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O&G > Diseases in and of pregnancy > Flashcards

Diseases in and of pregnancy Flashcards

1
Q

What is oligohydramnios?

A

Amniotic fluid less than expected for gestational age

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2
Q

What is polyhydramnios?

A

Amniotic fluid greater than expected for gestational age

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3
Q

What is the combination of intrauterine growth restriction and polyhydramnios suggestive of?

A

Trisomy 18 (Edwards syndrome)

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4
Q

What strain of GBS is carried by up to 20% of women vaginally?

A

Streptococcus agalactiae

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5
Q

What are 3 foetal risks of GBS?

A
  1. Preterm labour
  2. Rupture of membranes
  3. Neonatal infection
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6
Q

What is the nuchal translucency test?

A

Done during 11-14w USS

Measures the subcutaneous area between the skin and cervical spine of the foetus in the sagittal section

Nuchal translucency increases when fluid accumulates in the area e.g. in Down Syndrome

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7
Q

What tests are done around week 12 to screen for Down Syndrome?

A

Nuchal translucency (USS)

bHCG (elevated)

PAPP-A (decreased)

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8
Q

What is PAPP-A?

A

Pregnancy-associated protein A

A serum protein mainly synthesised by the placenta and therefore increases in pregnancy

Decreased in conditions involving chromosomal aberration

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9
Q

Why is hepatitis B screened for in pregnancy?

A

High rate of perinatal transmission

If an infant is infected the risk of chronic hepatitis is 90%

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10
Q

When in pregnancy is chorionic villus sampling (CVS) performed?

A

10-13 weeks

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11
Q

From when in pregnancy can amniocentesis be performed?

A

From the 15th week of pregnancy onwards

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12
Q

What is the risk of miscarriage with CVS?

A

1%

0.5% for amniocentesis

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13
Q

What is the definition of a spontaneous abortion/miscarriage?

A

Loss of pregnancy before 20 weeks’ gestation

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14
Q

What is the definition of a stillbirth?

A

Loss of pregnancy after 20 weeks’ gestation

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15
Q

What is a threatened abortion and is the cervical os closed or dilated?

A

Vaginal bleeding has occurred and the cervical os is closed, but the diagnostic criteria for spontaneous abortion has not been met

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16
Q

What is an inevitable abortion? Is the cervical os open or closed?

A

The patient has vaginal bleeding and visible/palpable products of conception

The internal cervical os is open

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17
Q

What is an missed abortion? Is the cervical os open or closed

A

Abortion in which the products of conception are not expelled spontaneously from the uterus. Symptoms of early pregnancy e.g. nausea, breast tenderness, disappear

The cervical os is closed

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18
Q

What is an incomplete abortion? Is the cervical os open or closed

A

Products of conception within the cervical canal or uterus

Open cervical os

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19
Q

What is a complete abortion? Is the cervical os open or closed?

A

Products of conception are entirely out of the uterus and cervix

The cervical os is closed, the uterus is small and well-contracted, vaginal bleeding and pain may be mild or resolved

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20
Q

How is a threatened abortion managed?

A

Expectant

(symptoms will resolve or progress to inevitable, incomplete or complete abortion)

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21
Q

What is a grade 1 perineal tear?

A

Laceration of the vaginal mucosa or perineal skin only

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22
Q

What is a grade 2 perineal tear?

A

Laceration involving the perineal muscles

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23
Q

What is a grade 3 perineal tear?

A

Laceration involving the anal sphincter muscles

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24
Q

What is a grade 4 perineal tear?

A

Laceration extending through the anal epithelium resulting in a communication of the vaginal and anal epithelium

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25
Q

What is the quantitiative definition of oligohydramnios?

A

Amniotic fluid index (AFI) < 5cm

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26
Q

What is the quantitiative definition of polyhydramnios?

A

Amniotic fluid index (AFI) > 25cm

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27
Q

What are 3 causes of a higher than expected hCG?

