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403- O&G > Chronic disease in pregnancy > Flashcards

Chronic disease in pregnancy Flashcards

1
Q

Warfarin effects in pregnancy

A

It is tertogenic= fetal warfarin syndrome

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2
Q

Effects of 1st trimester exposure to warfarin

A

Physical abnormalities

  • Nasal hypoplasia
  • Short limbs and digits
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3
Q

Effects of 2nd-3rd trimester exposure to warfarin

A

CNS abnormalities

  • Hydrocephalus
  • Hypotonia
  • Intellectual disability

Ocular
- Cataracts

Stillbirth

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4
Q

Greater risk of VTE occurs …

A

Immediately after delivery/ 6-weeks post-partum

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5
Q

Pre-existing risk factors for VTE in pregnancy

A

Previous VTE/ FH

Obesity

Thrombophilia

Smoking

HTN, DM, hypercholesterolaemia

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6
Q

Obstetric risk factors for VTE

A

Multiple pregnancies

Pre-eclampsia

C-section

Prolonged labour

Ovarian hyperstimulation syndrome

Post-partum haemorrhage >1L

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7
Q

Mechanical thromboprophylaxis only is indicated when?

A

Antenatally in score >3

Post-natally for score 2+.

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8
Q

Surgical management of VTE

A

IVC filter

- Indicated when medical fails

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9
Q

1st line pharamacological management of VTE in pregnancy is…

A

LMWH= enoxaparin (clexhane)

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10
Q

The enoxaparin dose for a pregnant woman <50Kg is..

A

40mg BD or 60 mg OD

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11
Q

The enoxaparin dose for a pregnant woman 50-69Kg is..

A

60mg BD or 90mg OD

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12
Q

The enoxaparin dose for a pregnant woman 70-89Kg is..

A

80mg BD or 120mg OD

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13
Q

The enoxaparin dose for a pregnant woman 90-109Kg is..

A

100mg BD or 150mg OD

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14
Q

The enoxaparin dose for a pregnant woman 110-125Kg is..

A

120mg BD or 180mg OD

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15
Q

The last dose of LMWH must be given at least ______ before an epidural and next dose given at least ______ post epidural

A

12 hours before

4 hours post

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16
Q

The last dose of unfractionated heparin must be given at least ______ before an epidural and next dose given at least ______ post epidural

A

At least 4 hours before

1 hour post.

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17
Q

Medical management of massive PE

A

Unfractionated heparin

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18
Q

VTE prophylaxis should be started at ______ if there are ______

A

From 28 weeks, If there are 3 risk factors

1st trimester if there are 4+ risk factors

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19
Q

_______ period carries the highest risk for the exacerbation of seizure frequency

A

Immediate post-partum

20
Q

Obstetric risks of epilepsy in pregnancy

A
  • Spontaneous miscarriage
  • APH/PPH
  • Hypertension
  • Induced labour
  • C-section
  • IUGR
21
Q

What AED are considered safest in pregnancy

A

Carbamazepine

Keppra

Lamotrigene

22
Q

What AED are considered least safe in pregnancy

A

Sodium valproate

Topiramate

23
Q

_______ is given to minimised congenital defects associated with AED in pregnancy

A 
High dose (5mg) folic acid
- From before pre-conception
24
Q

Delivery plan for women with epilepsy

A

Must be done in hospital

- Continue with AEB during labour

25
Q

Babies born to epileptic mums taking enzyme inducing AEB should have _______ to prevent ______

A

Vitamin K IM

- Prevents haemorrhage disease of new born

26
Q

Examples of enzyme-inducing AEBs

A

Carbamazepine

Phenytoin

Phenobarbital

Topiramate

27
Q

Contraception preferred for women with epilepsy

A

IUD/ IUS/ Depot injection

- Not affected by enzyme-inducing AEDs

28
Q

Definitons of anaemia in pregnancy

A

First trimester
- <110

Second
- <105

Post-partum
- <100

29
Q

When is anaemia screened for in pregnancy

A

Booking

24 weeks
- Multiple pregnancy

28 weeks

30
Q

Risks associated with anaemia in pregnancy

A

Increased risk of PPH

Puerperal sepsis

Symptoms impacting daily activities

Foetus/ infant

  • IUGR/ low birth weight
  • Pre-term
  • Delay in cognition and language
31
Q

Most common cause of anaemia in pregnancy is…

A

Iron deficiency anaemia

32
Q

Management of iron-deficiency anaemia in pregnancy

A

Dietary
- 27mg recommended daily intake towards end of pregnancy

Foods: meat, fish, poultry, vitamin c

33
Q

Recommened daily dose of elemental iron

A

40-80mf ferrous sulphate/ ferric salts

34
Q

Contraindications of IV iron

A

Decompensated liver disease

Bacteraemia

1st trimester

Previous anaphylaxis/ transfusion reaction

35
Q

All pregnant women are advised to take _____ daily supplement of folic acid

A

400mcg

36
Q

Folate deficiency in pregnancy is associated with _____ defects

A

Neural tube

37
Q

Features of obstetric cholestasis

A

Pruritus with no rash
- Especially in palms and soles

Reduced appetite

Abdominal pain

Signs

  • Dark urine
  • Pale, greasy stools
  • Jaundice (uncommon)
38
Q

Obstetric cholestasis usually presents when?

A

Third trimester

39
Q

The biggest complication of obstetric cholestasis is…

A

Stillbirth

40
Q

What population has the highest risk of obstetric cholestasis

A

South-Asian

41
Q

Symptomatic relief in obstetric cholestasis

A

Ursodeoxycholic acid

Pruritis
- Emollients

Insomnia
- Antihistamines

42
Q

Women with obstetric cholestasis have to have induced labour at…

A

37 weeks

- Due to risk of stillbirth

43
Q

Investigations of obstetric cholestasis

A

Bloods

  • LFTs: abnormal liver enzymes,
  • FBC
  • Urea

Abdominal ultrasound

Rule out other causes

  • Viral Hepatitis
  • Primary biliary cirrhosis
  • Acute fatty liver of pregnancy
44
Q

Risks of obstetric cholestasis in pregnancy [5]

A

Dermatitis

Pre-term birth

Neonatal morbidity/ stillbirth

Meconium aspiration

C-section

45
Q

Definition of hyperemesis gravidum

A

Vomiting in pregnancy leading to

  • 5% pre-pregnancy weight loss
  • Dehydration
  • Electrolyte imbalance
46
Q

Complications of hyperemesis gravidum

A

Wernicker’s encephalopathy

Mallory-Weiss tear

Fetal: small for gestation, pre-term birth

403- O&G (21 decks)

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