Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA Content > Antenatal Obstetrics 3 > Flashcards

Antenatal Obstetrics 3 Flashcards

1
Q

How much does hypertension affect pregnancies?

A
  • Pregnancy induced hypertension (PIH) affects 6-7% of pregnancies.
  • Chronic hypertension complicates 3-5% of pregnancies (more common due to an older pregnant population).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathology of hypertension in pregnancy??

A

• BP is directly related to systemic vascular resistance and cardiac output and follows a distinct course during pregnancy:

  • ↓ in early pregnancy until 24 weeks due to ↓ in vascular volume.
  • ↑ after 24 weeks until delivery via an ↑ in stroke volume.
  • ↓ after delivery but may peak again 3-4 days post-partum.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Definition of PIH? Risks? When does it resolve?

A

• PIH = hypertension (>140/90mmhg) when >20w gestation, during labour or puerperium in the absence of proteinuria or other markers of pre-eclampsia.

  • At ↑ risk of developing pre-eclampsia (↑ with earlier onset HTN).
  • BP usually returns to the pre-pregnancy limits within 6 weeks of delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Definition of chronic hypertension in pregnancy? Risks?

A

• Chronic = pregnant women who have a high booking BP (130-140/80-90 or more) are likely to have chronic HTN.
- ↑ risk of developing pre-eclampsia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define post-partum hypertension?

A

• Post-partum = new HTN which arises in the post-partum period.
- BP peaks on the 3rd – 4th day post-partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Secondary causes of HTN?

A
  • Renal disease (e.g. polycystic disease, renal artery stenosis or chronic pyelonephritis)
  • Diabetes
  • Cardiac disease (e.g. coarctation of the aorta)
  • Endocrine causes (e.g. Cushings, Conns or rarely phaeochromocytoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms, risks of HTN in pregnancy?

A 
•	Symptoms are often absent
-	Fundal changes, renal bruits and radiofemoral delay should be excluded. 
•	Women with chronic HTN are at risk of:
-	Superimposed pre-eclampsia.
-	Fetal growth restriction
-	Placental abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations in hypertension in pregnancy?

A

• Urinalysis – look for protein.
• Bloods – FBC, U&Es, urate, LFTs and clotting.
- These would be expected to be normal if essential HTN in pregnancy (unless there was a secondary cause of the HTN).
• USS
• Investigations for underlying cause (e.g. CXR, ECG, 24h urine collection for creatinine and for catecholaemines [if phaeochromocytoma is clinically suspected]).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is hypertension an emergency in pregnancy?

A

• BP of >160/110 in pregnancy is medical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of PIH? Mild/moderate/severe?

A

Secondary care

If mild (140-149/90-99)
 Weekly urine and BP
 4 weekly foetal growth scans

If moderate (>150/100)
	Biweekly BP and urine

If severe (>160/110)
 Admit to hospital
 Measure BP QDS and check urine daily
 FBC, U&E, AST/ALT, bilirubin at presentation and weekly
 If not stabilised on oral treatment – aim for delivery 37 weeks unless pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of PIH during labour and after?

A

o During Labour
 Monitor BP hourly, if abnormal – operative delivery
o Review at 2 and 6 weeks, if treatment still needed refer to specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Antenatal management of chronic hypertension?

A

 Change drugs over to labetalol/methyldopa before conception
 Aim for <150/90
 Aspirin 75mg PO daily
 Admit if >160/110
 Foetal USS every 4 weeks from 28 weeks to assess growth, fluid volume, Doppler
• If abnormal, arrange CTG
 Induction of labour around EDD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Perinatal management of chronic hypertension?

A

 Monitor BP hourly & regularly post-natally
 Oxytocin alone at 3rd stage of labour (Ergometrine causes severe hypertension)
 Avoid methyldopa postnatally – psychiatric complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the problems with hypertensive drugs and which are used in pregnancy?

A

o ACEi are teratogenic and affect foetal urine production.
o β-blockers are associated with ↓ birth weight and used rarely.
o Labetalol is first line choice.
o Methlydopa/Nifedipine is second line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Definition of pre-eclampsia?

A

o BP >140/90 after 20 weeks with 1 or more + proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathology of pre-eclampsia?

A
  • Failure of trophoblastic invasion of spiral arteries leaving them vasoactive
  • Endothelial cell damage + exaggerated maternal inflammatory response
  • Vascualr hyperpermeability, thrombophilia and hypertension which may compensate for reduced flow of uterine arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sequelae of pathology of pre-eclampsia?

