Conditions of Pregnancy

Question 1

What do palpitations and/or extra-systoles indicate in pregnancy?

Answer 1

Nothing - they are very common and mostly benign

Question 2

What is the most common and mostly benign murmur of pregnancy?

Answer 2

Systolic murmur

Question 3

What is the most common arrhythmia of pregnancy?

Answer 3

SVT

Question 4

What is used for anti-coagulation in pregnancy?

Answer 4

LMWH

Question 5

What drug is used for hypertension in pregnancy?

Answer 5

Labetalol

Question 6

What might orthopnoea in pregnancy during the 3rd trimester indicate?

Answer 6

Peri-partum cardiomyopathy (cardiac failure in 3rd trimester)

Question 7

Where is the most common place to get a DVT in pregnancy?

Answer 7

Left leg - ileo-femoral

Question 8

Out of this list, which drugs are safe in pregnancy and which are not?

• NSAIDs
• Steroids
• Aspirin
• Methotrexate
• Sulfasalazine
• Hydroxychloroquine
• Insulin
• Azathioprine
• Phenytoin
• Carbamazepine
• Sulfonylureas
• Lamotrigine
• Sodium valproate

Answer 8

Safe:

• Steroids
• Azathioprine
• Sulfasalazine
• Hydroxychloroquine
• Aspirin
• Lamotrigine
• Carbamazepine
• Insulin

Not safe:

• NSAIDs
• Methotrexate
• Sodium valproate
• Phenytoin
• Sulfonylureas

Question 9

What epilepsy drug causes cleft palate in pregnancy?

Answer 9

Phenytoin

Question 10

What epilepsy drug causes neural tube defects in pregnancy?

Answer 10

Sodium valproate

Question 11

What is the treatment for Rhesus disease?

Answer 11

Anti-D

Question 12

What are the first line drug for morning sickness/hyperemesis gravidarum?

Answer 12

Cyclizine

Question 13

What are the risk factors for gestational diabetes?

Answer 13

• BMI >30 kg/m2
• Previous macrosomic baby weighing 4.5 kg or above
• Previous gestational diabetes
• Family history of diabetes (first‑degree relative with diabetes)
• South Asia (India / Pakistan / Bangladesh), Middle Eastern, Black Caribbean
• Polyhydramnios

Question 14

How much folic acid should diabetics take in pregnancy?

Answer 14

5mg 3 months before conception to 12 weeks of pregnancy

Question 15

What is the definition of pre-eclampsia?

Answer 15

Pregnancy induced hypertension + proteinuria

Question 16

What is the classic triad of pre-eclampsia?

Answer 16

• Hypertension – increasing BP since 20th week
• Proteinuria (≥0.3g/l or ≥0.3g/24h)
• Oedema – especially hands and face

Question 17

What does HELLP syndrome stand for

Answer 17

Haemolysis, Elevated Liver Enzymes, Low Platelets

Question 18

Name as many signs and symptoms of pre-eclampsia as you can

Answer 18

• Hypertension/proteinuria/oedema (classic triad)
• Headache
• Visual disturbance
• Epigastric / RUQ pain
• Nausea / vomiting
• Disorientation
• Small for gestational age / fetal growth restriction
• Hyper-reflexia / involuntary movements / clonus
• ARDS

Question 19

What is the treatment for pre-eclampsia?

Answer 19

• Labetolol/methyldopa/nifedipine for hypertension
• 75mg aspirin for high risk women
• Steroids before delivery

Question 20

What is the definition of eclampsia?

Answer 20

Tonic-clonic seizure + features of pre-eclampsia

Question 21

What is the treatment for eclampsia?

Answer 21

• IV labetolol/IV Hydralazine for BP
• Run patient dry to avoid pulmonary oedema
• Magnesium sulphate for seizures
• Aim for vaginal birth but c-section if necessary

Question 22

What is aortocaval compression?

Answer 22

From 20 weeks gestation, in the supine position the gravid uterus can compress IVC and aorta reducing venous return.

Compressed vessels = decreased cardiac output = hypotension = collapse

Question 23

What is the treatment for aortocaval compression?

Answer 23

Turn women into left lateral position