235 Pregnancy 2 Flashcards by Jess Godfrey

What are the 3 key elements of pre-eclampsia?

Increased BP
Proteinuria
Oedema

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When does pre-eclampsia usually present?

3rd trimester - term/during labour/6 weeks post partum

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Name 3 S&S of pre-eclampsia

6 listed

HA
Visual disturbances
N&amp;V
Epigastric pain (?HELLP)
Sudden weight gain 
Brisk reflexes

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Name 3 R/F od pre-eclampsia

9 listed

Primip
Multip but new partner
Previous Hx
Expecting multiples
35
Obesity
DM
Renal failure
Sister had it

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What is HELLP syndrome?

Eclampsia with:
Haemolytic anaemia
Elevated Liver enzymes
Low Platelet count

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What is the usual PCR (protein creatinine ratio - 24 hr urine) in an expectant mother with pre-eclampsia?

> 0.3g

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What is the treatment for and prevention of pre-eclampsia?

Magnesium sulphate

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What is the cure for pre-eclampsia?

Placental delivery usually by 37 weeks

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Which drug can be given in 23-32 weeks gestation in a mother showing signs of pre-eclampsia?

Steroids

Anti-hypertensives

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At how many weeks should delivery happen in a 32 week gestation mother with pre-eclampsia?

34 weeks

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What is the term for twins who have separate placenta’s?

Dichorionic-diamniotic

DCDA

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What is the term given for twins who share a placenta but have their own amniotic sacs?

Monochorionic-diamniotic

MCDA

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What is the term given for twins who share a placenta and an amniotic sac?

Monochorionic-monoamniotic

MCMA

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What chorionicity and amnionicity are dizygotic twins? (always)

DADC

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Name 3 foetal complications of monochorionicity

7 listed

Miscarriage
Congenital abnormalities
Preterm
IUGR
Perinatal loss
TTT (twin to twin transfusion)
Malpresentation

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Name 3 maternal complications of monochorionicity

7 listed

Hyperemesis gravidarum
Miscarriage
PIH/pre-eclampsia
GDM
Anaemia
APH and PPH
Placenta praevia

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During which scan is chorionicity determined?

Dating scan i.e. 12 weeks

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At how many weeks should an uncomplicated DCDA be delivered?

37-38 weeks

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At how many weeks should a MCDA be delivered?

36-37 weeks

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Name 2 complications which can happen during twins delivery
(4 listed)

Insufficient uterine contraction
Foetal distress
Cord prolapse when membranes ruptured
PPH

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When do maternal cardiovascular changes happen during pregnancy?

6/40 weeks

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What is the increase of maternal CO during pregnancy?

30-50%

i.e. 4.5L/min –> 6L/min

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What is the % increase in maternal blood volume during pregnancy?

150%

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What is the average increase in HR of a woman during pregnancy?

10bpm

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Why is there a reduction in afterload during pregnancy?

Decline in systemic vascular resistence

What is the cardiac demand of the uterus?

~ 400ml/min

What is the % increase of CO immediately post partum?

80%

What effect does progesterone have on peripheral vascular resistance?

Decreases

What happens to systemic arterial BP during pregnancy?

Reduces in first 24 weeks and gradual rise to non-pregnant levels by term

What causes oedema during pregnancy?

Increased RAAS activity leading to retention of Na and H2O

Name 3 normal clinical features of the CVS O/E during pregnancy

Dyspnoea Oedema CXR - cardiac rotation/oedema Axis deviation

What ECG changes may be present during pregancy? | 3 listed

Sinus tachy Left axis deviation ST changes and T wave inversion of lead III and aVF

Why does Hct and Hb seem to decrease during pregnancy?

RBC mass increases ~30% so Hct and Hb reduce relative to this

What happens to the levels of serum protein, albumin and gamma globulin during pregnancy?

