Common Disorders in Pregnancy Flashcards
A 27 year old woman at 24 weeks gestation in her first pregnancy comes to see you. She has been on thyroxine 0.1mg per day for the last 5 years to treat hypothyroidism. Her FT4 is 10.5 pmol/L (10-17 pmol/L) and her TSH is 4.2 munits/mL (0.27-4.2 munits/mL). Which of the following statements about her care during this pregnancy is false?
a) Her thyroxine dose is appropriate
b) Her baby should be assessed by the paediatric service after delivery
c) She can breastfeed whilst taking thyroxine
d) The fetal heart rate should be counted at each visit
e) She should have her thyroid function tests checked every 6 weeks
a) Her thyroxine dose is appropriate
A 35 year old woman in her second pregnancy has her routine 36 week bloods and you discover that her platelets have fallen from 210 (x109/L) at 28 weeks to 120 (x109/L) at 36 weeks. Which of the following is correct?
a) She should be referred to a haematologist for review
b) No further examination or investigation is required as she has gestational thrombocytopenia
c) She should have her platelet antibody levels checked
d) The next time she should have her platelets checked is in early labour
e) She should be eligible for an epidural as long as her platelets remain above 100
e) She should be eligible for an epidural as long as her platelets remain above 100
Regarding the risk of preeclampsia in nulliparous women, which statement is correct:
a) Supplementation with fish oil is an effective preventative treatment
b) Proteinuria of 2+ confirms the diagnosis of preeclampsia
c) If the woman’s mother had preeclampsia her risk is 40%
d) A booking blood pressure is 135/78 is not associated with increased risk
e) A booking BMI of 35 is associated with a 10-15% risk
e) A booking BMI of 35 is associated with a 10-15% risk
A 34 year old P2G3 Samoan woman books at 16 weeks with a BMI of 48. In her last pregnancy she developed gestational diabetes, which of the following is true:
a) She should be screened for diabetes at 24 weeks
b) She should be advised to lose 10kg in weight during the pregnancy
c) A fasting glucose of 5.6 is an indication for insulin treatment
d) An Hb A1C of 50mmol/mol suggests she may have type 2 diabetes
e) Weight gain of 9 to 12 kg should be recommended
d) An Hb A1C of 50mmol/mol suggests she may have type 2 diabetes
With regards to management of depression in pregnancy, which of the following is true:
a) Women continuing on SSRIs should be discouraged from breastfeeding
b) Paroxetine has been associated with an increased risk of congenital heart defects
c) Post natal depression is unlikely to be recurrent
d) SSRI drugs should be stopped as soon as pregnancy is diagnosed
e) Women who conceive on SSRI drugs should be offered termination of pregnancy
b) Paroxetine has been associated with an increased risk of congenital heart defects
A 40 year old woman presents to your rooms at 25 weeks gestation (certain dates). She has not received any antenatal care so far. An ultrasound reveals a twin pregnancy. Regarding determination of chorionicity at 25 weeks, which of the following is the best answer?
a) Chorionicity can only be determined in the first trimester
b) If the membrane is thin the twins are always monochorionic
c) If there is a single placental mass these twins are monochorionic
d) If the fetuses have discordant sexes then the twins are always monochorionic diamniotic
e) Unless the fetuses have discordant sexes you cannot determine chorionicity
e) Unless the fetuses have discordant sexes you cannot determine chorionicity
A 30 year old woman presents at 20 weeks gestation for a routine twin pregnancy anatomy scan. Clinically her uterus is tense and the fundal height is 30 cm. The ultrasound reveals a growth restricted twin with oligohydramnios and absent end - diastolic flow in the umbilical artery whereas the larger twin shows cardiomegaly with ascites and severe polyhydramnios. With regards to this twin pregnancy, which of the following is the best answer?
