Term
| incidence hypertensive disorders in pregnancy |
|
Definition
|
|
Term
| #1 cause of maternal mortality |
|
Definition
|
|
Term
| risk factors for hypertension in pregnancy - 12 |
|
Definition
| primpip, history of, >35yo, AA, CHTN, renal disease, IVF, DM1-2, obesity, vascular disease, APAS, CT disorder, new paternity |
|
|
Term
| maternal complications of HTN in pregnancy - 9 |
|
Definition
| death, stroke, MI, pulmonoary edema, renal failure, pre-e, abruption, PPH, GDM |
|
|
Term
| fetal complications of HTN in pregnancy - 6 |
|
Definition
| stillbirth 2-4x, perinatal death, IUGR, PTD, anomalies (all worse if severe range in 1T), oligohydraminos |
|
|
Term
| when should you get an ECHO for a CHTN in pregnancy at baselne |
|
Definition
| long standing disease, severe disease |
|
|
Term
| why do we get a baseline ECHO for CHTN |
|
Definition
| LV hypertrophy is associated with increased risk of cardiomyopathy |
|
|
Term
| causes of secondary HTN - 8 |
|
Definition
| pheochromocytoma, primary aldosteronism, cushings, OSA, meth, cocaine, renal artery stenosis, hyperthyroid, white coat HTN |
|
|
Term
| why do we care about white coat HTN |
|
Definition
|
|
Term
| when should prophylactic ASA be started in pregnancy |
|
Definition
|
|
Term
|
Definition
| bronchospasm, IUGR, fetal hypoglycemia, rebound HTN/MI, increased TG/VLDL, lower HDL, fetal bradycardia |
|
|
Term
| labetalol contraindications - 3 |
|
Definition
| asthma, conoduction abnormalities, CHF |
|
|
Term
| outside of pregnancy labetalol is 1st line for |
|
Definition
| compensated systolic CHF, rapid AFIB/Aflut |
|
|
Term
|
Definition
| headache, tachycardia, orthostatic hypotension, MI in CAD, vasospasm with DC |
|
|
Term
| outside of pregnancy what are CCB used for - 2 |
|
Definition
| effective in AA and elderly |
|
|
Term
|
Definition
| sedation, increased LFTs, hepatitis, hemolysis, fever, depression |
|
|
Term
|
Definition
| dizziness, headache, rebound HTN with rapid DC, dry mouth |
|
|
Term
|
Definition
| volume depletion, lyte disorders, increased UA, low PLT (mat/fetal), fetal hypokalemia, arrhythmia |
|
|
Term
|
Definition
| flushing, headache, lupus like reaction, tachycardia, hypotension. NRFHT |
|
|
Term
|
Definition
|
|
Term
|
Definition
| IUGR, fetal renal failure, fetal death, cough 5-10%, hypotension during surgery |
|
|
Term
|
Definition
| syncope after 1st dose, dizziness, stress incontinence, weakness, decreased cholesterol, decreased LDL, increased HDL |
|
|
Term
| urine protein diagnosis pre-e |
|
Definition
|
|
Term
| severe features pre-e - 7 |
|
Definition
| >160/110, PLT <100, LFT x2, Cr >1.1 or double, pulmonary edema, visual changes, headache |
|
|
Term
| rate of thrombocytopenia in pre-e |
|
Definition
|
|
Term
| rate of LFT elevation n pre-e |
|
Definition
|
|
Term
| what value is most associated with cerebral injury in pre-e |
|
Definition
|
|
Term
| when do most eclamptic seizures occur |
|
Definition
| 50% before labor, 30% postpartum, rare after 48h |
|
|
Term
| when to deliver NOW (not wait for steroids) in pre-e - 2 |
|
Definition
| eclampsia, pulmonary edema, non-viable, suspect abruption, uncontrolled BP |
|
|
Term
| when to deliver before 34wk potentially, but wait for steroids, in pre-e - 6 |