A
  1. Molar pregnancy
  2. Twins
  3. Choriocarcinoma
  4. Embryonic carcinoma
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28
Q

What are 2 causes of a lower than expected hCG?

A
  1. Ectopic pregnancy
  2. Threatened abortion
  3. Missed abortion
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29
Q

What is the most common cause of abnormal hCG?

A

Inaccurate dating

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30
Q

What is the intrapartum treatment for GBS positive mothers?

A

IV penicillin or ampicillin

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31
Q

When is GBS screened for in pregnancy?

A

35-37 weeks

GBS carriage fluctuates so colonisation is screened close to term

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32
Q

What is the treatment of intrahepatic cholestasis of pregnancy?

A

Ursdeoxycholic acid (a bile acid; symptomatic relief and may improve foetal outcomes)

Delivery at 37 weeks

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33
Q

What is the major function of human chorionic somatomammotropin (human placental lactogen)?

A

Increases maternal insulin resistance

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34
Q

What is the definition of gestational hypertension?

A

Onset after 20 weeks gestation

SBP > 140

DBP > 90

On two separate occasions at least 4 hours apart

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35
Q

What is the definition of pre-eclampsia?

A

Gestational hypertension with

  • proteinuria
  • renal insufficiency
  • thrombocytopenia
  • evidence of liver damage
  • pulmonary oedema
  • cerebral oedema
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36
Q

What is HELLP syndrome?

A

A life-threatening form of pre-eclampsia

H = haemolysis

EL = elevated liver enzymes

LP = low platelets

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37
Q

What are 3 teratogenic effects of ACE inhibitors?

A
  1. Altered kidney development
  2. Neonatal renal failure
  3. Pulmonary hyperplasia
  4. Foetal growth retardation
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38
Q

What is alloimmunisation?

A

An immune response to foreign antigens after exposure to genetically different cells or tissues

e.g. pregnancy, transplant, transfusion

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39
Q

What condition is characterised by hyperthryoidism in the first trimester which spontaneously resolves?

A

hCG-mediated hyperthyroidism

hCG acts on the maternal thyroid

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40
Q

Which drugs are used for hyperthyroidism in pregnancy?

A

Propylthiouracil until 16 weeks

Carbimazole may be taken after 16 weeks

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41
Q

What is postpartum lymphocytic thyroiditis?

A

Autoimmune thyroiditis within a year of birth

Hyperthyroidism → hypothyroidism → recovery

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42
Q

How is hypothyroidism in pregnancy treated?

A

Levothyroxine

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43
Q

What are the adverse effects of cocaine use during pregnancy?

A

Vasoconstriction

→ placental abruption

→ preterm birth

→ low birth weight

→ small for gestational age

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44
Q

How is foetal anaemia assesed?

A

Blood flow through the middle cerebral artery on US

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45
Q

What are the sonographic features of hydrops?

A

Ascites, pleural and pleural effusions (rims of echolucent fluid inside the abdominal wall, chest and heart)

Skin oedema (subcutaneous tissue thickness on chest or scalp > 5mm) - late sign

May also be associated with polyhydramnios and placental oedema

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46
Q

When do pregnant women have an OGTT?

A

Weeks 26-28

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47
Q

What fasting plasma glucose is diagnostic of GDM?

A

5.1 mmol/L or greater

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48
Q

What 1-hour glucose following 75g oral load is diagnostic of GDM?

A

10.0 or greater

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49
Q

What 2-hour glucose following 75g oral load is diagnostic of GDM?

A

8.5 or greater

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50
Q

What is hydrops fetalis?

A

Abnormal fluid accumulation in two or more foetal compartments

(ascites, pleural effusion, pericardial effusion, skin oedema)

May also be associated with polyhydramnios and placenta oedema

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51
Q

What is the most common cause of recurrent miscarriages in the second trimester?

A

Bicornate uterus, resulting from incomplete fusion of the paramesonephric ducts during uterine development

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52
Q

Name 3 conditions that predispose a women to preeclampsia or eclampsia

A
  1. Hypertension
  2. Chronic renal disease
  3. Diabetes
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53
Q

What is thought to be the initial insult that leads to increased vascular tone in preeclampsia?