A

a) Increased vascular resistance - HTN
b) Increased vascular perm - proteinuria
c) Reduced placental flow - IUGR
d) Reduced cerebral perfusion (maternal) - eclampsia (maternal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Classifying pre-eclampsia?

A

Mild
Proteinuria + BP 140-160

Severe
Proteinuria + BP >160 before 32 weeks or with maternal complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How common is pre-eclampsia?

A

5% in nulliparous women, pts with pre-existing HTN are x6 more likely to get pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Risk factors for pre-eclampsia?

A

1) Nulliparity
2) Prev Hx
3) Maternal age (>40 or teen)
4) Twins
5) BMI >35
6) Molar preg
7) Pre-existing hypertension, DM
8) Diabetes
9) Autoimmune disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Symptoms of pre-eclampsia?

Signs of pre-eclampsia?

A 
Symptoms
-	Asymptomatic
-	Severe Headache
-	Drowsy
-	Visual disturbances (blurring, flashing lights)
-	N/V
-	Epigastric pain – at late stage
-	Oedema – face, hands and feet
Signs
HTN= 1st sign (late), proteinuria, oedema, confusion, clonus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnosis of pre-eclampsia?

A
  • BP >140/90

- Urinalysis: Proteinuria 1+ or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Secondary diagnosis of pre-eclampsia?

A
  • Urine MSU M,C&S = proteinuria >0.5g/L (exclude infection by urine culture)
  • Urine PCR >30 diagnostic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Monitoring antenatally in pre-eclampsia?

A
  • BP
  • Serial FBC (rapid decline in platelets due to platelet aggregation suggests impending HELLP or DIC)
  • Serial U&E (raised creatinine and uric acid)
  • LFTs – prolonged APTT&PT
  • Clotting and G&S
  • Foetal USS surveillance (CTG or Doppler)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Referring pre-eclampsia?

A

o BP >140/90 with proteinuria 1+ or more
o Systolic >160
o Diastolic >110
o Any signs of pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Preventative measures in pre-eclampsia management?

A

Aspirin from 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Management of pre-eclampsia?

A
  • Admission to hospital (>140/90 + 1+ proteinuria, signs of pre-eclampsia)
  • CTG at diagnosis and repeat if change in foetal movements, PV bleeding, abdominal pain
  • IOL at 37/40 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Management of mild pre-eclampsia?

A

o BP QDS
o Monitor U&E, FBC and LFTs 2x a week
o Foetal growth scans every 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management of moderate pre-eclampsia?

A

o PO labetalol (Aim <150/100, diastolic >80) (alternatives: nifedipine/methyldopa)
o BP QDS
o Monitor U&E, FBC and LFTs 3x a week
o Foetal growth scans every 2 weeks
o BDS CTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Management of severe pre-eclampsia?

A

o PO labetalol (Aim <150/100, diastolic >80) (alternatives: nifedipine/methyldopa)
o Senior help - may need IV labetalol, fluid restriction
o Prophylactic MgSO4
o Steroids for lung maturation
o Deliver if >34 weeks (if <34 weeks, deliver within 24-48 hours)
o BP QDS, monitor U&E, FBC and LFTs 3 times a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Delivery in pre-eclampsia?

A
  • Deliver mild by term
  • Deliver mod/severe >34-36 weeks if poss
  • Deliver if maternal comps or foetal distress- whatever the gestation
  • Pre-eclampsia only cured by delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Post-natal management of pre-eclampsia?

A
  • BP QDS when in hospital
  • FBC, LFT and U&E 72h after birth
  • Measure BP 1-2 days for up to 2 weeks when transferred to community care, review at 2 weeks and 6 weeks (urine dip done)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Maternal complications of pre-eclampsia?

A
  • Eclampsia (tonic-clonic seizures resulting from cerebrovascular vasospasm)
  • Haemolysis, elevated liver enzymes, low platelet count (HELLP)
  • CVAs (cerebral haemorrhage)
  • Liver/renal failure
  • DIC
  • Pulmonary oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Foetal complications of pre-eclampsia?

A
  • IUGR
  • Morbidity and mortality
  • Placenta abruption
  • Pre-term birth
  • Hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When does pre-eclampsia resolve?

A

Cured by delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is eclampsia?

A
  • Obstetric emergency
  • Tonic-clonic seizures + pre-eclampsia
  • Occurs in 1% of pregnancies with pre-eclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When do seizures occur in eclampsia?

