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Obstetrics + Gynaecology > Abnormal Pregnancy > Flashcards

Abnormal Pregnancy Flashcards

1
Q

What is the definition of gestational hypertension?

A

High BP which develops after 20 weeks gestation but does not involve proteinuria or oedema

  • systolic > 140 or diastolic > 90
  • or an increase above booking readings of > 30 systolic or > 15 diastolic
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2
Q

What is the definition of pre-eclampsia?

A

Seen AFTER 20 weeks gestation

  • pregnancy induced hypertension
  • plus proteinuria > 0.3g/24hrs
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3
Q

What are the risks of pre-eclampsia?

A 
Foetal prematurity + IUGR
Eclampsia
Placental abruption
Cardiac failure
Stroke
VTE
DIC + HELLP
Pulmonary oedema
Multi-organ failure
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4
Q

Which investigations should be done for high BP during pregnancy?

A

Blood pressure
Urinalysis (proteins)
Hb, platelets, U&Es, LFTs, coagulation screen, urate

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5
Q

What are the risk factors for pre-eclampsia?

A 
Previous HTN in pregnancy
CKD
Autoimmune disease
Diabetes
Chronic hypertension 
First pregnancy
Age 40 or over
Pregnancy interval > 10 years
BMI > 35
Family history of pre-eclampsia
Multiple pregnancy
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6
Q

What are the clinical features of severe pre-eclampsia?

A 
Hypertension >170/100 + proteinuria
Headache (cerebral oedema)
Visual disturbance
Papilloedema
RUQ/epigastric pain
Sudden onset oedema
Hyperreflexia, clonus
Features of HELLP syndrome
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7
Q

What are the features of pre-eclampsia developing into eclampsia?

A

Grand mal seizures

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8
Q

What is the management for pre-existing hypertension during pregnancy?

A 
Stop ACE inhibitors (teratogenic)
Start either:
- labetalol
- nifedipine
- methyldopa
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9
Q

What is the management for pregnancy induced hypertension?

A

Labetalol
Nifedipine
Methyldopa
Hydralazine

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10
Q

What is the management for pre-eclampsia?

A

Delivery of baby (depends on gestation)
Antihypertensive (as for pregnancy induced HTN)
IV magnesium sulpahte –> if severe, reduces chance of eclampsia
IM steroids (if < 34 weeks or <38 weeks if c-section)

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11
Q

Why are steroids given in pre-eclampsia?

A

To encourage foetal lung development (surfactant production) as delivery is likely to be necessary

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12
Q

How is eclampsia managed?

A

IV magnesium sulpahte

+ urgent delivery by c-section (unless fully dilated and deliverable by vaginal delivery)

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13
Q

What is the secondary prevention for pre-eclampsia in women with history of pre-eclampsia or risk factors?

A

Low dose aspirin started at 12 weeks gestation

Increased surveillance and regular growth scans

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14
Q

What are the risk factors for gestational diabetes (GDM)?

A 
Previous GDM
BMI > 30
First degree relative with GDM
Ethnicity - SE Asia, Middle East, Black Caribbean
Previous big baby
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15
Q

What are the signs of GDM?

A

Glycouria

Polyhydramnios

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16
Q

What are the consequences of GDM?

A

Macrosomia
Shoulder dystocia + vaginal trauma
Increased need for forceps or CS
Hypoxaemic state in utero - higher risk of stillbirth
Neonatal hypoglycaemia
Increased risk of obesity, DM + CVD in infant

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17
Q

Which complications can occur during pregnancy in both pre-existing + gestational DM?

A

Pre-eclampsia
Neonatal hypoglycaemia, obesity, CVD
Macrosomia, obstructed labour, vaginal trauma
Shoulder dystocia

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18
Q

What should be included in pre-pregnancy counselling for women with type 1 or type 2 DM?

A

Aim for HbA1c 48 (6.5%), avoid pregnancy if HbA1c >86 (10%)
Folic acid 5mg - 3 months before conception to 12 weeks gestation
Low dose aspirin from 12 weeks

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19
Q

When should the foetus be delivered in women with DM?

A 
T1DM: 38 weeks (earlier if complications)
- offer CS if estimated weight > 4.5kg
GDM:
- diet alone: 40-41 weeks
- metformin: 39-40 weeks
- insulin: 38 weeks
20
Q

What is the diagnostic criteria for GDM?

A

Fasting glucose >/= 5.1

2 hour glucose >/= 8.5

21
Q

What are the management options for GDM?

