Clinically deteriorating woman

Question 1

Pregnancy specific causes of collapse

Answer 1

PPH
Obstetric haemorrhage
Accreta
Uterine rupture
Amniotic fluid pulmonary embolism
Pre-eclampsia/eclampsia
Chorio/endometritis/sepsis
Post partum cardiomyopathy
Acute fatty liver disease

Question 2

What are the symptoms of local anaesthetic toxicity

Answer 2

tinnitus, blurred vision, dizziness, tingling

SEVERE –> tonic-clonic activity

Question 3

What is the treatment for local anaesthetic toxicity

Answer 3

lipid emulsion therapy

Question 4

What is the upper limit of creatinine in pregnancy

Answer 4

ideally lower than 70.

Question 5

Why does blood pressure decrease during pregnancy

Answer 5

oestrogen and progesterone dilate the vasculature

Question 6

ECG changes with pregnancy

Answer 6

LAD, some ST segment depression, flattening of T in lead III

Question 7

Changes with cardiac output during pregnancy

Answer 7

Higher stroke volume, higher heart rate –> higher cardiac output

Question 8

What is the cause of physiological anaemia in pregnancy

Answer 8

The plasma is increased by oestrogen and progesterone stimulating the renin-angiotensin - increases by 45%

The renal EPO increases red cell production but by 35%

This leads to haemodilution

Question 9

When do white cells go back to normal after birth

Answer 9

4 weeks

Question 10

What happens to clotting during pregnancy

Answer 10

All clotting factors ( apart from fXI and XIII) and fibrinogen go up.

Platelet production is increased but plt fall due to dilution

These changes increase coagulability to be protective against blood loss but also increase the risk of VTE

Question 11

What happens to the resp system during pregnancy

Answer 11

Hormones (progesterone) make the ligaments more lax and therefore the chest wall can compensate for the inferior space being taken up by the gravid uterus.

Oxygen consumption massively increases and there is a decreased functional residual capacity so mums can become hypoxic quite quickly.

Takes 6-12 weeks to go back to normal

Question 12

What are the changes with gastro system during pregnancy

When does it return to normal?

Answer 12

GI motility decreases, food absortion decreases and lower oesophageal spincter pressure decreases

Progesterone causes the sphincter to relax

24-48h after

Question 13

Why is ALP raised in pregnancy?

Answer 13

Excreted by the placenta

Question 14

What happens to glucose levels during pregnancy

Answer 14

fasting glucose is lower because of increased substrate use

human placental lactogen causes insulin resistance. This means glucose is higher after meals and causes it to diffuse across the placenta to the baby.

The fetus relies on its own insulin as insulin does not cross the placenta