|
Definition
| IUGR <5%ile, HELLP, severe oligo, reversed flow, PROM, significant renal dysfunction |
|
|
Term
| how much does Mg lower seizure risk |
|
Definition
|
|
Term
|
Definition
|
|
Term
| signs of Mg toxicity per level |
|
Definition
8 - loss of DTRs
9 - flushing
10 - somnolence, slurring
15 - paralysis, respiratory difficulty
30 - cardiac arrest |
|
|
Term
|
Definition
| Ca gluconate IV over 3h - reverse at signs of respiratory depression |
|
|
Term
| what percent of eclamptic seizures happene on Mg |
|
Definition
|
|
Term
| fetal risks of seizure - 4 |
|
Definition
| abruption, prematurity, IUGR, hypoxia |
|
|
Term
|
Definition
|
|
Term
| recurrence of pre-eclampsia depending on onset |
|
Definition
20% if was term
50% if was 28-30wk
65% if 2T |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 20, 40, 80, hydralazine 10 |
|
|
Term
|
Definition
|
|
Term
| BP monitoring after giving IV anti-hypertensives |
|
Definition
q10m 1h
q15m 1h
q30m 1h
q60m 1h |
|
|
Term
| when to start prophylactic aspirin |
|
Definition
1 high risk factors - hx pre-e, CHTN, pre-gest DM, renal disease, autoimmune disease
or
2 moderate risk factor - nullip, fhx pre-e, >35yo, ASA, low SES, prior IUGR, >10y pregnancy interval, prior adverse pregnancy outcome |
|
|
Term
| HELLP % that did not have HTN prior |
|
Definition
|
|
Term
|
Definition
|
|
Term
| HELLP % that had pre-e first |
|
Definition
|
|
Term
| hemolysis criteria in HELLP - 4 |
|
Definition
| schistocytes, bili >1.2 (2x), LDH >600, haptoglobin <25 |
|
|
Term
|
Definition
|
|
Term
| signs there could be a liver hematoma or infarct in HELLP |
|
Definition
|
|
Term
|
Definition
| periportal fibrin deposits, hemorrhagic hepatocellular necrosis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| nausea, vomiting, RUQ pain all 65% |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| rate of perinatal mortality in HELLP |
|
Definition
|
|
Term
| rate of maternal death in HELLP |
|
Definition
|
|
Term
| when do you do a CD for HELLP |
|
Definition
| if you think labor will be too long |
|
|
Term
|
Definition
|
|
Term
| risk of pre-e in next pregnancy after HELLP |
|
Definition
|
|
Term
| incidence of thrombocytopenia in pregnancy |
|
Definition
|
|
Term
| definition of thrombocytopenia |
|
Definition
<150
mild 100-150
moderate 50-100
severe <50 |
|
|
Term
| PLT level with surgical bleeding risk |
|
Definition
|
|
Term
| PLT level with spontaneous bleeding risk |
|
Definition
|
|
Term
| causes of thrombocytopenia decreased production - 8 |
|
Definition
| hep C, parvo, EBV, congenital, marrow aplasia, alcohol toxicity, B12/folate deficiency |
|
|
Term
| causes of thrombocytopenia increased destruction - 14 |
|
Definition
| ITP, SLE, HIV, transfusion, transplant, NAT, DIC, TTP, APAS, HELLP, heparin, valproic acid, CMV, mono |
|
|
Term
| causes of thrombocytopenia hiding platelets - 3 |
|
Definition
| pseudothrombocytopenia/clumping, splenomegaly/liver disease, dilutional |
|
|
Term
| #1 cause of thrombocytopenia in pregnancy |
|
Definition
|
|
Term
| PLT level in gestational thrombocytopenia |
|
Definition
|
|
Term
| incidence of neonatal thrombocytopenia when mom has gestational thrombocytopenia |
|
Definition
|
|
Term
