Health conditions

Question 1

how many women get eclampsia?

Answer 1

1-2%

Question 2

What is the incidence of fits in different stages of the natal period

Answer 2

AN- 38%
PN-44%
IP- 18%

Question 3

How is eclampsia managed?

Answer 3

To lower the blood pressure labetelol iv or oral- nifedipine in asthatics with a prompt onset of 5 minutes,
magnesium sulphate for the management of seizuires

Question 4

How is eclampsia managed in labour?

Answer 4

Regular bp monitoring, continued anti-hypertensives, magnesium sulphate, continous CTG, strict fluid balance, IV access, Active management in the 3rd stage however, syntometrine or ergometrine avoided as increase BP.

Question 5

What is the cause of hypothyroidism?

Answer 5

In 90% of cases hashimotos thyroiditis.

Under of over consumption of iodine in the diet

Question 6

How much ion do pregnant women require each day?

Answer 6

250ug/day

Question 7

what is the pathway for managing hypothyroidism?

Answer 7

bloods taken at booking, then every 4 weeks, testing tft.

Question 8

How much is thyroxine increased by?

Answer 8

30-50% from 4-6 weeks gestation

Question 9

what drugs are used to control hyperthyroid in pregnancy?

Answer 9

Propylthiouracil in place or carbimazole- kept at lowest dose

Question 10

What is the pathway for hyperthyroidism in pregnancy?

Answer 10

Blood taken at booking to measure TFT then every 4 weeks to stabilise TSH and T4.

Question 11

What are the symptoms of epilepsy?

Answer 11

Jerking and shaking, losing awareness and staring into space. Becoming stiff, strange sensations

Question 12

What implications can epilepsy have on pregnancy?

Answer 12

Neural tube defects in the fetus, physical and emotional stress, injury during seizures, birth defects from AEMs

Question 13

What percentage of babies acquired developmental issues from the use of sodium valporate?

Answer 13

40%

Question 14

what is the pathway for managing epilepsy in pregnancy?

Answer 14

Consultant lead care, continue AEDs, 5mg folic acid prior to pregnancy up until the 13th week, regular scans, FBC checks if hb is reduced then AEDs are increased.
Enter onto uk epilepsy register

Question 15

What is the cause of PCOS?

Answer 15

a hormone imbalance, high testosterone which antagonises the effect of oestrogen

Question 16

What percentage of women are affected by PCOS?

Answer 16

6-15% BUT 50% remain undiagnosed

Question 17

symptoms of PCOS?

Answer 17

Excessive hair growth, acne, 
cysts on ovaries
pelvic pain
obesity
anxiety and depression
suppressed ovulation

Question 18

Risk factors of PCOS in pregnancy?

Answer 18

30-50% chance of stillbirth, preeclampsia, gestatioal diabetes, macrosomia, premature birth, 50% chance of female fetus developing PCOS. Higher C section rates, delay in lactation, increased insulin

Question 19

How much does insulin levels increase by in pregnancy for PCOS women?

Answer 19

200-250%

Question 20

What is the cause of cholestasis?

Answer 20

Bile stoppage in the bile ducts of the liver, which leads to increased conc of bile salts in the blood.

Question 21

When does cholestasis typically develop?

Answer 21

post 30 weeks

Question 22

Symptoms of cholestasis?

Answer 22

itching of hands and feet, severe body itching, jaundice, dark urine.

Question 23

Management of cholestasis in pregnancy?

Answer 23

Blood tests and bile acids taken weekly.
IOL if BA 40+ umol/L
offered IOL at 37-38 weeks even with stabilised BA levels.
Supplemented vit K, and ursodeoxycholic medication to reduce BA and itching.

Question 24

Complications of increased BA on pregnancy?

Answer 24

40umol/L or above 1-2% misscarriage rate

80umol/L 4-5% rate. IOL offered to all women if bile acids are above 40.

Question 25

What is the physiological cause for anaemia in pregnancy?

Answer 25

Haemodilution due to increase in blood volume not being matched by increase in plasma and HB.

Question 26

Pathway to manage anaemia?

Answer 26

if hb <105g/dl for iron supplementation
ie ferrous sulphate, citon or ferrous fumarate.
Of under 90g/dl make obstetric referral for iv/im iron supplementation FBC to monitor hb.

Question 27

In late pregnancy, how much does the cardiac output increase by

Answer 27

from 5 to 7 litres

Question 28

how many pregnancies in western countries are affected by cardiovascular disease?

Answer 28

0.2-4%

Question 29

Complications of cardiac conditions in pregnancy?

Answer 29

Misscarriage, stillbirth, reduced placental perfusion, fetal growth restriction, inheritance, maternal death, cyanosis

Question 30

Care pathway for cardiac issues

Answer 30

Consultant care with pre pregnancy counselling and multidisciplinary care combine clinic with cardiologist

Question 31

What is offered to women if they are affected by a serious cardiac condition in pregnancy?

Answer 31

they are offered at TOP before 16/40, if the decide against they will be advised to take anticoagulant therapy.

Question 32

How to manage a heart attack in pregnancy?

Answer 32

in community- call 999 ask paramedics for a defibrillator, sit woman upright, reassure
in hospital- sit the woman upright, apply facial oxygen,. document the times events and drugs administered.
Emergency team to insert cannula, obtain blood samples, provide pain relief, stabilise woman and possibly transfer to coronary care.