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4th Year Obs and Gynae > Abnormal pregnancy > Flashcards

Abnormal pregnancy Flashcards

1
Q

Hypertension in pregnancy before __ weeks is not gestational but instead pre-existing hypertension.

A

20 weeks

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2
Q

What is the first line management in gestational hypertension?

A

Labetalol

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3
Q

What is first line gestation hypertension management in asthmatics?

A

Nifedipine

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4
Q

Define hyperemesis gravidarum:

A

Persistent vomiting in pregnancy which leads to greater than 5% weight loss of pre-pregnancy weight and ketosis

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5
Q

What anti-emetics are licensed for hyperemesis gravidarum

A

cyclizine
Metoclopramide
Promethazine

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6
Q

What antiemetic is not licensed for hyperemesis gravidarum but is reserved for when all other options fail?

A

Ondansetron IV

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7
Q

Aside from antiemetics what other medications can be given in hyperemesis gravidarum?

A

Steroids - prednisalone or hydrocortisone
Folic acid 5mg
Thiamine to prevent Wernicke’s encephalopathy
Thromboprophylaxis

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8
Q

How is pre-eclampsia defined?

A

Gestational induced hypertension and proteinuria of great than 0.3g/24hours

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9
Q

In gestational hypertension, at what point should you consider admitting to hospital?

A

If BP >160/110

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10
Q

If a patient requires LMWH during their pregnancy at what point post partum can it be discontinued?

A

minimum 6 weeks

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11
Q

If a patient undergoes a c-section do they require any anti-coagulation?

A

Yes. For 7 days postnatally the require anticoagulation with LMWH

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12
Q

What investigation normally used for DVTs and PEs isn’t very appropriate in pregnancy?

A

D-Dimers

They tend to be raised anyway due to pregnancy physiological changes

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13
Q

At what stage in the pregnancy is the foetus most at risk of damage is the mother is infected by rubella?

A

The first 16 weeks - risk is 80%

Afterwards it is <5%

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14
Q

List some risk factors (at least 5) for developing pre-eclampsia:

A 
Previous pre-eclampsia
Diabetes
Smoking >20 a day
BMI >35kg/m2
CKD
Autoimmune disease
FHx 
Age >40
Multiple pregnancy
Chronic` hypertension
Age gap between pregnancy >10years
First child
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15
Q

What are some of the features of severe pre-eclampsia?

A 
Headache
Papilloedema
Brisk reflexes
Peripheral oedema
BP >170 systolic
RUQ pain
HELLP sydrome
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16
Q

What medication is given to help with seizures in eclampsia?

A

Magnesium sulphate

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17
Q

How can you correct an overdose from magnesium sulphate?

A

Calcium gluconate

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18
Q

What medication is given in patients with gestational hypertension to reduce their risk of preeclampsia (give dose), or to any woman with risk for preeclampsia?

A

Aspirin 75mg

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19
Q

What is eclampsia?

A

Grand mal seizures occurring due to pre-eclampsia

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20
Q

In patients with preeclampsia what medication is given to benefit the foetus?

A

Steroids (dexamethasone)

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21
Q

What are the benefits of dexamethasone

A

Lung maturation
Reduced risk of neonatal death
Reduced risk of NEC
Reduced risk of intraventricular haemorrhage

22
Q

What are some of the complications for a neonate when a mother has pre-existing diabetes?

A

Congenital anomalies
Miscarriage
Intrauterine death

23
Q

How often should pregnant women with diabetes (any kind) monitor their blood sugars?

A

4x daily

24
Q

What is the target fasting blood glucose in women with diabetes during pregnancy?

A

3.5 - 5.5 mmol.mol

25
Q

What is the target blood glucose 1 hour post meal in pregnant women with diabetes?

A

<7.8mmol/mol

26
Q

What are some clinical signs of gestational diabetes?

A

Polyhydramnios

Glycosuria

27
Q

What are the clinical symptoms of gestational diabetes?

A

Polyuria
Polydipsia
Dysuria

28
Q

What are some risk factors for developing GD

A 
>BMI 30
Ethnicity (BAME more likely)
Previous GD in pregnancy
FHx
Previous big baby
29
Q

Give some complications assoc. with any kind of diabetes in oregnancy?

A 
Large baby - complicated delivery 
Shoulder dystocia
Macrosomia
Neonatal hypoglycaemia
Pre eclampsia
30
Q

What are some of the main causes of PPROM?

A 
Previous pre-term labour (20% risk after 1 previous episode, 40% risk after 2 episodes)
Multiple pregnancy
Smoking
Uterine anomalies
Parity (=0 or >5)
Ethnicity
Poor socio-economic status
Drugs (especially cocaine)
31
Q

What % of pregnancies suffer from obstetric cholestasis?

A

0.7%

32
Q

What ethnic group is obstetric cholestasis most common in?

A

Asians

33
Q

What are the main symptoms of obstetric cholestasis?

A

Itching - pruritus mainly contained to hands and soles of feet
Jaundice
Raised bilirubin

34
Q

What medications can be given in obstetric cholestasis?

A

Ursodeoxycholic acid
Vitamin K
Antihistamines may ease pruritus
Topical emollients to stop itching

35
Q

What investigations are appropriate for intrahepatic cholestasis of pregnancy? (Obstetric cholestasis)

A

Liver function tests
USS of liver
FBC
Serum bile acids

36
Q

What are we trying to rule out when we USS liver and do a FBC and clotting screen in obstetric cholestasis?

A

HELLP syndrome

In cholestasis of pregnancy, the LFTs will be mainly normal with deranged bilirubin, and the USS and clotting ties will be normal

37
Q

Why should mothers with cholestasis of pregnancy be induced at 37 weeks?

A

There is an increased risk of stillbirth

38
Q

What does HELLP syndrome stand for?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

39
Q

What are some of the maternal consequences of pre-eclampsia?

A 
Renal failure
Pulmonary Oedema
HELLP syndrome
DIC
Eclampsia
Death
40
Q

Define premature preterm rupture of the membranes (PPROM)

A

This is when the amniotic sac breaks before the onset of labour, before 37 weeks

41
Q

What are some of the mechanisms that may lead to PPROM?

A

Infections weaken tensile strength of the foetal membranes
Cervical incompetence
Over distension of uterus
Vascular causes incl. placental abruption

42
Q

For the neonate, what are some of the consequences of PPROM?

A

Infection
Death
Pulmonary hypoplasia

43
Q

What is the main risk for the mother in PPROM?

A

Chorioamnioitis

44
Q

On speculum examination, what would be seen in PPROM?

A

Vaginal pooling of blood in the vaginal posterior fornix

45
Q

What are the main principles of management in PPROM?

A 
Antibiotic cover to prevent chorioamnionitis
Monitor vital signs for infection
Tocolytics
Maternal steroids
Mg Sulphate
46
Q

Why should co amoxiclav be avoided as antibiotic cover in PPROM?

A

It has an increased risk of causing NEC in neonates

47
Q

What antibiotic is given 1st line as cover in PPROM?

A

Erythromycin

48
Q

Before __ weeks foetal blood sampling cannot be carried out.

A

34 weeks

49
Q

What is hydrops fetalis?

A

This is when there is fluid accumulation in 2 compartments or more of the foetus e.g. ascites, pericardial effusion, oedema, pulmonary oedema

50
Q

If a mother has high levels of Rh d antibodies what is done with the foetus?

A

It is checked for anaemia by checking the middle cerebral artery

51
Q

What are the consequences of neonatal anemia?

A

Heart failure leading to Hydrops fetalis

4th Year Obs and Gynae (7 decks)

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