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July > 3.7.2013(OG,PIH)56 > Flashcards

3.7.2013(OG,PIH)56 Flashcards

0
Q

Cause of PIH

A

Lack of invasion of chorionic villi to spiral arterioles
Imbalance btw vasodilators and vasoconstrictors
PG mediated
Free radicals
Low calcium

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1
Q

PIH definition

A

BP more than or equal to 140/90 after 20 weeks,2 readings 6 hours apart
Or MAP of more than or equal to 105

No longer used:
Systolic more than 30 or diastolic more than 15 of previous value
MAP increase of 20

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2
Q

Most common organ affected in PIH

A

Kidney(glomerular endotheliosis)

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3
Q

Liver changes in PIH

A

Periportal hemorrhagic changes

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4
Q

Brain changes in PIH

A

Cerebral Edema
Thrombosis
Hemorrhage

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5
Q

Heart changes in PIH

A

Subendothelial hemorrhages

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6
Q

Hematological changes in PIH

A 
Hematocrit increased
Thrombin increased
Low platelets
Low fibrinogen
Low plasminogen
Low Antithrombin III
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7
Q

Weight gain in PIH

A

More than 1 pound a week

More than 5 pounds a month

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8
Q

Alarming symptoms in PIH

A 
Headache
Epigastric pain 
Visual disturbance 
Decreased urine output
Disturbed sleep
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9
Q

Complications of PIH

A 
Maternal 
 Eclampsia 
 APH
 PPH
 preterm labor
 Puerperal sepsis
 HELLP
Fetal
 IUD 
 IUGR
 prematurity
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10
Q

Serum Uric acid levels in PIH risk prediction

A

More than 5.9mg/dl

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11
Q

Lab values in PIH

A

Serum proteins decreased

Serum chloride increased

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12
Q

Definitive Rx of PIH

A

Termination of pregnancy

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13
Q

Early detection of PIH

A

Roll over test
Uric acid 5.9mg/dl
Angiotensin sensitivity test
Urine calcium less than or equal to 12mg/dl in 24hrs
uterine artery Doppler showing persistence of diastolic notch after 20-24 weeks