A

Poor dilation of the spiral arteries → placental insufficiency → increased vascular tone

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54
Q

If a foetal anomaly has caused polyhydramnios, what process is likely failing to occur?

A

Swallowing of amniotic fluid

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55
Q

Name two congenital conditions associated with polyhydramnios

A

Oesophageal or dueodenal atresia

Anecephaly

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56
Q

If a foetal anomaly has caused oligohydramnios, what process is likely failing to occur?

A

Decreased urine excretion

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57
Q

Name two congenital conditions associated with oligohydramnios

A
  1. Bilateral renal agenesis (no urinary tract)
  2. Posterior urethral valves (obstructed urinary excretion)
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58
Q

What is the Potter sequence?

A

Oligohydramnios → decreased amniotic fluid ingestion → pulmonary hypoplasia (severe neonatal respiratory insufficiency) → death

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59
Q

What are the main DDx for RUQ pain in pregnancy?

A
  1. Gallstones
  2. Severe preeclampsia/HELLP
  3. Acute fatty liver
60
Q

Which anticoagulant is preferred for thromboprophylaxis during pregnancy?

A

LMHW

Clexane/enoxaparin

61
Q

What is the second most common clinical feature of pre-eclampsia, following hypertension?

A

Proteinuria

62
Q

List 8 clinical features of pre-eclampsia

A
  1. Protienuria
  2. Elevated creatinine
  3. Oliguria
  4. Raised transaminases
  5. Epigastric/RUQ pain
  6. Convulsions
  7. Hyper-reflexia with sustained clonus
  8. Headache
  9. Visual disturbances (blurring, photopsia, scotoma, cortical blindness)
  10. Stroke
  11. Pulmonary oedema
63
Q

What is the definition of gestational hypertension?

A

New-onset hypertension wihtout maternal or foetal signs of pre-eclampsia after 20 weeks gestation

64
Q

What are 5 maternal complications of pre-eclampsia?

A
  1. Placental abruption
  2. DIC
  3. HELLP syndrome
  4. Ascites
  5. Pulmonary oedema
  6. Acute renal failure
  7. Liver rupture
  8. ICH
  9. Eclampsia
65
Q

What are two foetal complications of pre-eclampsia?

A
  1. Growth restriction
  2. Death
66
Q

List 5 risk factors for pre-eclampsia

A
  1. Family history of pre-eclampsia
  2. Pre-eclampsia in a previous pregnancy
  3. Late maternal age
  4. 1st pregnancy
  5. New partner
  6. Multiple gestation
  7. Chronic hypertension
  8. Chronic renal disease
  9. GDM
  10. Thrombophilia
67
Q

Why do mothers with pre-eclampsia have hyper-reflexia with clonus?

A

Vascular dysfunction → cerebral damage → damage of UMNs → loss on LMN inhibition

68
Q

Why do women with pre-eclampsia have weight gain, oedema, crackles, papilloedema?

A

Endothelial dysfunction → increased vascular permeability

69
Q

Why do patients with pre-eclampsia have RUQ pain?

A

Endothelial dysfunction → vasoconstriction → hepatic venous congestion → liver enlargement → stretching of the liver capsule

70
Q

Why can women with pre-eclampsia have an AKI?

A

Endothelial dysfunction → arterial vasoconstriction → afferent arteriole vasoconstriction → decreased GFR

71
Q

Why can oligohydramnios be a feature of pre-eclampsia?

A

Decreased placental perfusion → decreased foetal blood flow → redistribution of blood from the kidneys towards more vital organs

72
Q

What signs warrant the use of magnesium sulfate prophylactically in women with pre-eclampsia?

A

Hyperreflexia/clonus

Severe headache

Visual changes

Severe preeclampsia (DBP > 110, proteinuria >300mg, thrombocytopenia)

73
Q

What is a velamentous cord insertion?

