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Obs and Gynae > Complications In Pregnancy > Flashcards

Complications In Pregnancy Flashcards

1
Q

What is the action of ergotamine?

A

Causes contraction of uterus

Used to treat heavy vaginal bleeding in pregnancy

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2
Q

What is the action of endothelin?

A

Potent vasoconstrictor

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3
Q

Action of prostin?

A

Prostaglandin E2
Used in induction of pregnancy
Softens/dilates neck of womb
Stimulates contractions

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4
Q

What is the action of oxytocin?

A

Uterine muscle contraction

Increases production of prostaglandin

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5
Q

Action of Misoprostol?

A

Prostaglandin analogue
Causes cervical ripening
Softening and dilation of the cervix

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6
Q

Action of relaxin

A

Secreted by the placenta

Causes cervix to dilate and prepares the uterus for the action of oxytocin during labour

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7
Q

What is the action of nifedipine?

A

Calcium channel blocker

Used to treat severe hypertension in pregnancy

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8
Q

What is the role of nitric oxide in pregnancy?

A

Nitric oxide levels maintain a healthy flow of blood to the baby
When NO levels in the placenta are reduced or the NO is blocked from doing its work the risk of pre-eclampsia can occur

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9
Q

Role of indomethacin

A

NSAID

Used as a tocolytic medicine - prolongs pregnancy by slowing preterm uterine contractions

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10
Q

Action of terbutaline

A

β2 adrenergic receptor agonist

Help prevent and slow contractions of the uterus

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11
Q

Tocolytic drugs

A 
Nitric oxide 
Relaxin
Magnesium
Terbutaline
Atosiban 
Indomethacin
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12
Q

What is antepartum haemorrhage?

A

Bleeding from genital tract from 24 weeks onwards

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13
Q

Important causes of antepartum haemorrhage

A

Placenta praevia

Placental abruption

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14
Q

Types of HTN in pregnancy

A

Pre-existing - pre or early in pregnancy
Pregnancy induced HTN - HTN after 20 weeks (pre-eclampsia risk 25%)
Pre-eclampsia - HTN after 20 with proteinurea

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15
Q

How does BP change in pregnancy

A

Normal 1st trimester
Drop in 2nd trimester (no drop in prev HTN or pre-eclampsia)
Return to normal/rise in 3rd trimester

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16
Q

How to diagnose pre-eclampsia

A

> 140/90 on 2 occasions 4 hours apart

Proteinurea >300mg/24 hours or >30mg on spot test PRC

17
Q

How does pre-eclampsia happen?

A

Mother predisposed to pre-eclampsia
Leads to poor placental development
Hypoperfused placenta and release of circulating factor
Damages and activates vascular endothelium
HTN, Organ Damage

Associated with foetal growth restriction

18
Q

Management of pre-eclampsia

A

Delivery of placenta

Keep systolic <160 (labetalol, nifedipine, hydrallazine)
Fluid balance - restrict due to risk of pulmonary oedema
Prevention of fits (eclampsia) - magnesium sulphate

19
Q

What is HELLP?

A

Severe pre-eclampsia

Haemolysis
Elevated Liver enzymes
Low Platelets

20
Q

What does small for gestational age (SGA) mean?

A

Weight <10th centile

21
Q

What is Fetal Growth Restriction?

A

Failure off foetus to reach pre determined growth potential due to pathology

Symmetrical - insult early in pregnancy
Asymmetrical - insult late in pregnancy (lack of nutrition)

22
Q

Major risk factors for SGA (12)

A 
Maternal age >40
Smoker >11pd
Paternal or maternal SGA
Cocaine Use
Previous SGA or stillbirth
Chronic HTN
Diabetes with vascular disease
Renal impairment 
Antiphospholipid syndrome
Heavy bleeding PV
Low PAPP-A
Fetal echogenic bowel
23
Q

Minor risk factors for SGA

A 
Maternal age >35
IVF pregnancy
Nulliparity
BMI <20 or 25-34.9
Smoker 1-10pd
Previous PET
Pregnancy interval <6m or >6om
24
Q

Aetiology of FGR

A

Impairment of gas exchange and nutrient delivery to foetus

  • impaired maternal oxygen carrying
  • impaired oxygen delivery
  • placental damage

Intrinsic problems with foetus

  • chromosomal or congenital abnormalities
  • intrauterine infections
25
Q

Short term Implications for foetus FGR/SGA

A
  • premature birth (necrotising enterocolitis, HIE and sequelae, chronic lung disease, NICU stay)
  • Low Apgar’s
  • hypoglycaemia/hypocalcaemia
  • hypothermia
  • polycythemia/hyperbilirubinaemia
26
Q

Long term Implications for foetus FGR/SGA

A 
Learning difficulties
Short stature
Failure to thrive
Cerebral palsy
HTN
T2DM
Heart disease
27
Q

Factors used on growth scan

A

Femur length
Head circumference
Abdominal circumference

Umbilical artery Doppler (should be no resistance)
Liquor volume

28
Q

Management of early onset (<32 week) FGR

A

May suggest congenital infection or chromosomal abnormality
Detailed USS to exclude structural abnormalities
If chromosomal abnormality suspected, offer amniocentesis
Steroids
Intensive monitoring

29
Q

Management of late onset (>32 weeks) FGR

A

Surveillance
Delivery if evidence of Fetal compromise
Steroids if <36 weeks

30
Q

What is the APGAR score?

A

0-2

Appearance blue/acrocyanosis/pink
Pulse absent,<100,>100
Grimace absent,feeble,strong cry
Activity absent,some flexion,full movement
Respiration absent,weak,strong
31
Q

When is APGAR score taken?

A

1 minute
5 minute: normal = >7, neuro damage =<3
As needed

32
Q

What are the signs of magnesium toxicity?

A

Loss of tendon reflexes (due to neuromuscular blockade)
Respiratory depression
Cardiac arrest

33
Q

What pharmacological agents can be used to manage PPH?

A 
Syntocinon
Syntometrine
Ergometrine
Misoprostol
Carboprost
Transexamic acid
34
Q

Symptoms of pre-eclampsia

A 
Severe headache
Blurred vision or flashing
Sever pain just below the ribs
Vomiting 
Sudden swelling of face hands or feet
35
Q

Women at high risk of pre-eclampsia

A 
Hypertension during previous pregnancy 
Chronic kidney disease
Autoimmune diseases (SLE, Antiphospholipid syndrome)
T1 or T2DM
Chronic HTN
36
Q

Advice for women with pre-eclampsia

A

75mg of aspirin from 12weeks

37
Q

Risk factors for gestational HTN

A 
Nulliparity
>40
Pregnancy interval of more than 10 years
FH of pre-eclampsia
Multi-Fetal pregnancy
BMI >35
Gestational age at presentation
Previous  pre-eclampsia or gestational HTN
Pre existing vascular disease
Pre existing kidney disease

Obs and Gynae (19 decks)

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