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14
Q

Post partum BP control

A

Enlapril

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15
Q

Rx of APLAS

A

Low dose aspirin

LMWH

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16
Q

Best test to detect APLAS

A

Russell viper venom test

Commonly used test aPTT

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17
Q

Drug used for rapid reduction of BP in PIH

A

1.Labetelol
Nifedipine
Hydralzine

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18
Q

Therapeutic range of MgSO4

A

4-7 mEq/L

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19
Q

Toxic effects of MgSO4

A

10meq/L patellar reflex disappears

12meq/L respiratory paralysis

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20
Q

Antidote for MgSO4 poisoning

A

Calcium gluconate

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21
Q

Drugs used in prevention of PIH

A

Low dose aspirin

Calcium

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22
Q

First step in management of eclampsia

A

Airway management

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23
Q

Dx of HELLP

A 
Hemolysis
  Schistocytes
  Bilirubin greater than 1.2mg/dl
  Absent plasma haptoglobin
Platelets less than 1 lakh
SGOT(AST)more than 72IU/L
LDH more than 600IU/L
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24
Menon lytic cocktail
CPZ pethidine Promethazine
25
Proteinuria in preeclampsia
More than 0.3g in 24hr urine sample | More than 0.3g/L in 2 or more midstream specimen
26
Severe preeclampsia
BP more than 160/110 Urine albumin 3+ Imminent symptoms
27
Earliest sign of PIH
Weight gain
28
Common type of eclampsia
Antepartum
29
Risk factors for PIH
``` Family history Obesity Hypertension DM APLAS Thyroid disease Renal disease Collagen vascular disease Placental ischemia Nulliparous New paternity Age less than 20 or greater than 35 Molar pregnancy Multiple pregnancy Hydrops with large placenta ```
30
OG disorders for which smoking is protective
PIH fibroids Endometriosis
31
Pathological Edema in pregnancy
Pitting Not relieved by rest for more than 12 hrs Associated with weight gain
32
Epigastric pain in eclampsia ,reason
Sub capsular hemorrhage | Hemorrhagic gastritis
33
Most common visual symptom in PIH
Scotoma
34
Indicators of severe preeclampsia
Pulmonary Edema | IUGR
35
Grading of proteinuria
``` Trace 0.1g/L 1+ 0.3g/L 2+ 1g/L 3+ 5g/L 4+ 10g/L ```
36
Fetopathic effects of captopril
Pulmonary hypoplasia RDS PDA limb contracture
37
Most common side effect of methyl DOPA
Postural hypotension
38
Beta blocker of choice during pregnancy
Normally contraindicated in pregnancy | Propranolol
39
Second drug of choice for control of hypertension in eclampsia
Hydralzine
40
Rx of status eclampticus
Thiopentone
41
Most common cause of maternal death in eclampsia
Intracranial bleeding | ARF
42
Till when MgSO4 is given
Till 24 hrs postpartum
43
Most common symptom of HELLP
Epigastric pain
44
Most common cause of death in HELLP syndrome
Abruptio placenta | DIC
45
MOA of MgSO4
Decreases Ach release Decreases cerebral edema Increases cerebral,uterine and renal blood flow Blocks calcium channels
46
Parameters to be checked following MgSO4 admn
Knee jerks present Urine output greater than 30ml/hr Respiratory rate greater than 12/min
47
Contraindications for MgSO4
Myasthenia gravis | Renal failure
48
Roll over test is done after
28-32 weeks
49
Post partum eclampsia
Convulsions seen first time in peurperium within 48 hrs of delivery
50
Indications for diuretics in eclampsia
Pulmonary edema
51
Drug to be avoided while pt is being given MgSO4
Nifedipine
52
Roll over test
Pt turned from lt lateral to supine | Diastolic pressure increase of 20mm or more
53
Predictors of preeclampsia in maternal serum
Fetal DNA in maternal serum | Elevated Fibronectin
54
Drugs used in prophylaxis of PIH
``` Calcium Aspirin Folic acid Antioxidants Omega 3 fatty acids ```
55
Consequences of Rh isoimmunisation are not seen in first pregnancy because
IgM antibodies are formed during initial exposure
56
Critical sensitising volume of fetomaternal hemorrhage
0.1ml
57
Rh antigen gene is present on
1p
58
Erythroblastosis in first pregnancy,causes
Prior blood transfusion | Grandmother theory
59
RBC antigens that don't cause erythroblastosis
Lewis | I antigen
60
Conditions predisposing to Rh isoimmunisation