Reduces 70g/L to 60g/L

What causes the prothrombotic state during pregnancy?

``` Increase in factors: I (fibrinogen) VII VIII IX X XII ```

In which trimester is there in increase in factor VIII, platelet aggregation and coagulation?

3rd

How much blood loss will a pregnant woman tolerate before decompensating?

1.5L

What maternal respiratory changes happen during pregnancy?

Increased tidal volume (30-40%) Decreased residual vol (20%)

What effect does progesterone have on the urinary tract?

Decreased peristalsis Decreased contraction pressure (Smooth muscle effect)

On which side does hydronephrosis usually occur during pregnancy?

Right (90%) due to dextrorotation of uterus by sigmoid colon

What happens to the maternal GFR during pregnancy?

Increases by 150%

What effect does progesterone have on the GIT? | 4 listed

1. Causes relaxation of the LOS causing reflux 2. Reduction in GIT motility (improve absorption) 3. Constipation 4. Gall bladder dilatation and poor tone --> gallstones

What is Mendelson's syndrome?

Peptic aspiration pneumonia during pregnancy

What is the drug management for reflux during pregnancy?

Alginates --> H2 agonists --> PPI

Why would there be indication for operative vaginal delivery in a mother with CVD/Cardiac disease?

Would want to avoid valsalva

After how many hours would you consider operative vaginal delivery in a primip with regional anaesthesia?

3 hours

After how many hours would you consider an operative vaginal delivery in a multip with regional anaesthesia?

2 hours

What are the requirements for instrumental delivery? (ABC)

``` Adequate analgesia Bladder empty Cervix fully dilated + head below level of ischial spines + facilities available for Caesarean ```

What are Kiellands forceps?

Rotational forceps

When should operative vaginal delivery be abandoned?

No evidence of progression descent with each pull | Delivery not imminent after 3 pulls by experienced operator

What is the name of the incision made to the skin in a caesarian section?

Phanensteil

Where is the incision made in the uterus during a caesarian section?

Lower segment

What is the name of a vertical incision into the uterus?

Classical

Name 3 absolute indications for caesarian section | 5 listed

``` Placenta praevia Severe antenatal foetal compromise Uncorrectable abnormal lie Previous classical caesarian section Pelvic deformity ```

When should a foetus be delivered before 34 weeks?

Severe pre-eclampsia | Severe IUGR

Name the 2 causes of bleeding in early pregnancy

Ectopic | Miscarriage

Name the 3 causes of bleeding during late pregnancy and labour

Abruption Placenta praevia Ruptured uterus

Name 2 causes of bleeding postpartum | 4 listed

Uterine atony Trauma Retained placenta/products

In an incomplete miscarriage, what percentage has complete evacutaion after 3 days?

79%

In a missed miscarriage, what percentage has complete evacutaion after 7 days?

37%

What is the medical management of miscarriage?

Mifeprestone + prostaglandin

What are the risks associated with surgical removal of retained products of conception? (4 listed)

Cervical injury Uterine perforation Infection Excessive bleeding

When should Anti-D prophylaxis be administered to rhesus negative mothers?

How many international units of prophylactic Anti-D should be given to a rhesus negative mothers before 20 weeks?

250IU

How many international units of prophylactic Anti-D should be given to a rhesus negative mothers after 20 weeks?

500IU

What is the medical management of ectopic pregnancy?

Methotrexate

What is the incidence of molar pregnancy?

1-3:1000

How much blood loss is in a minor antepartum haemorrhage?

How much blood loss is in a major antepartum haemorrhage?

50-1000ml

What is a concealed placental abruption?

Blood collecting behind the placenta with no evidence of vaginal bleeding

Name 3 clinical features of placental abruption | 6 listed

``` Vaginal bleeding Abdo pain Irritable 'woody hard' uterus Disproportionate shock Foetal distress ```

What is placenta accreta?

Firmly adherent placenta

What is placenta increta?

Placenta invading the myometrium

What is placenta percreta?

Placenta invading through the serosa and beyond

What is vasa praevia?

Placental vessels overlying the cervix

This is the 3rd highest direct cause of maternal death in the UK

PPH

What is classed as primary PPH?

PPH

What is classed as secondary PPH?

PPH >24 hours to 6 weeks postpartum

What are the 4 'T's which cause PPH?

Thrombin Tissue Tone Trauma

Which drugs can be given to stop bleeding where there is placenta praevia?

Oxytocics

What is the Dx? - Hypertension ++ - Proteinuria ++ - Elevated liver enzymes + - Hypoglycaemia + - Hyperuricaemia + - Thrombocytopaeina (-DIC) ++ - DIC +

HELLP syndrome

What is the Dx? - Hypertension + - Proteinuria + - Elevated liver enzymes ++ - Hypoglycaemia ++ - Hyperuricaemia ++ - Thrombocytopaeina (-DIC) + - DIC ++

Acute fatty liver of pregnancy (AFLP)