mortality is 30-50%