ALSO - Advanced Life Support in
Obstetrics Exam Combined Tested
Questions With Revised Correct
Detailed Answers
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1) Prevention of Preeclampsia - ANSWER Aspirin has modest
benefit, calcium some benefit. Fish oils, Vit D/C/E, salt restriction,
bed rest does not prevent preeclampsia.
USPSFT: ASA 60-81mg daily for anyone with high risk factors (hx of pre-
E, multiple gestation, chronic HTN, antenatal DM, renal disease, SLE) or
multiple moderate risk factors (nulliparity, BMI>30, FHx of Pre-E, AA
ethnicity, or low SES, AMA >35 Yo)
2) Dx of Preeclampsia - ANSWER New onset HTN after 20 wks w/
proteinuria.
- HTN: 2 readings of >140/90, 4 hrs apart or 1 reading of >160/110
- Proteinuria: 24 hr urine protein >=300mg; time extrapolated urine
protein of >=300mg; protein/Cr ratio of >=0.3; urine dip +1 or more.
,- Proteinuria not required if new onset HTN w/ any of the following
severe features: platelet <100,000, Cr >1.1 or double baseline,
transaminases twice normal, pulmonary edema, cerebral or visual
symptoms, BP>=160/110
3) Management of Pre-E w/o Severe Features - ANSWER
Expectant Mx before 37 weeks with close monitoring for severe
features.
Establish baseline CBC, transaminases, Cr, LDH, and uric acid.
Antepartum surveillance w/ NST's, AFI, biophysical profiles, and growth
U/S every 3-4 weeks.
Weekly follow CBC, AST/ALTs. (Uprotein not needed to follow)
Plan for delivery at 37 weeks.
4) Management of Pre-E w/ Severe Features - ANSWER Admit to
hospital & bedrest
Goal: prevent seizures, ctrl BP to prevent cerebral hemorrhage
Expedite delivery, balancing maternal/fetal
5) Evaluation of Pre-E - ANSWER Symptom Assessment q8hr for
H/A, visual change, RUQ/Epigastric/Retrosternal pain/pressure
Vital Sign, neuro check, and DTRs q15-60min until stable
Monitor I's & O's. Insert foley if needed. Alert physician if <30mL/hr
urine output (esp. due to risk of magnesium toxicity)
, Labs: CBC, transaminases, Cr, Uric acid, LDH, consider blood smear &
coag panel. Type & screen in labor.
6) Magnesium sulfate - ANSWER Preferred anticonvulsant in
preeclampsia. Slows neuromuscular conduction and decreases CNS
irritability. No effect on BP.
Indicated for women w/ severe features
Initial Loading Dose of 4-6g IV over 15-20 min
Maintain with continuous infusion of 2g/hr
Check mag level if: Uout <30mL/hr, elevated serum Cr, symptoms of
mag tox (somnolence, respiratory depression, paralysis, cardiac arrest),
loss of DTRs.
7) Magnesium sulfate Antidote - ANSWER Calcium Gluconate 1 g IV
over 3 min.
8) Antihypertensives for Severe Preeclampsia - ANSWER Indication:
sustained BP >=160mm/>=110
Labetalol
Hydralazine
Nifedipine (PO med)
9) Delivery Decision for Severe Preeclampsia - ANSWER Vaginal
delivery preferred.