| how long does it take gestational thrombocytopenia to resolve |
|
Definition
|
|
Term
|
Definition
acute: childhood usually virus
chronic: adult
IgG to platelets |
|
|
Term
| risk of neonatal thrombocytopenia in ITP |
|
Definition
|
|
Term
| risk of fetal IVH when mom has ITP |
|
Definition
|
|
Term
| platelet histology in ITP |
|
Definition
| megathrombocytes, megakaryocytes, fragmented |
|
|
Term
|
Definition
| PLT <50 start prednisone which will pea in 1-4wk then you can start dropping 10-20% a week, if not responding do IVIG, splenectomy definitive |
|
|
Term
| when do you deliver for PLT in ITP |
|
Definition
| platelets are not functional, number cannot deteremine delivery, C-section improves fetal but worsens maternal outcomes |
|
|
Term
|
Definition
children: shiga toxin producing E. coli
adult: rare, infection |
|
|
Term
|
Definition
| NO NEURO, fever, nausea, vomiting, HTN, renal failure |
|
|
Term
|
Definition
increased renal labs - Cr, LDH, UA, proteinuria
decreased WBC
microangiopathic anemia
PLT <20 |
|
|
Term
|
Definition
| dialysis, plasmaphoresis, delivery only for fetal indications |
|
|
Term
|
Definition
deficiency in ADAMS13, vWF isn't cleared, it causes PLT to clump consuming them
initiated by cancer, pregnancy, HIV, SLE |
|
|
Term
|
Definition
| late gestation or postpartum onset, severe neuro symptoms (HA, vision changes, confusion, seizure), persistant after delivery >3d, fever |
|
|
Term
|
Definition
| PLT <20, microangiopathic hemolytic anemia, renal failure, elevated bilirubin, elevated LDH, decreased ADAMS 13, ADAMS 13 Ab |
|
|
Term
|
Definition
| plasmaphoresis, steroids, cyclophosphamide, vincristine, rituximab, delivery only for fetal indications |
|
|
Term
|
Definition
| fetal long chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency |
|
|
Term
|
Definition
| jaundice, nausea, vomiting, neuro changes, abdominal pain, renal and liver failure, DIC |
|
|
Term
| gold standard for AFLD diagnosis |
|
Definition
| liver biopsy - oil red fat stain, centrilobal microvascular fat and cholestasis |
|
|
Term
| why don't we biopsy the liver in ALFD |
|
Definition
|
|
Term
|
Definition
| elevated WBC, ammonia, Cr, LFT >500, bili 3-10, low glucose, DIC |
|
|
Term
|
Definition
| delivery, replace clotting factors |
|
|
Term
| rate of fetal death in AFLD |
|
Definition
|
|
Term
| when do you give PLT to an asymptomatic pregnant patient |
|
Definition
|
|
Term
| when do you give PLT to a symptomatic patient |
|
Definition
bruising/petechiae <50
symptomatic bleeding <30
life threatening bleeding <20 |
|
|
Term
| how long does it take for IVIG to increase PLT |
|
Definition
|
|
Term
| what has a better response rate for PLT increase - IVIG vs teroids |
|
Definition
|
|
Term
|
Definition
mom has 1b1b, dad has 1a1a or 1a1b, baby inherits an "a"
mom makes antibodies to the "a" |
|
|
Term
|
Definition
|
|
Term
| what percent of neonatal IVH is caused by NAT |
|
Definition
|
|
Term
| what percent of the population has the "a" required for NAT |
|
Definition
| 98% (so it would be rare mom was 1b1b |
|
|
Term
| 3 signs that NAT may be the cause of baby's symptoms |
|
Definition
| IVH, mom with a sister with NAT, fetal PLT <50 |
|
|
Term
|
Definition
|
|
Term
