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Yr 3 - Reproduction > Complications of Pregnancy 2 > Flashcards

Complications of Pregnancy 2 Flashcards

1
Q

What is chronic hypertension in pregnancy?

A

HTN at pre-pregnancy or booking <20wks gestation

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2
Q

What is gestational HTN?

A

BP above but new HTN after 20 weeks

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3
Q

What is pre-eclampsia?

A

New hypertension >20 weeks in association with significant proteinuria

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4
Q

What is significant proteinuria?

A

Strip urine protein >1+
Urinary protein:creatinine ratio >30mg/mmol
24hr urine protein collection >300mg/day

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5
Q

How should HTN be managed pre-pregnancy?

A 
Stop ACEI/ARBs
Diuretics
Lower dietary sodium
Keep BP <150/100
Monitor for pre-eclampsia
Monitor fetal growth
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6
Q

Hypertensive mothers have an increased risk of what?

A

Abruption

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7
Q

How is Pre-eclampsia defined?

A

Mild HTN on 2 occasions more than 4hrs apart
Moderate to severe HTN
+
Proteinuria >300mgms

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8
Q

What is the case of pre-eclampsia?

A

Immunological
Genetic predisposition
Secondary invasion of maternal spiral arterioles impaired
Imbalance between vasodilators/vasoconstrictors in pregnancy

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9
Q

What ar ethe risk factors for pre-eclampsia?

A 
First pregnancy
Extremes of maternal age
PMH
BMI >35
Multiple pregnancy
Chronic HTN
Pre-existing renal disease
Diabetes 
Autoimmune disorders
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10
Q

Which systems are involved in pre-eclampsia?

A 
Renal
Liver
Vascular
Cerebral
Pulmonary
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11
Q

What are the compliactions of pre-eclampsia?

A 
Eclampsia
Stroke/intracerebral haemorrhage
HELLP
DIC
Renal failure
Oedema
IUGR
Fetal distress
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12
Q

What is HELLP?

A

Hemolysis
Elevated liver enzymes
Low platelets

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13
Q

How does severe pre-eclampsia present?

A 
Headache, blurred vision, vomiting, swelling hands, epigastric pain
Severe HTN
Clonus, papilloedema
Reduced urine output
Convulsions
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14
Q

How does severe pre-eclampsia present on blood testing?

A 
Raised liver enzymes
Raised urea and creatinine
Low platelets
How Hb
Features of DIC
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15
Q

What is DIC?

A

Disseminated intravascular coagulation

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16
Q

How is pre-eclampsia managed?

A 
Frequent BP, urine protein
Check for symptoms - headaches, epigastric pain, visual disturbances
Check for clonus
Bloods
LFTs
RFTs
Coagulation screen
CTG
Growth scans for fetus
17
Q

How is pre-eclampsia managed?

A

Antihypertensives
Close monitoring
Steroids for baby if early delivery
Consider induction of labour of condition deteriorates
MONITOR MOTHER as risks persist post delivery

18
Q

Which hypertensives are indicated in pre-eclamptic women?

A

Labetolol
Methyldopa
Nifedipine

19
Q

How are seizures treated in eclampsic women?

A

Magnesium sulphate bolus + IV infusion
IV Labetolol, hydrallazine
Avoid fluid overload

20
Q

What prophylaxis is given in subsequent pregnancies for eclamptic women?

A

Low dose aspirin from 12 weeks til delivery

21
Q

What is gestational diabetes?

A

Diabetes onset in pregnancy
Abnormal glucose tolerance (returns to normal after delivery)
Increased risk T2DM later in life

22
Q

How does diabetes management change in pregnancy?

A

Increased insulin requirements

23
Q

What are the post-delivery effects of pre-existing diabetes in pregnancy?

A

Increased risk of neonatal hypoglycaemia

Increased risk of respiratory distress

24
Q

What are the risks of diabetes in a pregnant mother?

A 
Fetal congenital abnormalities
Miscarriage
Fetal macrosomia, polyhydramnios 
Operative delivery
Stillbirth
25
Q

What congenital abnormalities are more common with maternal diabetes?

A

Cardiac abnormalities

Sacral agenesis

26
Q

What complications are associated with maternal diabetes?

A

Increased risk of pre-eclampsia
Worsened maternal nephropathy, retinopathy, hypoglycaemia (less aware of hypos)
Infections
Neonatal impaired lung maturity

27
Q

How is maternal diabetes managed?

A 
Better glycaemic control
Folic acid 5mg
Dietary advice
Retinal/renal assessment
Metformin (may need to change to insulin)
Glucagon injections
Ketonuria/infection awareness
Monitor fetal growth
Observe for pre-eclampsia 
Macrosomia - c-section
28
Q

What are the risk factors for gestational diabetes?

A 
BMI >30
Previous macrosomic baby >4.5kg
Previous GDM
FH diabetes
Asian women
Polyhydramnios 
Recurrent glycosuria
29
Q

How is GDM screened for?

A

HbA1c at booking - OGTT if >43

Repeat at 24wks

30
Q

How is GDM managed?

A

Controlled blood sugars
Meformin/insulin
OGTT post-delivery
Yearly HbA1c

31
Q

What is the risk of VTE?

A

Virchow’s Triad:
Stasis
Hypercoagulability
Vessel wall injury

32
Q

Why is the risk of VTE increased in pregnancy?

A

Hypercoagulable state
Increased stasis
Vascular damage at delivery

33
Q

Why is pregnancy a hypercoagulable state?

A

Increased fibrinogen, factor VIII, VW factor, platelets
Decreased anticoagnulants
Increased fibrinolysis

34
Q

What are the risk factors for VTE in pregnancy?

A 
Older mothers
Smokers 
High BMI
IVDA
Pre-eclampsia
Dehydration/hyperemesis
Infections
Haemorrhage 
Previous VTE
Sickle cell disease
35
Q

What VTE prophylaxis is used in pregnancy?

A

TED stockings
Advise increased mobility, hydration
Prophylactic anticoagulation if >3 risk factors

36
Q

What are the signs of VTE?

A 
Pain in calf
Swollen leg
Calf muscle tenderness
Breathlessness
Pain on breathing
Tachycardia
Hypoxic
Pleural rub
37
Q

How should VTE be investigated?

A 
Doppler
ECG
Blood gasses
V/Q scan
CTPA

Yr 3 - Reproduction (37 decks)

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