Complications of pregnancy and labour

Question 1

What is the definition of anaemia during the first trimester of pregnancy?

Answer 1

Hb<110g/L

Question 2

What is the definition of anaemia during the second/third trimester of pregnancy?

Answer 2

Hb<105g/L

Question 3

What is the definition of anaemia postpartum?

Answer 3

Hb<100g/L

Question 4

What are the symptoms of anaemia?

Answer 4

1. Fatigue
2. Pallor
3. Weakness
4. Headache
5. Palpitations
6. Dizziness
7. Dyspnoea
8. Irritability
9. Pica
10. Impairment fo temperature regulation

Question 5

What are the consequences of anaemia on pregnancy?

Answer 5

1. Decreased immune function
2. Poor work capacity
3. Disturbance of postpartum cognition/emotions
4. Pre-term delivery
5. LBW
6. Placental abruption

Question 6

What additional precautions may be necessary for women with anaemia during delivery?

Answer 6

1. Delivery in hospital setting
2. Available IV access
3. Group & save
4. Active management of third stage of labour
5. Plans for excessive bleeding

Question 7

How should a woman with pre-existing anaemia be managed?

Answer 7

Women with established iron deficiency anaemia should be given 100- 200mg elemental iron daily. Supplementation should be continued for 3 months

Question 8

What are the main concerns with regard to a neonate born to a DM (esp. uncontrolled) mother?

Answer 8

1. Neonatal hypoglycaemia
2. Congenital heart defects
3. Sacral agenesis
4. Neonatal jaundice (due to polycythaemia)
5. Macrosomia

Question 9

What risks do DM present to a pregnancy?

Answer 9

1. Miscarriage
2. Congenital malformation
3. Stillbirth
4. Neonatal death

Question 10

What is the preconception target for HbA1c?

Answer 10

<6.5% - women should be advised to continue with contraception until this target is met

Question 11

What dose of folic acid should a DM mother take?

Answer 11

5mg/dy until 12/40

Question 12

What is the first choice for long acting insulin in pregnancy?

Answer 12

Isophane insulin

Question 13

How many times per day should a DM woman test her blood glucose?

Answer 13

4 - fasting, pre-meal, 1-hour post-meal and bedtime

Question 14

What should the fasting blood glucose reading of a DM pregnant woman be?

Answer 14

5.3mmol/L

Question 15

What should the 1-hour post-meal blood glucose reading of a DM pregnant woman be?

Answer 15

7.8mmol/L

Question 16

From 28-36wks, how often should DM women be offered USS screening?

Answer 16

Every 4wks

Question 17

What are the maternal complications of HTN in pregnancy?

Answer 17

1. Placental abruption
2. DIC
3. Cerebrovascular accident

Question 18

What are the foetal complications of HTN in pregnancy?

Answer 18

1. IUGR
2. Intrauterine death
3. Prematurity

Question 19

What defines mild gestational HTN?

Answer 19

BP 140/90-149/99

Question 20

How is mild gestational HTN treated?

Answer 20

As an OP
Check BP weekly
Check for proteinuria at each antenatal visit
No additional blood tests required

Question 21

What defines moderate gestational HTN?

Answer 21

BP 150/100-159/109

Question 22

How is moderate gestational HTN treated?

Answer 22

As an OP
Treat with labetalol to 150/80-100
Check BP 2x per wk
Check for proteinuria at each antenatal visit
U&Es, FBC, LFTs in first instance. Do not repeat if there is no proteinuria at subsequent visits

Question 23

What defines severe gestational HTN?

Answer 23

BP ≥160/110

Question 24

How is severe gestational HTN treated?

Answer 24

Admit as an inpatient until BP ≤159/109
Treat with labetalol to 150/80-100
BP 4x daily
Check for proteinuria daily
Weekly U&Es, FBC, LFTs

Question 25

When is proteinuria considered significant in pregnancy?

Answer 25

When proteinuria exceeds 300 mg/24 hours at any gestation

Question 26

What is antepartum haemorrhage (APH)?

Answer 26

Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby

Question 27

What are the most important causes of APH?

Answer 27

1. Placental abruption

2. Placenta praevia