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Reproduction Week 4 2018/19 > 3: Medical problems in pregnancy > Flashcards

3: Medical problems in pregnancy Flashcards

1
Q

Which groups of women are more likely to die during pregnancy?

A

Women with co-morbidities

Ethnic minority women

Overweight / obese women (cardiovascular disease risk i.e VTE)

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2
Q

What cardiovascular diseases are common causes of death in pregnancy?

A

Hypertension

Cardiac disease i.e MI

VTE i.e DVT, PE, stroke, MI

Diabetes

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3
Q

What cardiovascular changes occur in pregnancy?

A

Increased heart rate, contractility, stroke volume –> CO

Decreased BP and TPR

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4
Q

Why is the prevalence of heart disease in pregnancy increasing?

A

Increased maternal age

More obese women

More women with pre-existing or congenital heart disease

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5
Q

What is a major risk factor for ischaemic heart disease in women?

A

Pregnancy

:/

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6
Q

What innocent cardiovascular signs and symptoms are seen in pregnant women?

A

Innocent murmur

Palpitations

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7
Q

Which anticoagulant is teratogenic?

A

Warfarin

LMWH isn’t, so swap it

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8
Q

Which cardiovascular disease is often fatal if carried into pregnancy?

A

Pulmonary hypertension

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9
Q

What is Eisenmenger’s syndrome?

A

Right-to-left shunt caused by PH secondary to a congenital heart defect e.g VSD

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10
Q

Which

a) endocrine
b) genetic disorders are associated with congenital heart disease?

A

a) Diabetes

b) Marfan’s syndrome (aortic root dilation -> regurg)

+ a million more

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11
Q

Palpitations occuring during pregnancy are usually ___.

A

benign

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12
Q

What cardiac investigations should be done for a woman presenting with palpitations?

A

ECG

If dodgy, do echo

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13
Q

Which endocrine diseases may cause palpitations in pregnant women?

A

Hyperthyroidism

Phaeochromocytoma

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14
Q

Which NYHA class of cardiovascular disease is a contraindication for pregnancy?

A

3+

make sure the woman is using contraception

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15
Q

What respiratory changes occur during pregnancy?

A

Increased oxygen consumption

Increased tidal volume BUT NOT respiratory rate

Decreased functional residual capacity (lungs are compressed by pregnancy)

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16
Q

What blood gas changes occur during pregnancy?

A

% O2 increases

% CO2 decreases

So blood pH increases

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17
Q

Palpitations is a common cardio complaint in pregnancy.

What is a common respiratory complaint?

A

SOB

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18
Q

Which chronic respiratory condition is often seen in pregnant women?

A

Asthma

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19
Q

Why do many pregnant women experience a deterioration in their asthma early in pregnancy?

A

Concerns re: medication effect on baby (steroids, inhalers)

so they stop using them and their asthma gets worse

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20
Q

What should women on long-term steroids be given during childbirth?

A

IV steroids e.g hydrocortisone

bc. they will have adrenal insufficiency

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21
Q

Can women continue on their inhalers during childbirth?

A

Yes

22
Q

What is the most common direct cause of maternal death in pregnancy?

A

Venous thromboembolism

i.e DVT

23
Q

Where exactly do DVTs tend to occur in pregnant women?

A

Left leg

Iliac / femoral vein

24
Q

When in the course of pregnancy does DVT tend to occur?

A

Post-birth

25
Q

Virchow’s triad for venous thromboembolism includes epithelial damage, hypercoagulability and venous stasis.

How do pregnant women fulfill these factors?

A

Epithelial damage - rapid cardiovascular changes

Venous stasis - lying down a lot, especially in hospital

Hypercoagulability - some women have thrombophilia

26
Q

Which type of drug is given as prophylaxis for DVT in pregnant women?

A

Anti-coagulant

NOT warfarin - LMWH

27
Q

What congenital disease, causing hypercoagulability, causes DVT in pregnancy?

A

Thrombophilia

28
Q

What LMWH is used for pregnant women in Tayside?

A

Dalteparin

29
Q

What influences the dose of dalteparin given to pregnant women to prevent VTE?

A

Maternal weight

30
Q

What investigation is used to diagnose DVT in pregnant women?

A

Duplex ultrasound

like a doppler for your leg

31
Q

What biochemical test used for DVT and PE is useless in pregnancy?

A

D dimers

always raised

32
Q

Which investigations are used to diagnose PE in all patients?

A

CT pulmonary angiogram

V/Q scan

33
Q

CTPA and V/Q scans are used to diagnose PE.

What’s the problem with this in pregnant women?

A

CTPA involves a radiation dose to the woman and increases breast cancer risk

V/Q scan involves a radiation dose and increases risk to baby

34
Q

Which anti-coagulant drug is teratogenic?

What should you change it to?

A

Warfarin

LMWH e.g dalteparin

35
Q

Can mothers breastfeed while on warfarin or LMWH?

A

Yes

36
Q

Which rheu disease causes recurrent miscarriage and skin changes?

A

Anti-phospholipid syndrome (APS)

37
Q

APS causes which blood disorder in women?

A

Thrombophilia

38
Q

Which three autoantibodies are seen in APS?

A

Anti Lupus anticoagulant

Anti cardiolipin

Anti beta 2 glycoprotein

39
Q

What are the signs of APS?

A

Recurrent miscarriage

Recurrent early-onset pre-eclampsia

40
Q

How is APS managed?

A

If found during late pregnancy it’s probably not treatable

but can be subsequently treated with aspirin and LMWH + regular monitoring (USS)

41
Q

Which neuro disorder is common in pregnant women?

A

Epilepsy

42
Q

What symptom of epilepsy is responsible for pregnancy complications?

A

Seizures

trauma, premature rupture, premature delivery

43
Q

Many of the ___ used to treat epilepsy are teratogenic.

A

drugs

44
Q

Which anti-epilepsy drug is most likely to cause congenital malformations?

A

Sodium valproate

but they’re all dodgy

45
Q

The more anti-epilepsy drugs a pregnant woman is on, the more likely they are to develop what?

A

Foetal abnormalities

46
Q

Which drug is used to prevent neural tube defects in pregnant women?

In what doses?

A

Folic acid

400 micrograms normal risk

5 milligrams increased risk (e.g on antiepileptic drugs)

47
Q

What disease other than epilepsy causes seizures in pregnant women?

A

Eclampsia

48
Q

How are epileptic seizures terminated in labour?

A

Benzodiazepines

These are majorly teratogenic but the baby’s being delivered at that point

49
Q

What state increases your risk of virtually every complication of pregnancy?

A

Obesity

50
Q

What dose of folic acid should obese women take?

Why?

A

5 milligrams

Increased risk of neural tube defects

Reproduction Week 4 2018/19 (9 decks)

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