A 
o	Antenatally = 38%
o	Intrapartum = 18%
o	Postnatally (usually within the first 48 hours) = 44%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Management of eclampsia?

A

o Senior help (call for help)
o Airway
o Breathing (15L/m NRM)
o Circulation and IV access (Bloods - FBC, U&E, LFT & 2 wide bore cannula in ACF)
o Continuous monitoring of maternal O2 sats and BP
o MgSO4 4g IV over 5-10 mis, further 2g bolus (then IVI)
 IV calcium gluconate ready for MgSO4 toxicity
 Diazepam if repeated seizures
o If >160/110, use labetalol IV or nifedipine
o Consider steroids (dex) for lung maturity
o Restrict fluids to 80ml/hr
o Continuous foetal CTG
o Deliver once stable, LSCS quickest method as IOL takes a while

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Managing hypertension in eclampsia?

A

o If >160/110, use labetalol IV or hydralazine IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Monitoring during eclampsia management?

A

o Catheterise hourly urine output
o HR, BP, RR and O2 sats every 15 mins
o FBC, U&E, LFTs, creatinine and clotting every 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is HELLP syndrome?

A

Serious complication regarded as a variant of severe pre-eclampsia which manifests with haemolysis (H), elevated liver enzymes (EL) and low platelets (LP)

42
Q

Epidemiology of HELLP syndrome?

A
  • Incidence = 5-20% of pre-eclamptic pregnancies.
  • Materinal mortality = ~1%
  • Perinatal mortality = ~10-60%
43
Q

Symptoms and signs of HELLP?

A
  • Syndrome is usually self-limiting but permanent liver or renal damage may occur.
  • Symptoms include:
    • Epigastric or RUQ pain
    • N&V
  • Signs include:
    • Tenderness RUQ
    • increased BP and other features of pre-eclampsia
    • Dark urine (due to haemolysis)
44
Q

What complications of HELLP syndrome?

A
  • Eclampsia may co-exist

- DIC, liver failure and liver rupture may also occur

45
Q

Management of HELLP syndrome?

A
  • As for eclampsia and delivery is indicated

* If HELLP syndrome - consider high dose steroids

46
Q

Glucose metabolism changes in pregnancy?

A

o Insulin requirements increase throughout pregnancy and are maximal at term.
o A normal woman can increase the amount of insulin she produces to counteract diabetogenic hormones (human placental lactogen, cortisol, glucagon, oestrogen and progesterone) to maintain her blood sugars at 4-4.5 mmol/L.
o Diabetic women are unable to do this and need close monitoring of the blood sugars for good control.

47
Q

Effect of diabetes on pregnancy?

A
  • Increased foetal and neonatal morbidity and mortality.
  • Foetal hyperglycaemia - leads to hyperinsulinaemia through β-cell hyperplasia in foetal pancreatic cells.
  • Insulin in the foetus acts as a growth promoter. The net effect is therefore macrosomia, organomegaly and increased erythropoiesis.
  • Foetal polyuria causes polyhydraminos.
  • Neonatal hypoglycaemia.
  • Surfactant deficiency occurs through reduced production of pulmonary phospholipids – RDS
48
Q

Effect of pregnancy on diabetes?

A
  • Ketoacidosis
  • Retinopathy:
     There is a 2x ↑ risk of development or progression of existing disease
     All diabetic women should have assessment for retinopathy in pregnancy, proliferative retinopathy requires treatment
  • Nephropathy:
     Affects 5-10% of women.
     Renal function and proteinuria may worsen during pregnancy
  • Ischaemic heart disease:
     Pregnancy increases cardiac workload
49
Q

Optimal glycaemic control during pregnancy?

A

o Aim for normoglycaemia.
o Aim FBG 3.5-5.9mmol/L, 1hPPG <7.8mmol/L
o HbA1c <6.5%
o There is increased risk of miscarriage and congenital abnormalities with poor control.
o Monitor glucose at least 4x a day, usually before meals but post-meal glucose may give tighter control.

50
Q

How to assess severity of diabetes antenatally?

A

o HTN
o Retinopathy (funoscopy, ophthalmology assessment)
 First clinic appointment and 28 weeks
o Nephropathy (U&E, urinalysis, urinary protein:creatinine ratio, 24 hour urine for protein, creatinine clearance).
o Neuropathy (clinical assessment)
o Cardiac disease

51
Q

Antenatal education in pre-existing diabetes?