A

Abnormal cord insertion into the chorioamniotic membranes, resulting in exposed vessels only surrounded by foetal membranes in the absence of protective Wharton’s jelly

74
Q

What are the glycaemic targets for GDM?

A

Fasting: < 5.0 mmol/L

2 hours post-prandial: < 6.7 mmol/L

HbA1c: < 6%

75
Q

What is the Kleihauer-Betke test?

A

Blood test used to measure the amount of foetal haemoglobin transferred from a foetus to a mother’s bloodsteam

Usually performed in Rh-negative mothers to determine the required dose of anti-D

76
Q

What dosages of anti-D are used?

A

625 IU

250 IU is only used for a 1st trimester sensitising event

77
Q

What are the most common congenital abnormalities associated with diabetes in pregnancy?

A
  1. Cardiac (2/3) e.g. TGA, VSD, PDA
  2. Ancephaly and spina bifida

Highest risk in women with previous diabetes and poor glycaemic control at conception

    1. Flexion contracture of the limbs*
    1. Vertebral abnormalities*
    1. Cleft palate*
78
Q

How is varicella zoster exposure in non-immune women managed in pregnancy?

A

Zoster immunoglobulin

79
Q

How should a pregnant woman infected with varicella zoster be managed?

A

<24 hours since onset of rash: oral acyclovir

>24 hours: no treatment, monitor

80
Q

What is alloimmunisation?

A

An immune response to foreign antigens after exposure to genetically different cells or tissues

81
Q

What are the risks to the recipient twin in twin-twin transfusion syndrome?

A

Polycythemia

Polyhydraminos (if diamniotic)

82
Q

What are the risks to the donor twin in twin-twin transfusion syndrome?

A

Anaemia

Growth retardation

Oligohydramnios (if diamniotic)

83
Q

What drug is used to treat UTIs in pregnancy?

A

Cephalexin

84
Q

What laboratory investigations should be done for a woman who presents with antepartum haemorrhage?

A

FBC

Coagulation screen

Group and save, crossmatch

Rhesus and Kleihauer if positive

UEC, LFT

85
Q

What is the Kleihauer test?

A

Examining the blood film of the mother to look for fetal blood cells and hence determine whether there has been feto-maternal haemorrhage (as seen with placental abruption)

Foetal cells are less susceptible to acidic solutions

86
Q

What are the clinical features of placenta praevia?

A

Painless antepartum haemorrhage

87
Q

What would you expect to find on digital examination of a woman with antepartum haemorrhage caused by placenta praevia?

A

YOU MUST NEVER DO A DIGITAL EXAMINATION OF A WOMAN WITH SUSPECTED PLACENTA PRAEVIA AS THIS CAN PROVOKE MASSIVE BLEEDING

88
Q

What would you expect to find on abdominal examination of a woman with antepartum haemorrhage caused by placenta praevia?

A

Soft, non tender uterus

Cephalic presentation not engaged

89
Q

What are the risk factors for developing placental abruption?

A

Hypertension

Preeclampsia/eclampsia

Abdominal trauma

Cocaine/smoking

Previous abruption

Young/old maternal age

90
Q

On abdominal palpation of a patient with placental abruption, what would you expect to find?

A

Tender and firm uterus

91
Q

What test would confirm that blood loss is fetal and therefore possibly as a result of vasa praevia?

A

Kleihauer test - this must only be done if the CTG is normal as otherwise delivery should not be delayed.

92
Q

What is circumvallate placenta?

A

A type of placental disease in which the fetal membranes (chorion and amnion) “double back” on the fetal side around the edge of the placenta.

Does not affect placental function

93
Q

What are the risk factors for placenta accreta?

A

Prior damage to the endometrium e.g., ablation, D&C

Previous cesarean section

94
Q

If using hydralazine IV as an antihypertensive in a pregnant woman, what must you give before administering the drug?

