235 - Pregnancy 2

Question 1

what is the definition of preeclampsia?

Answer 1

hypertension after 20wks plus:

• proteinuria - >300mg in urine in 24hrs
• renal insufficiency - Cr > 0.09 mmol/L or *oliguria
• liver disease - raised transaminases or *RUQ pain
• neurological symptoms -convulsions or *hyperreflexia or *severe headaches or visual disturbances
• haematological disturbance - thrombocytopaemia or DIC or haemolysis
• foetal growth restriction

Question 2

what is the definition of sever preeclampsia?

Answer 2

pre-eclampsia with

• SBP>160 DBP >110
• proteinuria >500
• pulm oedema/cyanosis
• oliguria
• seizures
• pailloedema
• thrombocytopaenia
• liver pain

Question 3

what are the risk factors for pre-eclampsia?

Answer 3

• 35
• FH
• Primagravida
• some mother-father combo incr risj
• multiple gestation
• pre-existing HTN
• renal disease
• diabetes
• obesity

Question 4

what causes pre-eclampsia?

Answer 4

• impaired trophoblastic invasion of maternal spiral arteries
• placenta pre-disposed to hypoxia
• widespread coagulation
• renal injury through thrombus

Question 5

how would pre-eclampsia be managed?

Answer 5

*monitor - aim for mean art P of

Question 6

what are the requirements for am operative delivery?

Answer 6

*head not palpable, cervix fully dilated, adequate analgesia, bladder empty, CS facilities available

Question 7

what available operative delivery techniques and how does position affect this

Answer 7

• ventouse - cap and suction and Forceps
• OA - either
• OTventouse for descent forceps to rotate
• OP - rotate 190 deg with either

Question 8

what are the indications for CS

Answer 8

placenta praevia, uncorrectable normal lie, prolonged labour, foetal distress
Done with pfannesteil incision

Question 9

what is the antepartum haemorrhage severity scale?

Answer 9

• spotting - streaks

* minor - 1000ml +/- shock

Question 10

what are the causes of bleeding in early pregnancy?

Answer 10

miscarriage and ectopic pregnancy

Question 11

what are the types of miscarriage?

Answer 11

*threatened - bleed, foetus alive os closed
*inevitable - heavy bleed, foetus maybe alive os open
*incomplete - bleed some foetus passed os open
*complete - all tissue passed bleed settled os closed
*missed - foetus not develop os closed
*septic - infected uterine contents, tender uterus
give mifepristone or prostaglandin (misoprostal) to enduce labour

Question 12

what is placental abruption and risks?

Answer 12

• premature separation of placenta from uterus with vaginal bleeding, abdo/back pain, uterine tenderness and irritable woody hard, foetal distress, abnormal contractions and premature labour
• risks - preeclampsia or HTN, trauma, previous abruption, smoking/drink/drug, multiparity, assisted conception, low BMI
• treat -rapid delivery

Question 13

what is placenta praevia and risks?

Answer 13

• implantation of placenta over or near the internal os (total, marginal, low lying). Lower uterine segment disrupts causing shear and bleed. contractions promoted >more bleed. Painless bright red vaginal bleeding
• risks - previous praevia, previous caesarian, smoke, older, assisted conception
• treat - CS at 36-37 wks

Question 14

what is vasa praevia?

Answer 14

blood vessels communicatinf between 2 regions of placenta pass over internal os

Question 15

what are the causes of post partum haemorrhages?

Answer 15

more than >500ml blood loss after vaginal delivery

• atonic uterus - blood vessels not compressed
• trauma
• retained placenta
• coagulation failure

Question 16

how is post partum haemorrhages treated?

Answer 16

• empty uterus of placenta
• give oxytocics -prolong uterine contraction
• empty bladder
• fluids and clotting factors
• bimanual compression of uterus
• laparotomy to compress aorta and suture uterus

Question 17

what are the haematological changes in pregnancy?

Answer 17

• incr blood vol 2.5L to 5L
• incr red cell mass (incr iron demand), haematocrit and Hb decr (physiological anaemia) - decr blood viscosity and resistance reduces cardiac workload
• incr WCC - neutrophilia but cell mediated immunity supressed by incr corticosteroid secretion
• decr platelet count and protein
• incr coagulation factors (1,7,8,9,10,12) to produce prothrombotic state (less haemorrhage in labour but inc thromboembolism risk

Question 18

what are the CV changes in pregnancy?

Answer 18

• incr cardiac output due to hypervolaemia and O2 demand Cause 30% incr in SV, 15% incr in HR and 30-50% incr in CO. compensated by decr systemic vascular resistance and blood viscosity
• water and Na retention (more angiotensin 2) - oedema
• decr plasma osmolality
• IVC occlusion in supine
• murmurs - 3rd heart sound (passive ventricular filling)
• ECG changes - L axis deviation, sagging ST, inverted T vwave in lead 3 /avf

Question 19

what are the BP changes in pregnancy?

Answer 19

falls by 10mmHg in 2nd trimester but returns to normal in 3rd

Question 20

what are the renal changes in pregnancy?

Answer 20

• incr renal blood flow and GFR - incr Cr and urine clearance, mild proteinuria and glycosuria
• kidneys grow
• uteric dilation due to progesteron and stasis > obstruction and UTI

Question 21

what are the respiratory changes in pregnancy?

Answer 21

• inc O2 demand
• reduced maternal PaCO2 to help gas exchange with foetus causes compensated resp alkalosis
• incr tidal vol, decr residual vol, RR and VC unchanged
• decr total lung capacity in late pregnancy as abdo muscles pushed into diaphragm

Question 22

what are the GI changes in pregnancy?

Answer 22

• LOS relaxation - reflux, aspiration
• reduced GIT motility for incr absorp
• gall bladder dilation and poor emptying - cholesterol gall stones

Question 23

what is chorionicity and amniocity?

Answer 23

• chorionicity - placentation

* amniocity - amniotic membrane between twins