Term
| What are the definitions of anemia in pregnancy? |
|
Definition
Hb <11 g/dL (Hct<33%) in first or third trimester.
Hb <10.5 g/dL (Hct<32%) in second trimester. |
|
|
Term
| What is the most common cause of anemia in pregnancy? |
|
Definition
|
|
Term
| What is the most common cause of megaloblastic anemia in pregnancy? |
|
Definition
|
|
Term
| Which diseases are often complicated by folate deficiency in pregnancy? |
|
Definition
| Hemolytic diseases such as sickle cell anemia, hereditary spherocytosis and malaria. |
|
|
Term
| Name 6 drugs that interfere with folate absorbtion. |
|
Definition
1. Oral contraceptives
2. Phenytoin
3. Pyrimethamine
4. TMP-SFX
5. Primidone
6. Barbiturates |
|
|
Term
| Which two groups of women are especially at risk for vitamin B12 deficiency (in pregnancy)? |
|
Definition
S/P total or partial gastrectomy
Crohn's disease |
|
|
Term
| Name three drugs commonly used in pregnancy which may cause drug-induced hemolytic anemia. |
|
Definition
Acetaminophen
Cephalosporins
Erythromycin |
|
|
Term
| How can a G6PD-deficienct fetus be affected by maternal ingestion of oxidant drugs? |
|
Definition
Fetal hemolysis
Hydrops fetalis
Fetal death |
|
|
Term
| What are six complications of pregnancy that a sickle cell patient is at risk for? |
|
Definition
1. Hemolytic or megaloblastic anemia
2. Frequent crises
3. Pulmonary complications
4. CHF
5. Infection
6. Preeclampsia-eclampsia |
|
|
Term
| How should sickle cell disease be managed during pregnancy? |
|
Definition
Before pregnancy: stop hydroxyurea, genetic counselling, type and screen for Rh alloimmunization.
Prophylaxis: folate, pneumococcal and influenza vaccines.
F/U: antepartum testing starting at 32-34wks. |
|
|
Term
| How is α-thalassemia major (Hemoglobin H disease) affected by pregnancy? |
|
Definition
| Anemia worsens in pregnancy |
|
|
Term
| What is gestational thrombocytopenia? How common is it? |
|
Definition
Defined as platelet count <150,000/μL
Affects ~5% of pregnant women
Platelet counts usually exceed 70,000/μL. |
|
|
Term
| What is the risk to the fetus in a pregnant woman with immune thrombocytopenic purpura (ITP)? |
|
Definition
| 10% chance of severe fetal thrombocytopenia (<50,000/μL) |
|
|
Term
| What is the treatment of ITP in pregnancy? |
|
Definition
1. Steroids - improvement in 2/3 of patients
2. IVIG
3. Splenectomy - rarely needed |
|
|
Term
| What is the appropriate treatment of superficial thrombophlebitis? |
|
Definition
Perform U/S to rule out DVT!
Treat with compression stockings, ambulation, analgesia and local heat |
|
|
Term
| How should a thrombosis of the superficial femoral vein by treated? |
|
Definition
| Despite its name, the superficial femoral vein is part of the deep system, making a thrombosis in it a DVT. Treat appropriately. |
|
|
Term
| What are the common locations for DVTs in pregnancies? |
|
Definition
| Most are in the lower extremeties. >80% are in the left leg. |
|
|
Term
| How long should a pregnant patient continue prophylaxis after a DVT? |
|
Definition
For the rest of pregnancy + 6-12wks for a total of 3-6 months.
If post-partum: 3-6 months. |
|
|
Term
| Which 4 inherited thrombophilias require anticoagulation in pregnancy regardless of prior VTE? |
|
Definition
1. Antithrombin III mutation
2. Homozygote for factor V Leiden
3. Homozygote for prothrombin gene mutation
4. Compound heterozygote: factor V Leiden and prothrombin gene |
|
|
Term
| Which 4 inherited thrombophilias only justify anticoagulation in pregnancy is a history of VTE is present? |
|
Definition
1. Protein C deficiency
2. Protein S deficiency
3. Heterozygote for factor V Leiden
4. Heterozygote for prothrombin gene mutation |
|
|
Term
| Should a women with a history of VTE be anticoagulated in pregnancy? |
|
Definition
If cause was transient (e.g. immobility after surgery) - no.
If cause was estrogen-related (e.g. pregnancy or estrogen-containing contraceptives) - consider anticoagulation. |
|
|
Term
What is septic pelvic thrombophlebitis?
What is the common risk factor? |
|
Definition
Septic pelvic thrombophlebitis is thrombosis in the pelvic veins due to infection.
Commonly occurs after caesarean delivery (>90% of cases). |
|
|
Term
| What is the most common site for septic pelvic thrombophlebitis? |
|
Definition
|
|