A

o Ensure understanding of effects of hyperglycaemia on fetus and the need for tight control.
o Instruct to inform doctor as soon as pregnancy confirmed.
o Some drugs need stopping (e.g. ACEi)

52
Q

Antenatal general advice in pre-existing diabetes?

A

o Stop smoking
o Optimize weight (aim for a normal BMI)
o Minimise alcohol (max 1-2 units twice/week)

53
Q

Antenatal medication in pre-existing diabetes?

A
  • Aspirin
    o Take 75mg daily from 12 weeks onwards to reduce risk of pre-eclampsia
  • Folic acid:
    o ↑ risk of neural tube defects, so start on 5mg folic acid.
  • Rubella status:
    o Offer vaccination if not rubella immune.
54
Q

Antenatal contraception in pre-existing diabetes?

A

o Ensure effective contraception until good control achieved and pregnancy desired

55
Q

When to refer pregnant mother with pre-existing diabetes?

A

Specialist diabetic antenatal consultant clinic

56
Q

Other antenatal care needed with diabetic mother?

A
  • Foetal echo at 18-20 weeks

- Foetal growth scans every 4 weeks from 28 weeks

57
Q

Delivery of pregnancy with pre-existing diabetes?

A

• Timing of delivery:
- Elective delivery by induction at 38-39 weeks (40 weeks for GDM)
- Delivery should be sooner if complications occur
- Corticosteroids given in premature
• Mode of delivery:
- Vaginal is preferred.

58
Q

Labour of pregnancy with pre-existing diabetes?

A
  • Continuous electronic fetal monitoring
  • Avoid hyperglycaemia
  • Medications
    o Use sliding scale if DM on insulin, or CBG >7mmol/L
    o Aim for glucose 4-7
    o Insulin needs fall as labour progresses and immediately postpartum
    o Stop infusion at delivery if T2 or GDM not on insulin
    o IV fluids should always be given with sliding scale
    Stable situations = 5% dextrose
    High blood glucose = normal saline
  • Avoid maternal hyperglycaemia → causes fetal hypoglycaemia.
  • If steroids are given for threatened preterm labour monitor glucose closely as hyperglycaemia should be anticipated
59
Q

Postpartum care of pregnancy with pre-existing diabetes?

A

• Halve the sliding scale initially.
• Change back to SC insulin when eating and drinking.
• Start with the pre-pregnancy dose of SC insulin.
• If this is not known, it is roughly half the last dose
• Aim for a BM 4-9 mmol/L in the postpartum period.
• Encourage breast-feeding.
- Avoid oral hypoglycaemic drugs if breast-feeding, insulin is safe.
• Baby needs early feeding and glucose monitoring.

60
Q

Maternal complications of pregnancy with pre-existing diabetes?

A
  • UTI
  • Recurrent vulvovaginal candidiasis
  • Pregnancy-induced hypertension/pre-eclampsia
  • Obstructed labour
  • Operative deliveries (CS and assisted vaginal deliveries)
  • ↑ retinopathy (15%)
  • ↑ nephropathy
  • Cardiac disease
61
Q

Foetal complications of pregnancy with pre-existing diabetes?

A
  • Miscarriage (in diabetes with poor control)
  • Congenital abnormalities (in diabetics with poor control):
  • Preterm labour
  • Polyhydramnios (25%)
  • Macrosomia (25-40%)
  • IUGR
62
Q

Neonatal complications of pregnancy with pre-existing diabetes?

A
  • Polycythaemia
  • Jaundice
  • Hypoglycaemia
  • Hypocalcaemia
  • Hypomagnesaemia
  • Hypothermia
  • Cardiomegaly
  • Birth trauma:
  • Shoulder dystocia, RDS, Erbs
63
Q

Where is GDM more prevalent?

A

• More prevalent in women of South East Asian, Mediterranean and Afro-Caribbean origin.

64
Q

Risk factors for GDM?

A
  • Family history of 1st degree relative with diabetes.
  • Obesity (BMI >30)
  • Previous large baby (>4kg)
  • Previous unexplained still birth
  • Previous gestational diabetes
  • Polycystic ovarian syndrome
  • Polyhydramnios in this pregnancy
  • Glycosuria on two or more occasions in this pregnancy.
  • Abnormal timed random glucose
     >5.5mmol/L fasting or >2 hours after food.
     >7.0 mmol/L <2 hours after food
65
Q

Symptoms and signs of GDM?

