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How should aortic stenosis in pregnancy be managed?
- Similar problems with mitral stenosis
- Avoid tachycardia and fluid overload
- Give antibiotic prophylaxis
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How can one remember the difference between mitral valve prolapse and mitral stenosis in pregnancy?
- Prolapse=okay to be pregnant
- Stenosis=sick in pregnancy
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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.
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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%.
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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.
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How is hyperthyroidism (thryrotoxicosis) treated in pregnancy?
Prophythiouracil is DOC, methimazole may be used.
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How is thyroid storm treated in pregnancy?
- B-blocker
- Sodium iodide
- Parathyroid hormone
- Dexamethasone
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At what fetal weight should elective c-section be considered?
>4500 g
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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
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What is the CNS anomaly most specific to DM?
Caudal regression
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What probably causes gestational diabetes?
Placental lactogen, which has large glucagon-like effects.
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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.
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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.
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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
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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
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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
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What may chronic use of NSAIDs lead to?
oligohydramnios, constriction of fetal ductus arteriosus.
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Does heparin cross the placenta?
NO! It is the DOC in pregnant patients needing anticoagulation.
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What stage of fetal development is the maximum susceptibility to teratogen-induced malformation?
3-8 weeks: organogenesis phase
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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
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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!
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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%
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