150 Obstetrics and Gynecology Board Review •••
❍ What is the treatment of antiphospholipid antibody syndrome in pregnancy?
Low-dose aspirin daily concurrently with low-dose heparin twice daily during pregnancy and continued until 6 to
8 weeks postpartum. This treatment regimen may reduce pregnancy loss by 54%.
❍ What antepartum testing is recommended for women with antiphospholipid antibody syndrome?
Serial ultrasounds for growth and biweekly nonstress tests starting at 32 weeks.
OTHER RHEUMATOLOGIC CONDITIONS
❍ How does pregnancy affect rheumatoid arthritis?
90% of women with rheumatoid arthritis have symptomatic improvement in pregnancy. However, postpartum
exacerbation is common.
❍ What medications may be used for rheumatoid arthritis in pregnancy?
NSAIDs may be used prior to 24 weeks’ gestation, but not after due to concern for premature closure of the ductus
arteriosus. Aspirin may be used and low-dose corticosteroids. Disease-modifying drugs are usually avoided during
pregnancy due to their teratogenicity; however, azathioprine is considered safe during pregnancy.
❍ What effect does pregnancy have on scleroderma-associated dysphagia and reflux esophagitis?
Dysphagia and reflux are worsened by pregnancy; however, all other manifestations of the disease are stable in pregnancy.
❍ Can vaginal delivery be attempted in women with systemic sclerosis?
Yes, unless soft tissue thickening of the vulva produces dystocia.
❍ What is the preferred method of anesthesia for cesarean delivery for women with scleroderma?
Epidural or spinal anesthesia, given the limited ability to open the mouth wide for endotracheal intubation.
❍ Which rheumatologic disorder is associated with increased frequency of dissecting and ruptured aneurysms
during pregnancy?
Marfan syndrome.
❍ What pregnancy complications are associated with Ehlers-Danlos syndrome?
Preterm premature rupture of membranes, prematurity, and antepartum and postpartum hemorrhage.
HEMATOLOGIC
❍ What cutoff is used for anemia in pregnancy and why is it lower than in nonpregnant women?
11g/dL in the first and third trimesters and 10.5 in the second trimester, which is lower than nonpregnant values
due to expansion of the blood volume to a greater degree than the red blood cell mass in pregnancy.
❍ How much iron is required in pregnancy?
1000 mg per day; 300 mg for the fetus and placenta, 500 mg for maternal hemoglobin, and 200 mg lost through
the GI tract.