Abnormal Pregnancy Flashcards by Megan Rose

What is the definition of gestational hypertension?

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

How well did you know this?

Not at all

Perfectly

What is the definition of pre-eclampsia?

Seen AFTER 20 weeks gestation

pregnancy induced hypertension
plus proteinuria > 0.3g/24hrs

How well did you know this?

Not at all

Perfectly

What are the risks of pre-eclampsia?

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

How well did you know this?

Not at all

Perfectly

Which investigations should be done for high BP during pregnancy?

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

How well did you know this?

Not at all

Perfectly

What are the risk factors for pre-eclampsia?

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

How well did you know this?

Not at all

Perfectly

What are the clinical features of severe pre-eclampsia?

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

How well did you know this?

Not at all

Perfectly

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

Grand mal seizures

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What is the management for pregnancy induced hypertension?

Labetalol
Nifedipine
Methyldopa
Hydralazine

How well did you know this?

Not at all

Perfectly

What is the management for pre-eclampsia?

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)

How well did you know this?

Not at all

Perfectly

Why are steroids given in pre-eclampsia?

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

How well did you know this?

Not at all

Perfectly

How is eclampsia managed?

IV magnesium sulpahte

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

How well did you know this?

Not at all

Perfectly

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

Low dose aspirin started at 12 weeks gestation

Increased surveillance and regular growth scans

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What are the signs of GDM?

Glycouria

Polyhydramnios

How well did you know this?

Not at all

Perfectly

What are the consequences of GDM?

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

When should the foetus be delivered in women with DM?

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

What is the diagnostic criteria for GDM?

Fasting glucose >/= 5.1

2 hour glucose >/= 8.5

What are the management options for GDM?

Diet + exercise
Metformin
Insulin

How are GDM patients followed up after delivery?

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

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

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

What are the consequences of PPROM?

Neonatal:
- prematurity
- sepsis
- pulmonary hypoplasia
Maternal:
- chorioamnionitis

How is PPROM diagnosed?

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

How is PPROM managed?

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

How is foetal anaemia diagnosed and managed during pregnancy?

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

Which condition may result from severe foetal anaemia?

Heart failure | + Hydrops fetalis

What are the features of hydrops fetalis?

``` Ascites Pleural effusion Skin oedema Pericardial effusion May lead to death ```

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

VTE

What can be given as antenatal prophylaxis for VTE?

LMWH

Which women should receive antenatal VTE prophylaxis?

``` 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) ```

How is a PE diagnosed in pregnancy?

V/Q scan | However, if unclear, do CTPA --> risk of undiagnosed CTPA is greater

How is VTE treated in pregnancy/post partum?

LMWH (doesn't cross placenta, not secreted in breast milk) If emergency situation - use unfractionated heparin as quicker onset Thrombolysis if life threatening PE

Can DOACs or warfarin be used in pregnancy/breastfeeding?

``` DOACs - not recommended in pregnancy or breastfeeding Warfarin - teratogenic - but fine when breastfeeding ```

How is small for gestational age (SGA) defined?

Estimated foetal weight or abdominal circumference below the 10th centile

How is a SGA foetus identified?

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

How is SGA diagnosed?

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

How is a large for dates foetus defined?

Estimated foetal weight greater than 90th centile | Clinically - SFH will be more than 2cm over the gestational age

What are the causes of large for dates foetus?

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

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

Clinician + maternal anxiety Shoulder dystocia Postpartum haemorrhage

What is polyhydramnios?

Excess of amniotic fluid

What are the causes of polyhydramnios?

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

What are the symptoms of polyhydramnios?

Abdominal discomfort Prelabour rupture of membranes Preterm labour Cord prolapse

What are the signs of polyhydramnios?

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