| how can you tell that the babys thrombocytopenia is NAT and not an affect of TTP/ITP |
|
Definition
| mom is not thrombocytopenia, NAT has hemorrhages intrapartum not just after delivery |
|
|
Term
| how is NAT prevented next pregnancy |
|
Definition
| IVIG or prednisone starting at 12-20wk (depending on risk), delivery at 36-37wk via CD |
|
|
Term
| what PLT level in NAT has highest associated with IVH |
|
Definition
|
|
Term
| what is the recurrence rate of NAT |
|
Definition
|
|
Term
| incidence of DIC in pregnancy |
|
Definition
|
|
Term
|
Definition
| thrombocytopenia, low fibrinogen, elevated PT/PTT |
|
|
Term
| mortality rate of DIC in pregnancy |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| two words to sum up HELLP |
|
Definition
|
|
Term
|
Definition
|
|
Term
| HUS vs TTP vs ITP vs HELLP vs ALFD - neuro sx |
|
Definition
|
|
Term
| HUS vs TTP vs ITP vs HELLP vs ALFD - elevated LFTs |
|
Definition
| only HELLP and AFLD (which will be much higher) |
|
|
Term
| HUS vs TTP vs ITP vs HELLP vs ALFD - anemia |
|
Definition
|
|
Term
| HUS vs TTP vs ITP vs HELLP vs ALFD - fever |
|
Definition
|
|
Term
| HUS vs TTP vs ITP vs HELLP vs ALFD - HTN |
|
Definition
|
|
Term
| HUS vs TTP vs ITP vs HELLP vs ALFD - WBC changes |
|
Definition
|
|
Term
| HUS vs TTP vs ITP vs HELLP vs ALFD - proteinuria |
|
Definition
|
|
Term
| definition of anemia in pregnancy |
|
Definition
HBG white - 1T 33, 2T 32, 3T 33
HBG AA - 1T 31, 2T 30, 3T 31
Hbg - 1T 11, 2T 10.5, 3T 11 |
|
|
Term
| definition of severe anemia in pregnancy |
|
Definition
|
|
Term
| maternal physiology changes - RBC, plasma, hemoglobin, Fe requirement, Folate requirement |
|
Definition
RBC volume increases 50%
plasma volume increases 50%
hemoglobin stays same
Fe requirement 2-3x
Folate requirement 10-20x |
|
|
Term
| complications of Hbg <6 for baby - 5 |
|
Definition
| LBW, PTD, death, NRFHT, oligo |
|
|
Term
|
Definition
| Fe, chronic disease, thalassemia, hemoglobinopathies, sideroblastic, lead intoxication |
|
|
Term
| macrocytic megaloblastic anemias - 1 |
|
Definition
| B12 and folate deficiency |
|
|
Term
| macrocytic non-megaloblastic anemia - 5 |
|
Definition
| alcohol disease, liver disease, myelodysplasia, reticulocytosis, sideroblastic |
|
|
Term
|
Definition
| sickle cell, blood loss, marrow disorders |
|
|
Term
|
Definition
|
|
Term
| causes B12 deficiency - meds - 4 |
|
Definition
| PPIs, metformin, cimetidine, neomycin |
|
|
Term
| causes of B12 deficiency - GI - 4 |
|
Definition
| chrons, tapeworm, pancreatitis, ileal resection |
|
|
Term
| causes of B12 deficiency - systemic - 3 |
|
Definition
| pernicious anemia (autoimmune), transcobalamin 2 deficiency inherited, vegan diet |
|
|
Term
| signs of B12 deficiency - 8 |
|
Definition
| fatigue, symmetric UE/LE parasthesias, loss of balance, confusion, dementia, myalgias, weakness |
|
|
Term
| lab changes in B12 deficiency - |
|
Definition
| macrocytic anemia, hypersegmented neutrophils, elevated Fe, elevated bilirubin, elevated LDH, elevated homocysteine, elevated methylmalonic acid |
|
|
Term
| level of B12 for diagnosis of deficiency |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what can mask of B12 deficiency |
|
Definition
| folic acid supplementation |
|
|
Term
| peripherial smear signs of Fe deficiency - 3 |
