Risk factors for pre-eclampsia: - Parity [high/0] - [ 40yr] - [Long/short] interval - [High/low] BMI (Other risk factors include CKD, HTN, SLE, APS, DM and a FH)

Risk factors for pre-eclampsia: - Parity 0 - >40yr - LONG interval - HIGH BMI (Other risk factors include CKD, HTN, SLE, APS, DM and a FH)

3rd Trimester Conditions Flashcards by Imogen Smedley

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

It preexisted

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

Peri-partum cardiomyopathy

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What is the strongest RF for PET pre-eclampsia?

PMH of PET

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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)

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

Low dose aspirin

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What is the triad of pre-eclampsia PET?

HTN + oedema + proteinuria

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What is stage 1 pre-eclampsia?

Placental ischemia

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What is stage 2 pre-eclampsia?

Multi-system endothelial dysfunction

Anti-angiogenic
(Placenta spiral A narrow)

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What is the mechanism causing oedema in pre-eclampsia?

Decreased GFR

Retain Na and H2O

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Where is oedema most commonly in pre-eclampsia?

Hands and face

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How does pre-eclampsia present?

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

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How is pre-eclampsia screened for?

BP and urinalysis at every antenatal appointment

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

34 weeks

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

Late onset more common

Late onset higher eclampsia risk

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What is the only cure for pre-eclampsia?

Birth

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What should aim for BP to be in PET Mx?

140-150/90-100

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

US, CTG

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What blood tests are done when investigating PET?

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

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What drugs should be avoided in PET?

ACEI and diuretics

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

Methyldopa (CI depression) 
OR 
Labetolol (CI asthma) 
OR
Nifedipine

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What class of drugs is methyldopa?

Alpha agonist

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What class of drugs is labetolol?

Alpha + beta agonist

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What class of drugs is nifedipine?

CCB

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

Pre-eclampsia

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What is the presentation of eclampsia?

Tonic clonic seizures and big increase in BP | Or coma

Eclampsia occurs antepartum. T or F

False, can occur ante, intra or postpartum

What is the Mx of eclampsia?

IV labetalol OR hydralazine IV Mg sulfate Fluid balance Birth

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

Haemolysis Elevated liver enzymes Low platelets Pre-eclampsia

Define antepartum haemorrhage

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

What is the commonest cause of antepartum haemorrhage?

Placental abruption

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

False, rare cause of antepartum haemorrhage

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

Uterine rupture

Do contractions occur in uterine rupture?

How does uterine rupture present?

``` Severe abdo pain PV blood Collapse Shoulder tip pain Acute abdomen ```

What is the management of uterine rupture?

Surgical +- transfusion

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

Antepartum haemorrhage

What is placenta accreta?

An abnormally adherant placenta

What is placenta percreta?

Placenta attached to bladder

What is placenta increta?

Placenta in myometrium

What is the surgical prophylaxis for placenta accreta?

Internal iliac artery balloon

How much blood is lost in placenta accreta?

3 L

How is antepartum haemorrhage classified?

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

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

Vasa praevia

How is vasa praevia diagnosed?

US Doppler at screening | Or following bleeding

What is the management of vasa praevia diagnosed at screening?

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

What is placental abruption?

Normally implanted placenta separates partially / totally before birth

What is the pathology behind placental abruption?

Vasospasm causes arterioles to rupture into the decidua | Blood in amniotic sac

Trauma can cause placental abruption. T or F

True

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

Cocaine

What chronic conditions are risk factors for placental abruption?

HTN CKD DM Thrombophilia

How does placental abruption present?

``` Severe constant abdo pain +- Bleed Woody hard uterus Hard to palpate fetus Collapse ```

How is placental aburption diagnosed?

Clinical Dx

What is the prophylaxis for placental abruption?

Low dose aspirin LDA | Also cessation

What is the prophylaxis for placental abruption in APS?

LMWH + low dose aspirin

What is the management of placental abruption?

``` IV fluid 4-6 U RBC C-section CCS CTG ```

What is placenta praevia?

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

Where is the lower uterine segment?

Below utero-vesicle peritoneal pouch | 7cm above internal os

What part of the uterus doesn't contract in labour

Lower uterine segment passively dilates

How is placenta praevia classified?

Major or minor/partial

What is major placenta praevia?

Placenta covers internal Os

What is minor aka partial placenta praevia?

Placenta in lower segment but doesn't cover Os

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

True - DOUBLE CHECK THIS WITH JONAS

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

True

What are the S+S of placenta praevia?

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

What must be avoided in placenta praevia?

Digital vaginal exam

Are speculums safe in placenta praevia?

Yes

What is seen on CTG in placenta praevia?

CTG normal

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

MRI to exclude placenta accreta

Patients with placenta praevia should be admitted. T or F

True

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

CCS

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

Mg sulfate

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

No sex

What condition is associated with placenta praevia?

Placenta accreta

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

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

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

PET, amniotic fluid embolism

Is SOB worrying in a pregnancy PTx?

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

Do benign palpitations of pregnancy occur at rest or exertion?

At rest

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

AF, SVT, ST

Ix for palpitations in pregnancy?

``` ECG +-24hr ECG BP FBC, TFT, fT4 Echo 24hr urinary catecholamines ```

What position does aortocaval compression ijn?

Supine

What causes aortocaval compression?

Uterus compress IVC / aorta | Decreased CO, decreases BP, +-collapse

What is the Mx of aortocaval compression?

Turn to L lateral position

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3rd Trimester Conditions Flashcards

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