Fetal exposure to lithium in the first trimester has been strongly associated with:
Correct Answer C:
Ebstein's anomaly, also called Ebstein's malformation, is a heart defect in which the tricuspid valve is abnormally formed. The tricuspid valve normally has three "flaps" or leaflets. In Ebstein's anomaly, one or two of the three leaflets are stuck to the wall of the heart and don't move normally. Often there's also a hole in the wall between the atria, the heart's two upper chambers. This hole is called an atrial septal defect or ASD. Because the tricuspid valve is malformed in Ebstein's anomaly, it often doesn't work properly and may leak. If the valve leaks, some of the blood pumped by the right ventricle goes backwards through the valve with each heartbeat.
Studies suggest that lithium might be involved as a teratogen increasing the incidence of Ebstein's anomaly in the offspring of female patients with manic-depressive psychosis and lithium-administered during pregnancy.
A 25-year-old woman who has a 4 year history of ulcerative colitis is admitted to the hospital because of increasing abdominal pain, diarrhea and hematochezia. Her disease is limited to the descending colon. Current therapy includes sulfasalazine and corticosteroid enemas. While she is receiving parenteral corticosteroid therapy, she is discovered to be 8 weeks pregnant.
The statement that should be emphasized in discussing this pregnancy with her is:
Correct Answer E:
Sulfasalazine and corticosteroids are not known to be teratogenic.
The general consensus is that ulcerative colitis does not have an adverse effect on pregnancy outcome (choice A), and that pregnancy does not have an adverse effect on disease progression (choice B). Furthermore, use of the medications sulfasalazine and prednisone has not been associated with detrimental effects to the mother or the fetus (choice C). For women whose ulcerative colitis is in remission, the risk of miscarriage, stillbirth and congenital abnormality are the same as that for healthy women (choice D).
Which one of the following is contraindicated for the treatment of hypertension in pregnancy?
Correct Answer B:
ACE inhibitors such as lisinopril can be severely damaging to the fetus, with deformity, renal failure, and death possible. Placental blood flow may be markedly reduced and extreme fetal distress and in utero death may occur. The drugs are not recommended for use, even short-term use, during pregnancy. Methyldopa, nifedipine and labetalol all are used for the treatment of hypertension in pregnancy.
In performing preconceptual counseling to a young couple, you inform them that the most susceptible time period for teratogen exposure to the human embryo is at which embryonic week?
Organogenesis is the most susceptible time during pregnancy for the fetus. Organogenesis, the process of organ differentiation, occurs in most human organ systems between embryonic weeks 3 to 8 (menstrual weeks 5-10).
A 55-year-old woman comes to the office to discuss menopause.
You tell her all of the following are a part of this stage, except:
The symptoms of menopause include:
Also the risk of osteoporosis increases because estrogen is decreased, increasing bone resorption by osteoclasts.
Regression (not increase) of breast size during and after menopause is psychologically distressing to some women. For those who have been bothered by cyclic symptoms of breast pain and cyst formation, the disappearance of these symptoms postmenopausally is a great relief.
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