Pregnancy Problems

Anemia

• Presentation:
  • Hemoglobin Nadir 28-30 weeks
  • iron deficiency
• Dx: CBC – Hgb/Hct < 10/30
  • Decrease MCV
  • get Ferritin decrease
• Tx: Iron

DVT

• Increase Risk By:
  • – Estrogen
    
  • – Smoking
    
  • – 35 years of older

Hyperemesis Gravidarum

• Presentation:
  • B-HCG or Estradiol cause
  • Morning sickness till 2nd TM
    • N/V, Volume  depletion
    • Startvation -> ketones
    • Weight loss
• Dx:
  • B-HCG
  • US – r/o mole
• Tx:
  • IVF
  • Antiemetics
    1. Doxyalamine
    2. Promethazine
    3. Metaclopromide
    4. Ondasetron

HTN

• Presentation:
  • Goal: < 140/90
• Tx:
  • a-methyldopa
  • Hydralazine
  • Metoprolol
• Teratogenic: ACEi, ARBs, Diuretics, CCB

Rh Immunization

• Presentation:
  • Isoimmunization
  • Rh- mom and Rh + baby
  • mom -> IgM -> IgG -> kill anemia
• Dx: mom Rh status –
  • Ab status: Rh+
• Tx:
  • Rh + no Ab = Rhogam at 28 weeks and within 72 hrs of delivery/C-section
  • Rh +  Ab+ = too late

Seizures

• Path: ALL antiepileptic drugs are teratogens
  
• Pt: Dx of epilepsy
  
• Dx: Clinical
  
• Treatment:
  • Leviteracetam = lamotragine
    
  • No phenytoin, carbamazepine, valproate, balance benefits/risk
    
• f/u: If she does have a seizure use phenobarbital, it is safe in pregnancy (give folic acid)

Thyroid

• Path:
  • Hyper: Fetal demise
  • Hypo: Cretinism
    
• Pt:
  • Hyper: Increased
  • Hypo: Decreased
    
• Dx:
  • Hyper: Increased T4 with Decreased TSH
    
  • Hypo: Decreased T4 with Increased TSH
    
• Tx:
  • Hyper: PTU pregnancy, 2nd trimester pregnancy for surgery if absolutely necessary
    
• Hypo:
  • Levothryoxine f/u TSH q 4 weeks
    
• f/u:
  • Increased TBG, increased levothryoixine (need more T 4 in pregnancy by 25%)