a) If one of the twins dies spontaneously in utero, the risk of cerebral palsy in the surviving twin is low provided the pregnancy reaches 34 weeks
b) Selective laser coagulation of placental anastomoses offers the best survival chances for one or both fetuses
c) Parvovirus intrauterine infection is a likely cause
d) CMV intra-uterine infection is a likely cause
e) Serial amnioreduction offers the best survival chances for one or both fetuses
b) Selective laser coagulation of placental anastomoses offers the best survival chances for one or both fetuses
A healthy G2P1 has a midstream urine test at 15 weeks gestation showing bacteriuria. You recommend treatment because:
a) There is a 10% risk of preterm labour
b) There is likely to be loss of renal parenchyma and renal scarring which will be exacerbated
c) There is an increased risk of developing pre-eclampsia if treatment is not offered.
d) There is a 20-25% chance of developing pyelonephritis in this pregnancy if untreated
e) There is a small but significant risk of antepartum haemorrhage
d) There is a 20-25% chance of developing pyelonephritis in this pregnancy if untreated
A previously healthy Caucasian 23 year old G1 P0 is seen in the clinic at 27 weeks. The blood pressure is 140/90 (booking 135/78) and for the first time 3+ proteinuria is noted. The fundal height measures 27cm and the fetal heart is heard. She has noted some visual disturbance and epigastric discomfort. Raised AST/ALT.
Which of the following drugs is most appropriate now:
a) Betamethasone 11.4mg IM, 2 doses 24 hours apart
b) Methyldopa 250mg q.i.d. commencing now
c) Nifedipine slow release 20mgm b.d commencing now
d) Initiate treatment with low dose aspirin
e) No treatment as fetal growth is satisfactory and the maternal condition is stable
a) Betamethasone 11.4mg IM, 2 doses 24 hours apart
A 19 year old G0 P0 with a history of generalised tonic-clonic epilepsy, but seizure free for 5 years on Sodium Valproate, attends her General Practitioner for advice about pregnancy. She is particularly concerned about the effects of the medication on a future pregnancy. Which of the following do you advise?
a)Folic acid supplementation will reduce the risk of neural tube defect to levels as low as the general population
b) If she remained on Sodium Valproate, Vitamin K supplementation would be recommended from 36 weeks gestation
c) She should lower her dose of Sodium Valproate, or change to another anticonvulsant pre-pregnancy
d) Carbemazepine is recommended in place of Sodium Valproate as it is not teratogenic
e) Most anticonvulsants are excreted in high concentrations in breast milk so breast feeding is not advised
c) She should lower her dose of Sodium Valproate, or change to another anticonvulsant pre-pregnancy
Anti D should be administered to the rhesus negative pregnant woman in the following situations EXCEPT:
a) Salpingectomy for an ectopic pregnancy
b) Evacuation of uterus for incomplete miscarriage at 7 weeks
c) Appendicectomy at 14 weeks
d) A 14 week miscarriage with medical management
e) 15 week complete miscarriage
c) Appendicectomy at 14 weeks
With regard to antenatal screening for risk of maternal postnatal psychiatric illness:
a) It should be delayed until late pregnancy
b) It should include the Edinburgh Post Natal Depression Score
c) It should include questions on family history of bipolar Disorder
d) Screening is unlikely to reduce postnatal morbidity
e) It will accurately predict the development of post natal depression
c) It should include questions on family history of bipolar Disorder
Angela is a 32 year old G1P0 attending a routine antenatal clinic appointment at 36 weeks. She complains of fatigue, headache and swollen ankles. What is the most likely diagnosis?
a) Normal pregnancy
b) Pre-eclampsia
c) HELLP syndrome
d) Deep vein thrombosis
e) Venous sinus thrombosis
a) Normal pregnancy
With regard to pertussis (whooping cough) vaccine in pregnancy, which of the following is false?
a) It should be given between 28-38 weeks in pregnancy
b) Babies can be immunised at 6 weeks
c) The Boostrix vaccine confers protection against whooping cough, diphtheria and tetanus
d) In New Zealand it is free for fathers to be vaccinated
e) Most infections in neonates are caught from parents or close relatives
d) In New Zealand it is free for fathers to be vaccinated
Which of the following about cholestasis in pregnancy is false?
a) Common symptoms are itch of the soles and palms
b) There is thought to be an association with an increased rate of stillbirth
c) There is an increased risk of fetal growth restriction
d) Recurrence rates of up to 90% have been reported
e) Combined oral contraceptive use is not appropriate post-partum
c) There is an increased risk of fetal growth restriction