|
Definition
| microcytic, hypochromatic, scant rim of hemoglobin, pencil shaped cells |
|
|
Term
| what is DIAGNOSTIC of Fe deficiency in pregnancy |
|
Definition
|
|
Term
| how long does it take for Fe PO to increase Fe |
|
Definition
|
|
Term
| risk of anaphylaxis with IV Fe |
|
Definition
|
|
Term
|
Definition
| fumurate, sulfate, gluconate |
|
|
Term
|
Definition
| dextran, gluconate, sucrose |
|
|
Term
|
Definition
chronic - normal
Fe- >15
Thal - normal |
|
|
Term
| microcytic anemias - transferrin |
|
Definition
chronic - low
Fe - low
thal - normal |
|
|
Term
| microcytic anemia - ferritin |
|
Definition
chronic - normal
Fe - low
Thal - normal |
|
|
Term
| Hbg electrophoresis changes in thalassemia |
|
Definition
A - none
B - high HbgF, low Hbg A2 |
|
|
Term
| genotypes of a-thalassemia |
|
Definition
trait - aa/a-
minor - a-/a- or aa/--
H - -a/--
bart --/-- |
|
|
Term
| genotypes of b-thalassemia |
|
Definition
minor - B/B0, B/B+
intermedia - B0/B+, B0/B0, B+/B+
cooley - y/y |
|
|
Term
| severity of anemias in a-thalassemia genotypes |
|
Definition
trait - none
minor - mild
H - moderate to severe
bart - incompatiable with life |
|
|
Term
| severity of anemias in b-thalassemia genotypes |
|
Definition
minor - none
intermedia - mild to moderate
cooley - severe |
|
|
Term
| which thalassemias have splenomeagly |
|
Definition
HbgH (a-thal)
B-thal intermedia
B-thal severe (cooley) |
|
|
Term
| which thalassemias require transfusions |
|
Definition
some - HbgH/A-thal, B-thal intermedia
always - cooley/B-thal severe |
|
|
Term
| which thalassemias have fetal complications |
|
Definition
| B-thal intermedia and severe/coooley |
|
|
Term
| what complications could b-thal cause in baby - 1 |
|
Definition
| 50% risk stillbirth, infertility, IUGR, PTD |
|
|
Term
| signs of lead poisoning in labs - 2 |
|
Definition
| macrocytic anemia, basophilic stippling |
|
|
Term
| 4 genotypes of sickle cell disease |
|
Definition
trait - B/Bs
disease - Bs/Bs
SC - Bs/Bc
Sickle Thal - Bs/Bo or Bs/Bx |
|
|
Term
| complications of sickle cell in pregnancy - 10 |
|
Definition
| infection, anemia, acute chest, splenic sequesteration, leg ulcers, renal papillary necrosis, stroke, early death, sickle crisis, DVT |
|
|
Term
| average age of death in sickle cell disease |
|
Definition
|
|
Term
| cause of sickle crisis - 4 |
|
Definition
| volume depletion, hypoxia, cold, acidosis |
|
|
Term
| complications of sickle crisis - 3 |
|
Definition
| more = decreased life expectancy, DVT, organ damage |
|
|
Term
| management sickle crisis - 4 |
|
Definition
| fluids, O2, pain meds, lovenox |
|
|
Term
| why cant sickle cell patients take hydroxyurea in pregnancy |
|
Definition
| still birth, congenital malformations |
|
|
Term
| reasons to transfuse in sickle cell - 5 |
|
Definition
| acute chest, organ dysfunction, history of fetal death, HCT <21, severe protracted crisis |
|
|
Term
| labor management in sickle cell - 3 |
|
Definition
| keep O2 >95%, more pain meds, lovenox |
|
|
Term
| visit frequency sickle cell |
|
Definition
|
|
Term
| how often to monitor CBC sickle cell |
|
Definition
|
|
Term
| changes in PNV sickle cell |
|
Definition
| no Fe, only 1g folic acid total |
|
|
Term
|
Definition
|
|