``` Abortion Ectopic Molar Cesarean Vaginal Trauma Aminiocentesis Cordocentesis CVS attempted version Manual removal of placenta Antepartum hemorrhage POSTDATED pregnancy ```
61
Antibody titres
Safe less than 4IU/ml Isoimmunisation greater than 4IU/ml or 1:8 Critical titre more than 10IU/ml or 1:16
62
Critical titre
1:16 for all antibodies except kell(1:8)
63
Timing of indirect Coombs test
Primigravida at 12weeks,28th,34-36 wks | Multigravida 12 weeks,monthly interval after 28wks
64
Time of performance of amniocentesis in Rh incompatibility
28-30 wks | 10 wks prior to previous pregnancy loss
65
Optical density of amniotic fluid is measure at
450nm
66
Management of Rh positive pregnancy according to liley chart
Zone 1 repeat every 4 weeks,delivery at term Zone 2 repeat after 1-2weeks Zone 3 intrauterine transfusion if less than 34wks ,delivery if greater than 34 wks
67
Indication for fetal blood transfusion
Hb 2g/dl below mean
68
Route of blood transfusion
Intraperitoneal (small foetuses) | Intravascular
69
Abnormal peak systolic velocity of fetal MCA
More than 1.5 MOM
70
Dose of antiD
Less than 12wks gestational age 50ug | Beyond 12wks gestational age 300ug
71
Dose of anti D for fetomaternal bleed
1ug for 10ml fetomaternal bleed
72
Best time for anti D prophylaxis postpartum
Within 72 hrs Can be given upto 28days
73
Complications of Rh isoimmunisation in mother
``` Polyhydramnios Preterm labor Preeclampsia Big baby Hypofibrinogenemia PPH Mmaternal mirror syndrome ```
74
Maternal mirror syndrome
``` Generalised Oedema Pruritis Proteinuria In mother in Rh isoimmunisation Changes mimic fetal changes Sign of imminent death of fetus ```
75
Albumin agglutinins
IgG IgM saline agglutinin
76
X ray of erythroblastosis fetalis
Buddha position
77
Fetal effects of Rh incompatibility
Severe -erythroblastosis fetalis Moderate - icterus gravis neonatorum Mild- congenital Hemolytic Anemia
78
Increased risk of which conditions are seen in icterus gravis neonatorum
DIC thrombocytopenia NEC kernicterus
79
Nonimmune causes of hydrops
``` Cystic hygroma Trisomies Cardiac defects and arrythmias Twin twin transfusion syndrome Alpha Thalassemia TORCH Diaphragmatic hernia Chorangioma Umbilical vein thrombosis Inborn errors of metabolism ```
80
Most common cause of infectious hydrops
Parvo virus B19
81
Intrauterine infection that doesnot cause hydrops
HIV
82
Recurrent hydrops
Inborn errors of metabolism
83
First sign of hydrops seen on USG
Skin thickness more than 5mm
84
Features of hydrops
Increased skin thickness Placental thickness more than 4cm Ascites Pleural effusion
85
Early cord clamping is done for
``` Rh isoimmunisation(cord is kept long) Preterm baby Birth asphyxia HIV+ mother Infants of diabetic mother ```
86
Indication of prophylactic antiD
If indirect Coombs test is negative
87
Oral Hypoglycemic that can be given to pregnant women
Glyburide
88
Teratogenic effect of oral hypoglycemics
Ear defects
89
Effect of SUR on foetus
Hypoglycemia Hyperinsulinemia Hyperbilirubinemia
90
Daily calorie requirement in pregnant diabetic female
30-35Kcal/kg IBW
91
Dietary management in GDM
Carbs 50-60% Protein 20% Fat 25% with saturated fat less than 10%
92
Aim of dietary therapy in diabetic mothers
Fasting 75-95mg/dl 1hr postprandial less than 140mg/dl 2hr postprandial less than 120mg/dl
93
Indication for insulin Rx in GDM
FBG more than 105mg/dl and 2hr postprandial more than 120mg/dl even after 2 weeks of treatment
94
OGTT
75g of glucose Fasting more than 125mg% 2hr postprandial more than 140mg%
95
OGTT | Carpenter
``` Fasting 95 1hr 180 2hr 155 3hr 140 Two or more values should be abnormal ```
96
OGTT | NDDG values
``` Fasting 105 1hr 190 2hr 165 3hr 145 Two or more values should be abnormal ```
97
GCT
50g Performed at 24-28wks(early if risk factors are present) OGTT done if more than or equal to 140mg/dl If more than or equal to 200 pt has GDM(no need of OGTT)
98
Effect of hyperglycaemia in pregnancy
spontaneous abortion,congenital malformation(early) | Macrosomia(late)
99
Organ not affected by macrosomia
Brain
100
Fetal macrosomia,definition
More than 4.5kg
101
First sign of developing macrosomia
Increased abdominal circumference
102
Most sensitive screening test in diabetic mothers for congenital anomalies
HbA1C
103
Indications for GTT
``` Marked obesity Strong family history of Type II DM previous H/O GDM unexplained still birth H/O previous congenitally malformed baby ```
