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Y3 Reproductive > 3rd Trimester Conditions > Flashcards

3rd Trimester Conditions Flashcards

1
Q

If pregnancy induced HTN doesn’t resolve 6wk post delivery it is likely …..

A

It preexisted

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2
Q

What is the name of the condition that causes HF in the 3rd trimester and presents with orthopnoea?

A

Peri-partum cardiomyopathy

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3
Q

What is the strongest RF for PET pre-eclampsia?

A

PMH of PET

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4
Q

Risk factors for pre-eclampsia:

  • Parity [high/0]
  • [<25/>40yr]
  • [Long/short] interval
  • [High/low] BMI

(Other risk factors include CKD, HTN, SLE, APS, DM and a FH)

A

Risk factors for pre-eclampsia:

  • Parity 0
  • > 40yr
  • LONG interval
  • HIGH BMI

(Other risk factors include CKD, HTN, SLE, APS, DM and a FH)

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5
Q

If PET RF are established at the booking appointment, what prophylaxis should be commenced?

A

Low dose aspirin

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6
Q

What is the triad of pre-eclampsia PET?

A

HTN + oedema + proteinuria

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7
Q

What is stage 1 pre-eclampsia?

A

Placental ischemia

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8
Q

What is stage 2 pre-eclampsia?

A

Multi-system endothelial dysfunction

Anti-angiogenic
(Placenta spiral A narrow)

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9
Q

What is the mechanism causing oedema in pre-eclampsia?

A

Decreased GFR

Retain Na and H2O

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10
Q

Where is oedema most commonly in pre-eclampsia?

A

Hands and face

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11
Q

How does pre-eclampsia present?

A 
Screening
Edema
HA
Vision
Epigastric/RUQ pain
N&amp;V
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12
Q

How is pre-eclampsia screened for?

A

BP and urinalysis at every antenatal appointment

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13
Q

Pre-eclampsia can be early or late. What week gestation separates them?

A

34 weeks

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14
Q

Is early or late onset pre-eclampsia more common? Which one has the highest eclampsia risk?

A

Late onset more common

Late onset higher eclampsia risk

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15
Q

What is the only cure for pre-eclampsia?

A

Birth

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16
Q

What should aim for BP to be in PET Mx?

A

140-150/90-100

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17
Q

What Ix are done for PET to monitor the health of the baby?

A

US, CTG

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18
Q

What blood tests are done when investigating PET?

A

FBC, U+E, urate, LFT, coag screen

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19
Q

What drugs should be avoided in PET?

A

ACEI and diuretics

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20
Q

What are the 1st line options for the drug Mx of PET?

A 
Methyldopa (CI depression) 
OR 
Labetolol (CI asthma) 
OR
Nifedipine
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21
Q

What class of drugs is methyldopa?

A

Alpha agonist

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22
Q

What class of drugs is labetolol?

A

Alpha + beta agonist

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23
Q

What class of drugs is nifedipine?

A

CCB

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24
Q

-Cortical blindness
-CN palsy
-ICH
-Encephalopathy
-ARDS,
-Fetal growth restriction
-Abruption
-Intrauterine death
… Are all complications of what?

A

Pre-eclampsia

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25
Q

What is the presentation of eclampsia?

A

Tonic clonic seizures and big increase in BP

Or coma

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26
Q

Eclampsia occurs antepartum. T or F

A

False, can occur ante, intra or postpartum

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27
Q

What is the Mx of eclampsia?

A

IV labetalol OR hydralazine
IV Mg sulfate
Fluid balance
Birth

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28
Q

What is the triad of HELLP syndrome and what condition is it a complication of?

A

Haemolysis
Elevated liver enzymes
Low platelets

Pre-eclampsia

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29
Q

Define antepartum haemorrhage

A

Bleeding from or into the genital tract at >24wk gestation before 2nd stage labour

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30
Q

What is the commonest cause of antepartum haemorrhage?

A

Placental abruption

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31
Q

Vasa praevia is a common cause of antepartum haemorrhage. T or F

A

False, rare cause of antepartum haemorrhage

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32
Q

IOL, multiparity and a past C-section are all risk factors for what cause of antepartum haemorrhage?

A

Uterine rupture

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33
Q

Do contractions occur in uterine rupture?

A

No

34
Q

How does uterine rupture present?

A 
Severe abdo pain
PV blood
Collapse
Shoulder tip pain
Acute abdomen
35
Q

What is the management of uterine rupture?

A

Surgical +- transfusion

36
Q

Placental abruption, placenta praevia, placenta accreta and vasa praevia can all cause …..

A

Antepartum haemorrhage

37
Q

What is placenta accreta?

A

An abnormally adherant placenta

38
Q

What is placenta percreta?

A

Placenta attached to bladder

39
Q

What is placenta increta?

