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Path Week 3 > Ha - Obstetrics > Flashcards

Ha - Obstetrics Flashcards

1
Q

how is the FBC different in pregnancy

A

mild anaemia
macrocytosis
neutrophilia
thrombocytopaenia

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2
Q

why do you get a mild anaemia in preg

A

mainly due to plasma volume rising
red cell mass increases but not as much

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3
Q

why do you get thrombocytopaenia in preg

A

increased platelet size (immature platelets) due to increased turnover

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4
Q

what blood demands are increased in preg

A

increased iron req from 1-2mg to 6mg daily absorption
increased folate (200mcg/day extra)

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5
Q

what can iron def casue in preg

A

IUGR
prematurity
PP haemorhage

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6
Q

is iron excreted in the body?

A

NO - it is just recycled or not absorbed in the first place if it is not needed

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7
Q

when should folic acid supplements be given in preg

A

before conception and for the 12+ weeks of gestation

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8
Q

what dose of folic acid is given in preg

A

400 ug daily

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9
Q

define anaemia in preg (each trimester and PP)

A

Hb <110 1st trimester
Hb <105 2nd/3rd trimester
Hb < 100 PP

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10
Q

blood film results of iron def anaemia

A

low Hb
low MCV
low MCH
+ low ferritin

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11
Q

when does platelet count fall in preg

A

physiologically in 3rd trimester

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12
Q

causes of low platelets in preg

A

physiological
pre eclampsia
ITP
microangiopathic syndromes
others: BM failure, leukaemia, hypersplenism

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13
Q

if the platelets are severely low in preg, what is the most likely cause

A

ITP or pre eclampsia

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14
Q

if the platelets are marginally low in preg, what is the most likely cause

A

physiological

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15
Q

what is the physiological decrease in platelet count in preg %

A

10%

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16
Q

what is a sufficient platelet level for delivery

A

> 50x10^9

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17
Q

why does platelet count drop in preg

A

poorly understood - but dilution + increased consumption

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18
Q

when does platelet count start to rise again PP

A

2-5 days

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19
Q

what % of pre eclampsia pts have low platelets & how does it relate to disease

A

50% (proportionate to severity)

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20
Q

when does low platelets resolve in pre eclampsia

A

after delivery

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21
Q

why does pre eclampsia cause low platelets

A

increased activation and consumption leading to DIC

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22
Q

Tx of ITP in preg

A

IV IG or steroids

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23
Q

% of preg ppl with ITP

A

5% (many have it before preg)

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24
Q

can ITP affect baby

A

yes - variable though

25
Q

Mx of ITP in preg

A

check cord blood then daily baby blood as may fall for 5 days PP

26
Q

what is seen on blood film of microangiopathic syndromes

A

low platelets
schistocytes (RBC fragments)

27
Q

for which MAHA conditions does delivery affect / not affect course

A

affects pre eclampsia, HELLP syndrome
does not affect TTP or HUS

28
Q

leading cause of mortality in pregnancy

A

VTE

29
Q

blood in preg becomes ____coagulable due to ______ and ____fibrinolytic due to ______

A

hypercoagulable
- increase in factor 8 and vWF
hypofibrinolytic
- half of protein S and increased PAI-1

30
Q

why is blood in pregnancy procoagulant (3)

A

increased thrombin production
increased fibrin cleavage
reduced fibrinolysis

31
Q

when is VTE risk for preg mothers greatest

A

1-6 weeks PP

32
Q

which Ix are done for ?VTE in preg

A

doppler and VQ

33
Q

which Ix is not done for ?VTE in preg and why

A

D-dimer - raised anyway by preg

34
Q

what factors increase VTE risk for all preg mothers

A

increased coagulability of blood
reduced venous return
vessel wall is prothrombotic

35
Q

what variable factors can increase VTE risk for some preg mothers

A

hyperemesis / dehydration
obesity
pre-eclampsia
PMH thrombosis
age / parity
multiple preg
ovarian hyperstimulation IVF

36
Q

who is most at risk of VTE in preg (age)

A

> 40s

37
Q

how can VTE be prevented in preg

A

women with risk factors given heparin and TED stockings
mobilise early
maintain hydration

38
Q

why is LMWH used but not warfarin for VTE in preg

A

LMWH does not cross placenta
warfarin crosses placenta

39
Q

when does VTE prophylaxis need to be stopped in preg

A

for labour or planned delivery esp epidural

40
Q

what is the rule for anticoag and epidural

A

wait 24hrs after Tx dose or 12hrs after prophylactic dose to give epidural

41
Q

what issues does warfarin cause for baby

A

chondrodysplasia punctata
- abnormal cartilage and bone
- early epiphyses fusion therefore short
- nasal hypoplasia
- asplenia
- deafness
- seizures

42
Q

when in preg is warfarin teratogenic

A

1st trimester

43
Q

what is antiphospholipid syndrome

A

recurrent miscarriages, VTEs, persistent lupus anticoagulant +/- APL ABs

44
Q

what is the biggest maternal mortality factor in less developed countries

A

haemorrhage

45
Q

what 2 main causes of maternal haemorrhage are there

A

placenta praevia
placenta accreta

46
Q

define PP haemorrhage

A

> 500ml blood loss

47
Q

what % of preg have >1L blood loss

A

5

48
Q

4 causes of PP haemorhage

A

4Ts
tone - uterine atony
trauma - laceration / rupture
tissue - retained placenta
thrombin - coagulopathy

49
Q

2 main causes of PP haemorrhage

A

uterine atony
trauma

50
Q

what haematological factors can cause PP haemorrahage

A

dilutional coagulopathy after transfusion
DIC in abruption
amniotic fluid embolism

51
Q

what do coagulation changes in preg predispose the mother to

A

DIC - disseminated intravascular coagulation

52
Q

what precipitates a mother to decompensate into DIC

A

amniotic fluid embolism
abruptio placentae
retained dead foetus
pre-eclampsia
sepsis

53
Q

incidence of amniotic fluid embolism

A

1 in 20-30,000

54
Q

Sx of amniotic fluid embolism

A

sudden onset shivers, vomitting, shock, DIC

55
Q

mortality of amniotic fluid embolism

A

86%

56
Q

risk factors for amniotic fluid embolism

A

> 25 years old
third trimester
misoprostol (labour inducing drug)

57
Q

what haemaglobinopathies are screened for in babies

A

alpha thalassaemia
beta thalassaemia
sickle cell

58
Q

prognosis of alpha and beta thalassaemia

A

alpha - death in utero
beta - tranfusion dependent

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