A
  • Recurrent infections
  • Persistent glycosuria
  • Large for date foetus with macrosomia or polyhydramnios
66
Q

When to screen for GDM?

A 
o	1st degree relative
o	Previous baby >4.5kg
o	BMI>30
o	Ethnicity (South Asian, Caribbean, Middle East)
o	Previous GDM
67
Q

Diagnosis of GDM?

A

• 75g 2-hour OGTT soon after booking, 24-28 weeks and repeated at 34 weeks (if other two negative)
 Overnight fasting (8 hours minimum – water only, no smoking)
 75g load in 250-300mL water.
 Plasma glucose measured fast and at two hours

68
Q

Results of OGTT indicative of GDM?

A
  • Diabetic results
     Fasting glucose ≥5.6 mmol/L
     2-hour glucose ≥7.8 mmol/L
  • Only one value has to be abnormal to make the diagnosis
69
Q

Antenatal monitoring in GDM?

A

o USS & cardiac echo
o Foetal growth every 4 weeks from 28-36
o Glucose levels

70
Q

Immediate management of GDM?

A

o If diagnosed, offer review with diabetes and antenatal clinic within 1 week
o Inform GP
o Information
 Implications of diagnosis for her and baby (DVLA website)
 Importance of good glucose control – less risks of macrosomia, trauma during birth, hypoglycaemia, IOL
 Treatments offered

71
Q

Treatment for GDM if FPG <7 at diagnosis?

A

 Lifestyle advice
• Eat healthy diet, foods with low GI, refer to dietician
• Regular exercise (walking, etc)
 Pharmacological
• If failed with diet and lifestyle after 1-2 weeks
• Offer metformin
• Insulin is 2nd line, if metformin CI or not enough
• Glibenclamide is an option

72
Q

Treatment for GDM if FPG >7 at diagnosis?

A

 Pharmacological
• Insulin
• Glibenclamide is an option

73
Q

Antenatal care for GDM? Targets?

A

o Diabetes and antenatal clinic every 1-2 weeks through pregnancy
o Monitoring using home blood glucose monitor if on insulin (4x daily)
 1-hour PPG if on diet or OHA
o Targets:
 Fasting – <5.3
 1h PPG – <7.8
 2h PPG – <6.4
 ALWAYS ABOVE 4MMOL/L
o HbA1c
 At booking and consider 2nd and 3rd trimester in pre-existing diabetes
o Insulin
 Multiple daily injections with glucagon prescribed

74
Q

Labour management of GDM? Timing and glucose management?

A

o Timing
 Birth between 37-38+6 weeks of pregnancy
 If complications, elective birth <37 weeks (T1&T2)
 Birth no later than 40+6 weeks, offer elective birth
o Glucose monitoring
 Every hour during labour (4-7)
 Insulin sliding scale infusion may be needed
 2-4 hourly after birth and admit if:
• Hypoglycaemia, RDS, signs of cardiac decompensation, neonatal encephalopathy, need fluids/NG feeds

75
Q

Postnatal management of GDM?

A

o Lifestyle advice
o FPG at 6-12 weeks to exclude diabetes
o Annual HbA1c

76
Q

How common is VTE in pregnancy?

A
  • VTE is a leading cause of maternal morbidity and mortality in developed countries
  • 10x more common in pregnancy
  • DVT 3x more common than PE
  • Most common in post-natal period
77
Q

What does VTE include?

A

• Thromboembolic events include venous thrombosis (DVT) of the leg, calf or pelvis and pulmonary embolism (PE).
• Thomboembolic disease can occur at any point in the pregnancy:
- Antenatal DVT is more common than postpartum DVT
- VTE is higher in puerperium.

78
Q

Risk factors of VTE - pregnancy?

A
  • Venous stasis in the lower limbs
  • Possible trauma to the pelvic veins at the time of delivery
  • Changes in the coagulation system:
     ↑ in procoagulant factors (factors X, VII and fibrinogen)
     ↓ in endogenous anticoagulant activity
     Suppression of fibrinolysis
     Significant ↓ in protein S activity.
79
Q

Risk factors of VTE - high risk?

A

o Hx of >1 VTE, unprovoked or oestrogen-related VTE, single provoked VTE + thrombophilia or FHx, antithrombin 3 deficiency

80
Q

Risk factors of VTE - intermediate risk?