A

Diet + exercise
Metformin
Insulin

22
Q

How are GDM patients followed up after delivery?

A

Fasting glucose measure 6-8 weeks postnatally
If results suggest T2DM –> OGTT
Annual screening for DM by GP

23
Q

What are the causes of pre-term pre-labour rupture of membranes (PPROM)?

A

Infection
Cervical incompetence
Over distention of uterus - multiple pregnancy or polyhydramnios
Vascular causes - placental abruption

24
Q

What are the consequences of PPROM?

A 
Neonatal:
- prematurity
- sepsis
- pulmonary hypoplasia
Maternal:
- chorioamnionitis
25
Q

How is PPROM diagnosed?

A

Maternal history
Sterile speculum exam - pooling of blood in posterior vaginal fornix
USS may show oligohydramnios
AVOID digital exam because risk of infection + prostaglandin release leading to labour

26
Q

How is PPROM managed?

A

Monitor for signs of infection
Antibiotics e.g. erythromycin
Tocolytics e.g. nifedipine in earlier gestation to prevent labour
Maternal steroids (foetal lungs)
Magnesium sulphate IV - neuroprotection for foetus
CTG
Foetal blood sampling during labour

27
Q

How is foetal anaemia diagnosed and managed during pregnancy?

A

Screened for by checking the middle cerebral artery-peak velocity pressure (MCA-PSV)
If appears anaemia, specialist centre:
- foetal blood sampling + in utero transfusion via umbilical vein

28
Q

Which condition may result from severe foetal anaemia?

A

Heart failure

+ Hydrops fetalis

29
Q

What are the features of hydrops fetalis?

A 
Ascites
Pleural effusion
Skin oedema
Pericardial effusion
May lead to death
30
Q

What is the leading cause of maternal death in the UK?

A

VTE

31
Q

What can be given as antenatal prophylaxis for VTE?

A

LMWH

32
Q

Which women should receive antenatal VTE prophylaxis?

A 
Any previous VTE
Hospital admission
High risk thrombophilia
Comorbidities e.g.:
- cancer, HF, SLE, IBD, inflammatory polyarthropathy, nephrotic syndrome, T1DM with nephropathy, sickle cell
- current IVDU
Any surgical procedure e.g. appendectomy
OHSS (first trimester only)
33
Q

How is a PE diagnosed in pregnancy?

A

V/Q scan

However, if unclear, do CTPA –> risk of undiagnosed CTPA is greater

34
Q

How is VTE treated in pregnancy/post partum?

A

LMWH (doesn’t cross placenta, not secreted in breast milk)

If emergency situation - use unfractionated heparin as quicker onset

Thrombolysis if life threatening PE

35
Q

Can DOACs or warfarin be used in pregnancy/breastfeeding?

A 
DOACs
- not recommended in pregnancy or breastfeeding
Warfarin
- teratogenic
- but fine when breastfeeding
36
Q

How is small for gestational age (SGA) defined?

A

Estimated foetal weight or abdominal circumference below the 10th centile

37
Q

How is a SGA foetus identified?

A

Antenatal risk factors
Screening during antenatal care:
- measurement of SFH
- growth scans if single measurement below 10th centile

38
Q

How is SGA diagnosed?

A

Measurement of foetal abdominal circumference + head circumference +/- femur length –> estimated foetal weight
Additional information:
- liquor volume or amniotic fluid index
- doppler scans of umbilical artery

39
Q

How is a large for dates foetus defined?

A

Estimated foetal weight greater than 90th centile

Clinically - SFH will be more than 2cm over the gestational age

40
Q

What are the causes of large for dates foetus?

A

Polyhydramnios
Multiple pregnancy
Macrosomia secondary to DM
Wrong dates e.g. late bookers

41
Q

What are the risks associated with a large for dates foetus?

A

Clinician + maternal anxiety
Shoulder dystocia
Postpartum haemorrhage

42
Q

What is polyhydramnios?

A

Excess of amniotic fluid

43
Q

What are the causes of polyhydramnios?

A 
Diabetes
Anomaly - GI atresia, cardiac
Monochorionic twin pregnancy
Hydrops fetalis - rhesus isoimmunisation
Viral infection
Idiopathic
44
Q

What are the symptoms of polyhydramnios?

A

Abdominal discomfort
Prelabour rupture of membranes
Preterm labour
Cord prolapse

45
Q

What are the signs of polyhydramnios?

A

Large for dates
Malpresentation
Shiny, tense abdomen
Inability to feel foetal parts

Obstetrics + Gynaecology (22 decks)

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