complications in pregnancy

Question 1

when does preeclampsia occur?

Answer 1

> 20 wk or soon after delivery

Question 2

diagnosis + symptoms of preeclampsia

Answer 2

HTN (>140/90, 2 occasions 4h apart) + proteinuria

oedema
headache + vision problems
papilloedema
RUQ/epigastric pain
hyperreflexia
HELLP components

Question 3

prophylaxis of preeclampsia? who should take?

Answer 3

aspirin 75mg from 12wk till birth

prev hx
CKD
autoimmune conditions
diabetics

Question 4

risk factors for preeclampsia

Answer 4

diabetes, BMI > 30
previous hx
> 40y
1st pregnancy

Question 5

management of severe preeclampsia

Answer 5

fluid balance (pulmonary oedema)
hydralazine (thiazide)
MgSO4 - seizure prevention / treatment
aROM
IV oxytocin + syntocinon at delivery
quick delivery of placenta (placental problem)

Question 6

what is protein S?

Answer 6

anticoagulant factor - reduced in pregnancy

Question 7

how does BP change in pregnancy?

Answer 7

falls in trim 1, stays low trim 2, increases in trim 3 + ends on pre-pregnancy level

Question 8

risks of preeclampsia

Answer 8

mum:
eclampsia
cardiac + organ failure
intra-abdo or cerebral haemorrhage

foetal:
abruption
FGR + prematurity

Question 9

preeclampsia - investigations

Answer 9

serial BP
bloods - renal, liver + urate (organ damage), FBC (low platelets + Hb)
USS - growth restriction
markers of placental function - growth restriction

Question 10

preeclampsia - cure

Answer 10

deliver placenta (ie deliver baby)

Question 11

preeclampsia - management in hospital (where delivery isn’t indicated)

Answer 11

keep BP < 160 - labetalol
fluid balance - risk pulmonary oedema
MgSO4 infusion to prevent eclampsia

Question 12

what is HELLP?

Answer 12

haemolysis - low Hb
elevated liver enzymes - liver damage
low platelets

Question 13

management of HELLP

Answer 13

supportive - replace haematological elements - blood/platelet transfusion

Question 14

monitoring in pregnancy-induced HTN

Answer 14

regular screening of BP + urine for protein - 25% risk preeclampsia

Question 15

pregnancy - induced HTN - drug management

Answer 15

nifedipine / labetalol

Question 16

RFs for foetal growth restriction

Answer 16

previous small baby
smoking
preeclampsia/HTN
renal/other disease

reduced foetal movements

Question 17

foetal growth restriction - screening + diagnosis

Answer 17

customised symphysio-fundal height charts

USS:
EFW from 3 measurements
look at placental function/development

assess blood flow in uterine + umbilical artery + brain vs kidneys - determine if small as placental malfunction vs constitutionally

Question 18

foetal growth restriction - management

Answer 18

exclude causes - infection, chromosomal
monitor growth + FHR
doppler blood flow

steroids for lungs if premature
caesarean if needed

Question 19

APGAR - components

Answer 19

appearance
pulse
grimace
activity
respiration

Question 20

apgar - appearance

Answer 20

0 - blue/pale
1 - acrocyanosis
2 - pink

Question 21

pulse - APGAR

Answer 21

0 - absent
1 - <100
2 - >100

Question 22

grimace - APGAR

Answer 22

0 - no facial expression
1 - weak cry
2 - strong cry

Question 23

activity - APGAR

Answer 23

0 - absent
1 - some flexion
2 - full flexion

Question 24

respiration - APGAR

Answer 24

0 - absent
1 - weak
2 - strong

Question 25

relevance of apgar score at 5 mins

Answer 25

<3 - neuro damage | >7 - normal

Question 26

3 obstetric + 3 non-obstetric causes of abdo pain in pregnancy

Answer 26

labour placental abruption heartburn UTI GE constipation

Question 27

when should foetal movements be felt from?

Answer 27

18-24

Question 28

when does GDM develop?

Answer 28

end of 2nd - early 3rd trimester

Question 29

what are bad signs in case of RFM?

Answer 29

previous RFM in this pregnancy small baby - previous/current (FGR) congenital malformations

Question 30

indications for IOL

Answer 30

foetal problems: IUGR suspicious CTG PRoM with infection/foetal compromise mum's health: preeclampsia diabetic >38wk natural obstetric causes: rhesus incompatibility post dates

Question 31

what is AFP?

Answer 31

protein produced by developing foetus

Question 32

raised AFP - causes

Answer 32

NTDs | multiple pregnancy

Question 33

decreased AFP - causes

Answer 33

``` down's trisomy 18 (edward's) maternal diabetes ```

Question 34

chorioamnionitis - what is it?

Answer 34

emergency - life threatening to mum + foetus | result of ascending bacterial infection of amniotic fluid / membranes / placenta

Question 35

chorioamnionitis - what is the main thing that leads to it?

Answer 35

premature rupture of membranes - exposes sterile environment to pathogens

Question 36

chorioamnionitis - management

Answer 36

prompt delivery of foetus - poss caesarean | IV abx

Question 37

eclampsia - management

Answer 37

IV MgSO4 - til 24h after last seizure or delivery fluid restriction - avoid overload monitor urine output, reflexes, sats, RR

Question 38

group B strep - what is it?

Answer 38

present in 30% of mothers' bowels. infants exposed to it in labour + develop poss serious infections.

Question 39

group B strep - RFs

Answer 39

``` PPPP: Prematurity Prolonged RoM Positive in other sibling Pyrexia eg chorioamnionitis ```

Question 40

group B strep - management? when would you give treatment?

Answer 40

IV benzylpenicillin prophylaxis if PPP: Previous pregnancy was +ve for it Preterm labour Pyrexia in labour

Question 41

IOL - mechanism

Answer 41

membrane sweep intravaginal prostaglandin RoM oxytocin

Question 42

obstetric cholestasis - presentation, risks + management (note management isn't evidence based)

Answer 42

pruritus esp palms, soles, abdo risk prematurity/stillbirth vit K + ursodeoxycholic acid + IOL 37wk ur so deoxy cholic acid

Question 43

oligohydramnios - causes

Answer 43

IUGR (not grown enough) post-dates (grown too much) PRoM (fluid has gone) preeclampsia

Question 44

post term pregnancy - consequences

Answer 44

reduced placental perfusion oligohydramnios need for instrumental / caesarean / induction

Question 45

risks of smoking in pregnancy

Answer 45

IUGR prematurity miscarriage + stillbirth + SIDS

Question 46

risks of alcohol in pregnancy

Answer 46

foetal alcohol syndrome, learning diffs, growth restriction | microcephaly

Question 47

shoulder dystocia - risks

Answer 47

PPH perineal tears brachial plexus injury of foetus

Question 48

shoulder dystocia - management

Answer 48

call senior | mcroberts manoeuvre