A

Bolus of fluid as can cause rapid hypotension

95
Q

What % of patients with eclampsia have their seizures postnatally?

A

40% occur within 48 hours of delivery

96
Q

What is the MoA of methyldopa?

A

Alpha agonist

Prevents vasoconstriction

97
Q

What is the MoA of labetalol?

A

Alpha and beta blocker

98
Q

When in pregnancy is the risk of seizures at its highest?

A

Labour and the 24 hours following delivery. Epileptics women are advised against having home births.

99
Q

What are the guidelines surrounding breast feeding and anti-epileptic medications?

A

Breast feeding is considered safe in epileptic mothers taking medications.

100
Q

How should hyperthyroidism be treated while the mother is breastfeeding?

A

Carbimazole

101
Q

What is the role of vitamin K in obstetric cholestasis?

A

Give when prothrombin time is prolonged

102
Q

What are the risk factors for acute fatty liver of pregnancy?

A

Prior history

Multiple gestation

Pre-eclampsia/HELLP

Male fetal sex

Low BMI

103
Q

How do we treat people with acute fatty liver of pregnancy?

A

Stabilisation

Correction of hypoglycaemia and coagulopathy

Delivery

104
Q

When in pregnancy does acute fatty liver of pregnancy occur?

A

Third trimester

105
Q

What are the complications of acute fatty liver of pregnancy?

A

Acute liver failure

Acute renal failure

Encephalopathy

Fetal and maternal death (10%)

106
Q

What makes pregnancy a pro-thrombotic state?

A

Increase in certain clotting factors

Increase in fibrinogen levels

Decrease in fibrinolytic activity

Decrease in protein S and antithrombin

Increased venous stasis in lower limbs (left more than right)

107
Q

At what point will pregnant women be screened for HIV?

A

At booking appointment

108
Q

When does puerperal psychosis usually start?

A

2-3 weeks postnatally

109
Q

Are anti-psychotic medications safe in pregnancy and breastfeeding?

A

Data is limited but optimistic

Use the lowest dose of a single antipsychotic

110
Q

What congenital abnormality is associated with Lithium use in bipolar mothers?

A

Cardiac defects

111
Q

When in pregnancy do women tend to be affected by nausea and vomiting in pregnancy (NVP)?

A

Onset: 4-7/40

Peak: 9/40

Resolution: 20/40

112
Q

How do you manage hyperemesis gravidarum?

A
  1. H1 antagonists e.g., promethazine/doxylamine
  2. Phenothiazines e.g., prochlorperazine
  3. Metoclopramide
  4. Ondansetron

Ginger, fluids

113
Q

How are VTEs in pregnancy treated?

A

LMWH

Continue for the remainder of pregnancy and at least 6 weeks postnatally

114
Q

What is the loading dose for magnesium sulfate

A

4g (will be in 8mL)

115
Q

How is hyperemesis gravidarum diagnosed?

A
  1. > 5% prepregnancy weight loss
  2. Dehydration
  3. Electrolyte imbalance
116
Q

What happens to urea in pre-eclampsia?

A

Elevated

Afferent arteriolar vasoconstriction

117
Q

What is the apt test?

A

Hemoglobin alkaline denaturation test (Apt test)

  1. A foetal blood sample is mixed with an alkali
  2. If the mixture turns red to green-brown it contains foetal and maternal blood
118
Q

What is the first sign of magnesium toxicity?

A

Loss deep tendon reflexes (followed by respiratory then cardiac arrest)

119
Q

What is the antidote for magnesium sulfate?

A

Calcium gluconate

120
Q

Name 10 risk factors on the maternity VTE score

A
  1. Personal history of VTE
  2. Thrombophilia
  3. Ovarian hyperstimulation syndrome
  4. Cancer
  5. Pre-existing diabetes with vascular complication
  6. Nephrotic syndrome
  7. BMI > 30
  8. Non-obstetric surgery in pregnancy
  9. Parity 4+
  10. Smoker
  11. Extensive varicose veins
  12. Current sepsis
  13. Prolonged restricted mobility
  14. Pre-eclampsia in current pregnancy
  15. Mulitple pregnancy
  16. Hyperemesis
  17. PPROM
  18. Abruption
  19. 1st degree relative with VTE
121
Q

When are pregnant women at the greastest risk of VTE?