104
Most common anomaly in DM in pregnancy
CVS | 2nd is CNS
105
Most specific anomaly for GDM
Caudal regression syndrome/sacral agenesis
106
Most common cardiac anomaly in GDM
VSD ASD TGA Coarctation of aorta
107
CNS anomalies in GDM
Anencephaly | Spina bifida
108
Chromosomal abnormalities in GDM
Not associated
109
Effects of GDM on foetus
``` Increased chances of abortion Unexplained intrauterine death Prematurity IUGR congeintal malformations Macrosomia Shoulder dystocia ```
110
GDM effects on neonates
``` RDS Hypoglycemia Hypocalcemia Hypokalemia Hypomagnesimia Polycythemia Hyperbilirubinemia Hyper viscosity syndrome Hypertrophic cardiomyopathy Birth trauma- Erb and klumpke paralysis ```
111
Most common organ affected by macrosomia
Abdomen
112
Fetal hyperinsulinemia due to GDM is explained by
Pederson hypothesis
113
Drug of choice for tocolysis in pregnant diabetic pt
MgSO4
114
Maternal complications of GDM
``` During pregnancy abortion Preeclampsia Polyhydramnios Preterm delivery Ketoacidosis UTI and vulvovaginal candidiasis Lactation failure Puerperal sepsis ```
115
Females with GDM have ______ % chance of developing DM2 in later life
35-50%
116
Late complications of GDM infants
Diabetes Obesity Risk for CVD
117
Conditions associated with single umblical artery
Twins GDM infants Polyhydramnios
118
Advanced placental grading is a feature of
PIH
119
Tests for fetal lung maturity
``` L/S ratio Phosphatidyl glycerol(best marker) DPPC clement test/shake test Abbot TDx fetal lung maturity(measures surfactant to albumin ratio) ```
120
Normal CVS changes in pregnancy
``` Apex beat shifted to lt 4th ICS PR increased Split 1st sound Systolic murmur Lt axis deviation Enlarged cardiac shadow in X ray Cardiac out put increased by 40% Mid pregnancy drop in diastolic pressure Peripheral resistance is decreased ```
121
Plasma volume increase in pregnancy
50% | But RBC increase is only 20%
122
Persistent neck vein distension in pregnancy
Indicator of cardiac disease
123
Increase in cardiac output during pregnancy
``` 10wks 32wks 2nd stage of labor Immediate postpartum(max) 1 week after delivery ```
124
Admission of pt based on NYHA class
Class 1 normal term Class 2 28wks Class 3 and 4 immediately
125
Heart diseases where vaginal delivery is contraindicated
Coarctation of aorta Marfan with aortic root dilatation more than 4cm Aortic aneurysm
126
Induction in heart disease complicating pregnancy
Safe
127
Fluid balance in heart disease complicating pregnancy
Not more than 75ml/hr
128
Contraindication of ergometrine
Heart disease complicating pregnancy Rh isoimmunisation PIH multiple pregnancy
129
Group 3 cardiac disease
PPH eisenmenger Marfan with aortic root dilatation Complicated aortic coarctation
130
Absolute indications for termination of pregnancy
PPH eisenmenger Pulmonary veno occlusive disease
131
Most common cause of heart disease in pregnant women
RHD(congenital Heart disease in western countries)
132
Most common valvular lesion in pregnancy
Mitral stenosis
133
Most common congenital heart disease in pregnant women
ASD
134
Most common cause of death in eisenmenger syndrome
Right ventricular failure with cardiogenic shock
135
IE prophylaxis in pregnant women
Structural defects Artificial valves Ampicillin with gentamycin is given at the onset of labor or ruptured membranes
136
IE prophylaxis unnecessary in pregnant women with which cardiac lesions
corrected PDA ASD(Ostium secundum) MVP without MR
137
Sx procedure of choice for MS in pregnancy
Balloon mitral valvoplasty
138
Normal mitral valve area
4cm2
139
Stenosis grading based on size
Critical less than 1cm2 Moderate 1-2.5 cm2 Mild 2.5-4cm2
140
Fetal growth restriction is seen when mitral stenosis is (size)
Less than 1cm2
141
Sterilisation (tubectomy) in Heart disease complicating pregnancy
After 1 week in peurperium
142
Anti coagulation in pregnancy,first trimester
Discontinue warfarin at 6 weeks of conception | IV heparin in high risk cases and sub cutaneous heparin in low risk cases is given twice daily from 6th to 12 th week
143
Warfarin is given in pregnancy from
12th week to 36 weeks
144
Heparin should be stopped ________ hours before delivery
6
145
Heparin should be started ______ hrs after delivery
6 hours after vaginal | 24 hrs after Caesarian
146
Warfarin must be restarted after how days postpartum
3 days

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