Ha - Obstetrics Flashcards by Lottie Barot

how is the FBC different in pregnancy

mild anaemia
macrocytosis
neutrophilia
thrombocytopaenia

How well did you know this?

Not at all

Perfectly

why do you get a mild anaemia in preg

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

How well did you know this?

Not at all

Perfectly

why do you get thrombocytopaenia in preg

increased platelet size (immature platelets) due to increased turnover

How well did you know this?

Not at all

Perfectly

what blood demands are increased in preg

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

How well did you know this?

Not at all

Perfectly

what can iron def casue in preg

IUGR
prematurity
PP haemorhage

How well did you know this?

Not at all

Perfectly

is iron excreted in the body?

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

How well did you know this?

Not at all

Perfectly

when should folic acid supplements be given in preg

before conception and for the 12+ weeks of gestation

How well did you know this?

Not at all

Perfectly

what dose of folic acid is given in preg

400 ug daily

How well did you know this?

Not at all

Perfectly

define anaemia in preg (each trimester and PP)

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

How well did you know this?

Not at all

Perfectly

blood film results of iron def anaemia

low Hb
low MCV
low MCH
+ low ferritin

How well did you know this?

Not at all

Perfectly

when does platelet count fall in preg

physiologically in 3rd trimester

How well did you know this?

Not at all

Perfectly

causes of low platelets in preg

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

How well did you know this?

Not at all

Perfectly

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

ITP or pre eclampsia

How well did you know this?

Not at all

Perfectly

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

physiological

How well did you know this?

Not at all

Perfectly

what is the physiological decrease in platelet count in preg %

10%

How well did you know this?

Not at all

Perfectly

what is a sufficient platelet level for delivery

> 50x10^9

How well did you know this?

Not at all

Perfectly

why does platelet count drop in preg

poorly understood - but dilution + increased consumption

How well did you know this?

Not at all

Perfectly

when does platelet count start to rise again PP

2-5 days

How well did you know this?

Not at all

Perfectly

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

50% (proportionate to severity)

How well did you know this?

Not at all

Perfectly

when does low platelets resolve in pre eclampsia

after delivery

How well did you know this?

Not at all

Perfectly

why does pre eclampsia cause low platelets

increased activation and consumption leading to DIC

How well did you know this?

Not at all

Perfectly

Tx of ITP in preg

IV IG or steroids

How well did you know this?

Not at all

Perfectly

% of preg ppl with ITP

5% (many have it before preg)

How well did you know this?

Not at all

Perfectly

can ITP affect baby

yes - variable though

Mx of ITP in preg

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

what is seen on blood film of microangiopathic syndromes

low platelets schistocytes (RBC fragments)

for which MAHA conditions does delivery affect / not affect course

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

leading cause of mortality in pregnancy

VTE

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

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

why is blood in pregnancy procoagulant (3)

increased thrombin production increased fibrin cleavage reduced fibrinolysis

when is VTE risk for preg mothers greatest

1-6 weeks PP

which Ix are done for ?VTE in preg

doppler and VQ

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

D-dimer - raised anyway by preg

what factors increase VTE risk for all preg mothers

increased coagulability of blood reduced venous return vessel wall is prothrombotic

what variable factors can increase VTE risk for some preg mothers

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

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

>40s

how can VTE be prevented in preg

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

why is LMWH used but not warfarin for VTE in preg

LMWH does not cross placenta warfarin crosses placenta

when does VTE prophylaxis need to be stopped in preg

for labour or planned delivery esp epidural

what is the rule for anticoag and epidural

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

what issues does warfarin cause for baby

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

when in preg is warfarin teratogenic

1st trimester

what is antiphospholipid syndrome

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

what is the biggest maternal mortality factor in less developed countries

haemorrhage

what 2 main causes of maternal haemorrhage are there

placenta praevia placenta accreta

define PP haemorrhage

>500ml blood loss

what % of preg have >1L blood loss

4 causes of PP haemorhage

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

2 main causes of PP haemorrhage

uterine atony trauma

what haematological factors can cause PP haemorrahage

dilutional coagulopathy after transfusion DIC in abruption amniotic fluid embolism

what do coagulation changes in preg predispose the mother to

DIC - disseminated intravascular coagulation

what precipitates a mother to decompensate into DIC

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

incidence of amniotic fluid embolism

1 in 20-30,000

Sx of amniotic fluid embolism

sudden onset shivers, vomitting, shock, DIC

mortality of amniotic fluid embolism

86%

risk factors for amniotic fluid embolism

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

what haemaglobinopathies are screened for in babies

alpha thalassaemia beta thalassaemia sickle cell

prognosis of alpha and beta thalassaemia

alpha - death in utero beta - tranfusion dependent