A

Postnatally

122
Q

For which condition is smoking in pregnancy protective?

A

Pre-eclampsia

123
Q

How is asymptomatic bacteruria/UTIs/pyelonephritis treated in pregnancy?

A

Cephalexin

OR

Amoxycillin + clavulanate

124
Q

Can trimethoprim be used in pregnancy?

A

Avoid in the first trimester

Safe in 2nd and 3rd trimesters

125
Q

What is the importance of good glycaemic control intrapartum?

A

Hyperglycaemia is associated with fetal acidosis and neonatal hypoglycaemia

126
Q

What is the BP target in the management of pre-eclampsia?

A

140/90 +/- 10

Avoid hypotension

127
Q

Are uterine contractions more characteristic of placental abruption or placenta previa?

A

Placental abruption

128
Q

What proportion of pregnancies with maternal rubella infection result in fetal damage?

A

90%

+ the baby sheds the virus for 6-12 months after birth if it survives

129
Q

How are children born to HBV +ve mothers treated?

A

Immunisation and immunoglobulins at birth

130
Q

What is the significance of absent end-diastolic flow (AEDF) in an umbilical artery Doppler?

A

Indicates foetal vascular stress in mid/late pregnancy

Placental insufficiency → increased placental resistance → reduced diastolic flow

Associated with IUGR

131
Q

In which leg are DVTs in pregnancy more common?

A

Left (75%)

132
Q

How does maternal age affect Down Syndrome risk? specific numbers

A

20 - 1:1500

30 - 1:900

35 - 1:350

40 - 1:100

45 - 1:30

50 - 1:6

133
Q

How are pregnancy women with antiphospholipid syndrome managed?

A

Aspirin and LMWH from conception

134
Q

How is single deepest pocket interpreted?

A

Oligohydramnios - depth < 2cm

Normal - depth 2-8cm

Polyhydramnios - depth > 8cm

135
Q

What are the antepartum risks of obesity?

A

Early pregnancy loss

Preterm birth (induced and spontaneous)

Gestational hypertension

Pre-eclampsia

Obstructive sleep apnoea

Thromboembolism

VTE

136
Q

What are the neonatal risks of GDM?

A

RDS

Jaundice

Hypoglycaemia

Prematurity

Polycythemia

Macrosomia - shoulder dystocia, fratures, palsies, caesarean section, HIE

Hypocalcaemia

137
Q

What are the teratogenic effects of trimethoprim?

A

Neural tube defects

Folic acid antagonist

138
Q

What marker on the 2nd trimester quadruple screen is abnormal in neural tube defects?

A

Alpha feto protein

139
Q

How are mothers with hepatitis B managed in pregnancy?

A

Tenofovir in the 3rd trimester

To prevent transmission intrapartum

140
Q

What does a positive HBsAg suggest?

A

Hepatitis B surface antigen

Suggests active infection, acute or chronic

141
Q

What does a positive anti-HBs suggest?

A

Hepatitis B surface antibody

Suggests life-long immunity, either resolved infection or vaccination

142
Q

What does positive anti-HBc IgM suggest?

A

Current infection

Positive 4-8 months after infection

143
Q

What does a positive anti-HBc IgG suggest?

A

Resolution of acute infection

OR chronic infection (does not confer immunity)

144
Q

How do HBsAg levels change over time?

A

Positive: 2-10 weeks after infection

Negative: 4-6 months after infection (positive anti-HBc may be the only marker of acute infection)

Positive: > 6 months after infection (signals chronic infection)

145
Q

What does HBeAg reflect?

A

Marker of viral replication

Marker of infectibility/transmission

146
Q

What is a high risk first trimester screening result?

O&G (13 decks)

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