A

o Thrombophilia but no VTE, single provoked VTE, medical comorbidities (cancer, inflammatory conditions, significant cardiac or respiratory conditions, SLE, sickle cell, nephrotic syndrome), IVDU, antenatal surgery

81
Q

Other risk factors for VTE?

A

o Age>35, BMI>30, parity 3 or more, smoker, large varicose veins, current infection, pre-eclampsia, immobility, dehydration, multiple pregnancy, ART

82
Q

Symptoms and signs of VTE?

A
  • Clinical signs may be absent.
  • DVT
  • PE
  • Cerebral vein thrombosis (rare)
  • If VTE is suspected, treatment should be commenced while diagnostic tests are awaited.
83
Q

Screening performed for VTE?

A

• Women with previous VTE should be screened for thrombophilia before pregnancy

84
Q

If DVT/PE suspected, what investigations should be performed?

A

 FBC, U&E, LFT, clotting

 ABG, ECG and CXR in PE

85
Q

DVT imaging for diagnosis in pregnancy?

A

Compression or Duplex US
• If positive – DVT confirmed
• If high clinical suspicion but tests negative – LMWH and repeat imaging in 1 week
• If negative - ruled out and stop LMWH

86
Q

PE imaging for diagnosis in pregnancy?

A

CXR immediately, if normal:
• V/Q Scan
If abnormal CXR - CTPA

87
Q

Management if VTE suspected or at risk? When given? What are the criteria?

A

o LMWH (given 6 months and 6 weeks postpartum) - Enoxaparin SC
• Diagnosis of DVT/PE - BDS
• All high risk for VTE prophylaxis
• Any woman undergoing emergency LSCS need 7 days postpartum LMWH
• Antithrombin III deficiency = merits higher doses of LMWH

o Avoid immobility and dehydration
o Elevate legs and compression stockings

88
Q

Management of massive PE in pregnancy?

A

o Seek expert help
o Airway - assess and optimise if needed
o Breathing - assess - 15L/m NRM O2, ABG
o Circulation - assess - 2 WB cannula in ACF, Blood (FBC, CRP, coagulation), Fluids 0.9% NaCl 500ml bolus

o Ix - CXR, VQ scan

o Rx - LMWH (Carried on until 6 weeks post-partum), alteplase (only if mother moribund)

o Embolectomy in tertiary centres

89
Q

Management of VTE during labour?

A

o Stop LMWH, keep hydrated
o Planned elective IOL or CS- regional anaesthesia only acceptable >12h since prophylactic dose and >24 after therapeutic dose of LMWH

90
Q

Postnatal care of VTE?

A 
o	LMWH (can switch to warfarin following pregnancy)
o	During next pregnancy, needs VTE prophylaxis throughout and 6 weeks postpartum
91
Q

VTE management of antiphospholipid syndrome?

A

o Aspirin 75mg daily and LMWH from 6 weeks onwards

92
Q

VTE management of antithrombin 3 deficiency?

A

o LMWH (enoxaparin)

93
Q

Risk factors which score 4 in VTE risk asssessment?

A

Previous VTE

OHSS

94
Q

Risk factors which score 3 in VTE risk asssessment?

A

Previous provoked VTE
Co-morbidity (Cancer, HF, SLE, SCD, IBD)
Surgical procedure
Hyperemesis

95
Q

Risk factors which score 2 in VTE risk asssessment?

A

C-section in labour

BMI >40

96
Q

Risk factors which score 1 in VTE risk asssessment?

A

Thrombophilia
Dehydration
Parity 3 or more

Smoking
Age >35
Multiple pregnancy

FHx of VTE in 1st degree relative
Immobility
BMI >30

Varicose Veins
IVF/ART
Pre-eclampsia

97
Q

Score indications for giving VTE prophylaxis and when?

A

If 4 or more antenatally - first trimester LMWH
If 3 antenatally - from 28 weeks LMWH
If 2 or more postnatally - LMWH for 10 days
If admitted - consider LMWH
All given antenatally and 6 weeks postnatal

98
Q

Indications for aspirin in pregnancy?

A

12 weeks
1 high RF
2 or more moderate RF

99
Q

Name high RF for aspirin in pregnancy?

A 
Hx of PET
Diabetes
Chronic HTN
Renal disease
Multiple pregnancy
SLE/APS
100
Q

Name moderate RF for aspirin in pregnancy?

A

Nulliparity
BMI >30
FHx of PET
>35 years old

101
Q

Presciption of aspirin if indicated?

A

At 12 weeks, 75mg

MSRA Content (87 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions