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Obstetrics > Antenatal Care: Pre-Existing Medical Conditions > Flashcards

Antenatal Care: Pre-Existing Medical Conditions Flashcards

1
Q

What should be offered to epileptic women prior to conception

A

Folic acid (5mg) from 3 months to 12W

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2
Q

What is the least-teratogenic anti-epileptic

A

Carbamezapine

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3
Q

What is the advice about anti-epileptic medication during pregnancy

A

Continue medication, unless sodium valproate - then consider switching

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4
Q

If a women is on CYP450 inducing anti-epileptics, what should she be offered during last 4W and why

A

Vitamin K. To enable development of foetal vitamin-K coagulation factors, preventing haemorrhage disease of new-born

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5
Q

What is given postpartum to neonates of epileptic women and why

A

1mg vitamin K = prevent haemorrhage disease new-born

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6
Q

Why should epileptic women remain for 24h in hospital post-delivery

A

Highest risk of seizures is post-delivery

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7
Q

What does phenytoin during pregnancy cause

A

Cleft palate

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8
Q

What % of diabetes in pregnancy is GDM

A

88

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9
Q

What % of diabetes in pregnancy is T1DM

A

7.5

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10
Q

What % of diabetes in pregnancy is T2DM

A

5

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11
Q

What HbA1c should be aimed for pre-conception

A

Hba1C <43 (6.1%)

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12
Q

Explain diabetic medications prior to pregnancy

A

Metformin can be continued. Others should be stopped and switched to insulin. Find alternatives for ACEI and statins, if women is on them.

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13
Q

What is the regimen of growth scans in diabetic women

A

Growth scan every 4W from 28W

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14
Q

What should diabetic women be offered at 12W and why

A

Aspirin (75mg) to prevent pre-eclampsia as these women are at a higher risk

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15
Q

When should you aim for delivery in diabetic women

A

38W

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16
Q

What may be offered prior to delivery in diabetic women

A

Corticosteroids

17
Q

Can you breast feed with metformin

A

Yes

18
Q

What defines pre-existing HTN in pregnant women

A

BP >140/90mmHg before 20W

19
Q

Explain physiological changes in BP during pregnancy

A

BP initially decreases up to 24W as vascular resistance decreases. It then increases due to rise in stroke volume

20
Q

How should HTN be managed in pregnancy

A

Labetalol or Methyldopa

21
Q

What is target BP in pregnancy if women has HTN

A

<150/90 or <140/90 if end-organ damage

22
Q

What should women with HTN be given at 12W and why

A

Aspirin (75mg) to reduce risk pre-eclampsia

23
Q

Why should a women be switched from methyldopa after delivery

A

Increased risk of post-natal depression

24
Q

What are 4 risks of HTN during pregnancy

A
  • Pre-eclampsia
  • Placental abruption
  • Foetal growth restriction
  • Stroke
25
Q

What is antiphospholipid syndrome

A

Individual has autoantibodies to phospholipids on cells

26
Q

How can the aetiology of antiphospholipid syndrome be divided

A

Primary

Secondary

27
Q

What are secondary causes of antiphospholipid syndrome

A

SLE
RA
Systemic sclerosis

28
Q

What is the main feature of antiphospholipid syndrome during pregnancy

A

Recurrent miscarriages during first-trimester

29
Q

How many antiphospholipid syndrome present during pregnancy

A

Arterial or venous thrombosis

Pre-eclampsia

30
Q

What are the criteria to test for antiphospholipid syndrome

A

> 3 miscarriages
Unusual thrombosis - eg. unprovoked DVT
Recurrent thrombosis

31
Q

What antibodies are used to identify antiphospholipid syndrome

A

Anti cardio-lipid antibodies

32
Q

If a women with antiphospholipid syndrome with the following complications how should she be managed

a. recurrent pregnancy loss
b. previous IUGR or pre-eclampsia
c. Thrombosis

A

a. LMWH, aspirin in future pregnancies
b. aspirin from 12W
c. LMWH

33
Q

What are complications of antiphospholipid syndrome during pregnancy

A

IUGR
Miscarriage
Pre-Eclampsia
Venous thrombosis

Obstetrics (27 decks)

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