Term
| How are chronic migraines influenced by pregnancy? |
|
Definition
| 50-80% of patients will improve during pregnancy |
|
|
Term
| Which abortive medications are preferred to treat migraine headaches in pregnancy? |
|
Definition
Acetaminophen
Acetaminophen + codeine
Other narcotics
Magnesium sulfate |
|
|
Term
| How is the incidence of epilepsy affected by pregnancy? |
|
Definition
|
|
Term
| How should anti-epileptic drugs be monitored in pregnancy? |
|
Definition
| At least every trimester. Serum-free drug levels are preferable to total serum levels, due to alterations in protein binding. |
|
|
Term
| How is status epilepticus treated in pregnancy? |
|
Definition
1. Lorazepam 2mg IV + 2mg every min; max 0.1 mg/kg.
2. Phenytoin 20mg/kg slow IV push
3. General anesthesia + dexamethason, mannitol or hyperventilation to reduce cerebral edema |
|
|
Term
| What can seizures cause in a fetus? |
|
Definition
Spontaneous abortion
Premature labor
Fetal bradycardia |
|
|
Term
| Fetal hydantoin syndrome is comprised of what? |
|
Definition
Mental retardation
SGA
Craniofacial anomalies
Limb defects |
|
|
Term
| How common is fetal hydantoin syndrome? |
|
Definition
| 3-5%, 8-15% with careful assessment in first 3 years of life. |
|
|
Term
What is the overall (major) malformation rate of:
A. Valrpoic acid?
B. Phenobarbital?
C. Carbamazepine, phenytoin, lamotrigine? |
|
Definition
|
|
Term
| How is MS (multiple sclerosis) affected by pregnancy? |
|
Definition
| The rate of exacerbation is not influenced by pregnancy, but is increased in the 3 months post-partum. |
|
|
Term
| How should the treatment of MS be altered in pregnancy? |
|
Definition
| Women planning to conceive should be switched from IFN to glitramer, which should then be stopped altogether once pregnancy is established. |
|
|
Term
| How is the course of myasthenia gravis affected by pregnancy? |
|
Definition
1/3 of patients improve
1/3 deteriorate
1/3 remain unaffected. |
|
|
Term
| What are the three possible effects of myasthenia gravis on the fetus/neonate? |
|
Definition
1. Transient myasthenia gravis in the newborn - 12-15%
2. Arthrogryposis multiplex congenita
3. Pulmonary hypoplasia and polyhyrdramnios |
|
|
Term
| How is treatment of myasthenia gravis changed in pregnancy? |
|
Definition
| It is not, except for dose adjustments. |
|
|
Term
| How is the course of RA (rheumatoid arthritis) affected by pregnancy? |
|
Definition
| Approximately 75% of patients experience improvement of symptoms. |
|
|
Term
| High levels of Ro (SS-A) and La (SS-B) antibodies are associated with which fetal defect? |
|
Definition
|
|
Term
| What are the risks in pregnancy for a patient whose SLE was not active in the past 6 months? |
|
Definition
2- to 3-fold risk of superimposed preeclampsia and IUGR
20% chance of lupus flare |
|
|
Term
| What are the risks in pregnancy for a patient with active SLE? |
|
Definition
Superimprosed preeclampsia (60-80%)
IUGR
Preterm labor
Lupus flare (50-80%) |
|
|
Term
| What are the diagnostic criteria for APS? |
|
Definition
A clinical event AND one of: positive lupus anticoagulant, moderate- or high-titer anticardiolipin Ab, anti-β2 glycoprotein 1 Abs.
Serologies should be positive on 2 occasions, at least 12 weeks apart. |
|
|
Term
| What prophylactic treatment should be given to women with APS? |
|
Definition
|
|
Term
| What is the mainstay of treatment of SLE in pregnancy? |
|
Definition
Corticosteroids
Hydroxychloroquine
Azathioprine |
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|
