Haem: Obstetric Haematology pt.3 Flashcards

1
Q

What complications of pregnancy are associated with thrombophilia?

A

It is hypothesised that an increased tendency to thrombosis is associated with impaired placental circulation.

This results in:

  • Fetal growth restriction (IUGR)
  • Recurrent miscarriage
  • Late fetal loss
  • Placental abruption
  • Severe preeclampsia
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2
Q

What is the diagnostic criteria of antiphospholipid syndrome?

A

At least 1 clinical and 1 biochemical criteria

Clinical criteria:

  • Vascular thrombosis
  • Pregnancy morbidity

Biochemical criteria
(all must be on 2 occasions >12 weeks apart)

  • Lupus anticoagulant
  • High anticardiolipin antibodies
  • Anti-b2-glycoprotein 1 antibodies
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3
Q

What are the diagnositic criteria of pregnancy morbidity in anti-phospholipid syndrome?

A
  • Adverse pregnancy outcome: three or more consecutive miscarriages before 10 weeks of gestation (where anatomical, hormonal, and chromosomal causes have been excluded)
  • One or more morphologically normal fetal losses after the 10th week of gestation
  • One or more preeterm births before the 34th week of gestation owing to placental disease
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4
Q

What treatment may be given to improve outcome in women who have had recurrent miscarriages?

A

Aspirin

OR

Aspirin + Heparin

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5
Q

What is placenta praevia?

A

When the placenta covers the cervical os

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6
Q

What is placenta accreta?

A

When the placenta is attached to the surface of the myometrium

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7
Q

What are placenta increta and percreta?

A

Placenta increta: the placenta penetrates into the myometrium

Placenta percreta: the placenta penetrates through the myometrium to the uterine serosa

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8
Q

What do C-sections increase the risk of in future pregnancies?

A
  • Placenta praevia
  • Placenta accreta

C-sections increase the likelihood of having issues with the site of placental implantation

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9
Q

What is the definition of post-partum haemorrhage?

A

> 500 ml blood loss

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10
Q

What are the main causes of postpartum haemorrhage?

A

4 T’s:
Tone: uterine atony (main cause)
Trauma: perineal tears
Tissue: placenta accreta
Thrombin: hypocoagulative state (DIC in aminotic fluid embolism)

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11
Q

Name some obstetric causes of DIC

A
  • Amniotic fluid embolism
  • Placental abruption
  • Retained products of conception
  • Severe preeclampsia
  • Sepsis
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12
Q

What is amniotic fluid embolism?

A

AFE is a rare childbirth (obstetric) emergency in which amniotic fluid enters the bloodstream of the mother to trigger a serious reaction.

Very catastrophic with high mortality rate (86%)

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13
Q

What are the symptoms of AFE?

A
  • ARDS - SoB, hypoxia
  • Shock
  • Neurological - confusion, coma, seizures
  • DIC

Manifests during labour or immediately after but can occur up to 48 hours postpartum

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14
Q

Which haemoglobinopathies are screened for?

A
  • Sickle cell disease
  • Alpha thalasaemia
  • Beta thalasaemia
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15
Q

How are individuals selected for the haemoglobinopathy screening program

A
  • If from high prevalance area
  • Family Origin Questionnaire
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16
Q

What diagnostic technique is used in the haemoglobinopathy screening program?
What can this techique not diagnose?

A

High performance liquid chromatography

HPLC can identify haemoglobin variants (EXCEPT it cannot identify alpha thalassaemia)

  • Alpha thalassaemia requires DNA diagnosis.
  • HPLC can quantify HbA2 (>3.5% = beta thalassemia)
17
Q

What antenatal tests may be done to diagnose potential foetal haemoglobinopathies?

A
  • CVS (10-12 weeks)
  • Amniocentesis (15-17 weeks)
  • Fetal blood sampling
  • Ultrasound screening for hydrops
18
Q

What are the key features of haemoglobinopathy counselling?

A

Important disorders are all recessive
Therefore if mother is heterozygous partner should be tested
Combinations as important as homozygous states
Prenatal diagnosis by 12 weeks: allows for termination of pregnancy in severe cases

19
Q

What are the differences in FBC and Hb electrophoresis of iron deficiency anaemia vs. thalassaemia trait?

A
Hb, MCV, MCH, Red cell count thalassaemia smaller cells so MCHC same Red cell count always increased in thalassaemia trait (normal in IDA)
20
Q

Name 2 other important immune disorders in pregnancy that affect the neonate.

A
  • Haemolytic disease of the newborn (HDN)
  • Neonatal alloimmune thrombocytopenia (NAITP)

Maternal immune responses against fetal antigens requiring monitoring and intervention during pregnancy.