Comorbid Diseases in Pregnancy课件.ppt

Comorbid Diseases in Pregnancy Chapter 105 Tintinalli Presented by Dr. Kelley December 6, 2005 Diabetes 2-3% of all pregnancies Gestational- 90% A1- diet controlled A2- insulin controlled Predated Diabetes- 10% Always insulin dependent. Do NOT use oral hypoglycemics!!! Goals- 90mg/dL fasting 140 1o postprandial ? insulin needs as pregnancy progresses. Diabetes Complications Hypertensive diseases, preterm labor, spontaneous Ab, pyelonephritis, DKA, hypoglycemia DKA- Rapid occurrence at lower glucose levels. Same tx as nonpregnant Diabetes Complications Cont. Hypoglycemia 45% occurrence Symptoms: swelling, tremors, blurred vision, diplopia, weakness, hunger, confusion, paresthesias, anxiety, palpitations, vomiting, HA, stupor Tx: Levels 70mg/dL able to talk and follow commands- 1 cup milk with bread and crackers q 15 min. Severe- 1 amp D50W IVP or glucagon 1-2mg IM/SQ with or without D5W IV @ 50-100 cc/hr. Hyperthyroidism Associated with ? risk of preeclampsia, neonatal morbidity, low birth weight, and possible congenital malformations. Symptoms: nervousness, palpitations, heat intolerance, inability to gain weight (Thyrotoxicosis may present as hyperemesis gravidarum.) Tx: PTU (100-150mg PO TID) Thyroid Storm Symptoms: fever, volume depletion, cardiac decompensation Mortality rate of 25% Tx: IVF, Oxygen, antipyretic agents, PTU 400mg PO q8o, sodium iodide 1g in 500mL IVF q day, propranolol 40mg PO q6o (unless cardiac failure), cooling blanket. NO radioactive iodine therapy (congenital hypothyroidism)! Hypertension Divided into chronic or preeclampsia, however chronic HTN can lead to preeclampsia. Chronic 4-5% occurrence ? BP 140/90mmHg before 12th week gest. Tx (indicated when systolic 160 or diastolic 100): Aldomet, Labetalol, nifedipine Acute Hypertensive Crisis IV Labetalol (10mg q5-10 min up to 300 mg total) or Hydralazine (5-10mg q 15 min IV) Goal: 140-150/90-100 Dysrhytmias Rare Lidocaine, digoxin, procainamide can be used as indicated. Maintenance