6 - Obs - Other Medical Disorders in Pregnancy - VTE disease + Obesity in pregnancy

Question 1

Preg = ?, VTE incr risk ?x, highest risk ?. Clotting factors ?, ? activity reduced and BF altered by mechanical ?/?. Women w ? prothrombotic conditions, personal/FHx are esp prone.

Answer 1

prothrombotic 
6
increased
fibrinolytic
obstruction/immobility
inherited

Question 2

PE: important cause of maternal ?, less common due to better ?
? same as non preg: ???, ABG, CT +/- ?? scan. ???
mimics normal preg.
DVT: 1% preg women, often ? and on ?. Doppler used.

Answer 2

death
thromboprophylaxis
Diagnosis
CXR
VQ
ECG
iliofemoral
left

Question 3

? screen done before trt. VTE trt w subcut ????. ? shortly before labour, restart and continue into ?. Warfarin is ?.

Answer 3

thrombophilia
LMWH
stop
puerperium
teratogenic

Question 4

Postnatal risk assessment for VTE:

• High risk - if used ? or prev ??? - trt = 6 weeks ????
• Intermediate risk - thrombophilia, ? in labour, BMI >?, prolonged ?, ?? drug abuser, ? illness. - trt = ? week LMWH if ?+ RF’s
• Mod risk - BMI>?, Age>? or parity >/=?, smoker, ? caesarean, ? veins, current ? infection, ?, immobility, ?? haemorrhage, ? delivery, Labour >?h - trt = 1 week LMWH if ?+ RF’s

Can be given 24h after c sec or delivery.

Answer 4

antenatally
VTE
LMWH
caesarean
40
hospitalization
IV
medical
1
1
30
35
3
elective
varicose
systemic 
preeclampsia
postpartum
rotational
24
2

Question 5

Thromboprophylaxis
General Measures: for all, ? and ?.
TEDS: where ????contraindicated (?).
? LMWH: Women at high risk eg prev ? , esp if unprovoked/thrombophilia, hospitalized, immobile, other RFs, ? -> dose.

Answer 5

hydration and mobilization
LMWH
surgery
Antepartum
thrombosis
weight

Question 6

Obesity - most risks linearly related to ???

-20% preg women now have BMI>?

Answer 6

BMI

30

Question 7

Obesity - Risks in pregnancy
-Maternal: Obesity incr risk of ???, pre-eclampsia and ??, C section, ? infections, ? surgery, ??? and maternal ?.
Fetal: Higher rate ?abnormalities eg ???, diabetes and pre-eclampsia -> perinatal ? increased 2-3x.

Answer 7

VTE
DM
wound
difficult
PPH
death
congen
NTDs
mortality

Question 8

MGMT of obesity in preg.
-? weight advice, ? dose preconceptual ? acid (5mg). Vit ? recommended. Weight best ?: loss in preg could -> ?. High risk preg esp if BMI >?, screening for ? diabetes, closer ?? surveillance. Formal ? risk assessment if BMI >40. ? used. ? c section in v obese women.

Answer 8

preconceptual
high
folic
D
maintained
malnutrition
35
gest
BP
anaesthetic
Thromboprophylaxis
Elective