A

Placenta in myometrium

40
Q

What is the surgical prophylaxis for placenta accreta?

A

Internal iliac artery balloon

41
Q

How much blood is lost in placenta accreta?

A

3 L

42
Q

How is antepartum haemorrhage classified?

A

Minor (<50ml)
Major (50-1000ml)
Massive (>100ml or shock)

43
Q

What is the name of the cause of antepartum bleeding where unprotected fetal vessels traverse the fetal membranes over the internal os?

A

Vasa praevia

44
Q

How is vasa praevia diagnosed?

A

US Doppler at screening

Or following bleeding

45
Q

What is the management of vasa praevia diagnosed at screening?

A

CCS from 32wk, elective C-section at 34-36wk

46
Q

What is placental abruption?

A

Normally implanted placenta separates partially / totally before birth

47
Q

What is the pathology behind placental abruption?

A

Vasospasm causes arterioles to rupture into the decidua

Blood in amniotic sac

48
Q

Trauma can cause placental abruption. T or F

A

True

49
Q

What non-prescription drug is a risk factor for placental abruption?

A

Cocaine

50
Q

What chronic conditions are risk factors for placental abruption?

A

HTN
CKD
DM
Thrombophilia

51
Q

How does placental abruption present?

A 
Severe constant abdo pain
\+- Bleed
Woody hard uterus
Hard to palpate fetus
Collapse
52
Q

How is placental aburption diagnosed?

A

Clinical Dx

53
Q

What is the prophylaxis for placental abruption?

A

Low dose aspirin LDA

Also cessation

54
Q

What is the prophylaxis for placental abruption in APS?

A

LMWH + low dose aspirin

55
Q

What is the management of placental abruption?

A 
IV fluid
4-6 U RBC
C-section
CCS
CTG
56
Q

What is placenta praevia?

A

Low-lying placenta: totally / partially implanted in lower uterine segment

57
Q

Where is the lower uterine segment?

A

Below utero-vesicle peritoneal pouch

7cm above internal os

58
Q

What part of the uterus doesn’t contract in labour

A

Lower uterine segment passively dilates

59
Q

How is placenta praevia classified?

A

Major or minor/partial

60
Q

What is major placenta praevia?

A

Placenta covers internal Os

61
Q

What is minor aka partial placenta praevia?

A

Placenta in lower segment but doesn’t cover Os

62
Q

TOP are a RF for future placenta praevia. T or F?

A

True - DOUBLE CHECK THIS WITH JONAS

63
Q

Fibroids are a RF for placenta praevia. T or F?

A

True

64
Q

What are the S+S of placenta praevia?

A

Painless PV bleeding randomly or during sex (spotting to severe)

65
Q

What must be avoided in placenta praevia?

A

Digital vaginal exam

66
Q

Are speculums safe in placenta praevia?

A

Yes

67
Q

What is seen on CTG in placenta praevia?

A

CTG normal

68
Q

If placenta praevia is seen on antenatal US what investigation should be performed next and why?

A

MRI to exclude placenta accreta

69
Q

Patients with placenta praevia should be admitted. T or F

A

True

70
Q

What medication should be given between 24 and 34 weeks gestation to women with placenta praevia?

A

CCS

71
Q

What medication should be given between 24 and 32 weeks gestation as neuro-protection to women with placenta praevia?

A

Mg sulfate

72
Q

What ‘lifestyle advice’ should be given to patients with placenta praevia?

A

No sex

73
Q

What condition is associated with placenta praevia?

A

Placenta accreta

74
Q

In placenta praevia, a ____ should be planned if the placenta is less than 2cm from the os, and ____ should be planned if the placenta is more than 2cm from the os

A

In placenta praevia, a C-SECTION should be planned if the placenta is less than 2cm from the os, and VAGINAL DELIVERY should be planned if the placenta is more than 2cm from the os

75
Q

Other than the 4Hs and 4Ts, what are the 2 additional causes of collapse in pregnant women?

A

PET, amniotic fluid embolism

76
Q

Is SOB worrying in a pregnancy PTx?

A

No - happens to 75% of mothers.
Happen at rest or when talking.
Relief on exertion.
If so, require no Ix

77
Q

Do benign palpitations of pregnancy occur at rest or exertion?

A

At rest

78
Q

What are the 3 abnormal heart rhythms caused by thyroid disease?

A

AF, SVT, ST

79
Q

Ix for palpitations in pregnancy?

A 
ECG +-24hr ECG
BP
FBC, TFT, fT4
Echo
24hr urinary catecholamines
80
Q

What position does aortocaval compression ijn?

A

Supine

81
Q

What causes aortocaval compression?

A

Uterus compress IVC / aorta

Decreased CO, decreases BP, +-collapse

82
Q

What is the Mx of aortocaval compression?

A

Turn to L lateral position

Y3 Reproductive (28 decks)

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