health conditions

Question 1

what causes hypothyroidism?

Answer 1

an under or over consumption of iodine in the diet

Question 2

how much iodine do pregnant women require in their diet?

Answer 2

250ug/day

Question 3

what is the care pathway for hypothyroidism?

Answer 3

Bloods taken at first appt and then every 4 weeks to test the thyroid function

Question 4

how much does thyroxine need to increase by in pregnancy?

Answer 4

30-50% by 4-6 weeks gestation

Question 5

What drug is used to control hyperthyroidism?

Answer 5

Propylthiouracil in place of carbimazole- still kepton lowest dose possible

Question 6

Pathway for hyperthyroidism in pregnancy?

Answer 6

Take bloods at booking to measure TFT, then every 4 weeks to stabilise TSH and T4

Question 7

what are the symptoms of epilepsy?

Answer 7

jerking and shaking,losing awareness and staring into space, becoming stiff, strange sensations

Question 8

implications of epilepsy in pregnancy?

Answer 8

neural tube defects in the baby,
physical and emotional stress
injury during seizures,
birth defects from AEDs

Question 9

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

Answer 9

40%

Question 10

what is the pathway of care for epilepsy in pregnancy?

Answer 10

consultant lead care,
continue AED’s
5mg folic acid priorto pregnancy and continued unto the 13th week
regular scans
FBC- if Hb reduced increase AEDs
enter onto UK epilepsy in pregnancy register

Question 11

What is PCOS caused by?

Answer 11

a hormone imbalance

high testosterone levels which antagonises the effect of oestrogen.

Question 12

what percentage of women are affected by PCOS?

Answer 12

6-15% BUT 50% remain undiagnosed

Question 13

symptoms of PCOS?

Answer 13

excessive hair growth, acne, cysts on ovaries,interrupted menstrual cycle, pelvic pain, obesity, anxiety and depression supressed ovulation

Question 14

risk factors of PCOS in pregnancy?

Answer 14

30-50% chance of misscarriage 
pre-eclampsia 
gestational diabetes
macrosomia 
premature birth
50%chance of female fetus developing PCOS
C Section
increased insulin by 200-250%
Delay in lactation

Question 15

Is the care for PCOS women consultant lead or mw lead?

Answer 15

mw lead but may have referrals made to dietician if BMI 35+

Question 16

what causes cholestasis?

Answer 16

bile stoppage in the ducts of the liver, which leads to increased concentration of bile acids in the blood.

Question 17

when does cholestasis typically develop?

Answer 17

post 30 weeks

Question 18

what are the symptoms of cholestasis?

Answer 18

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

Question 19

what should happen next for women who are suspected to have cholestasis?

Answer 19

Blood tests should be taken and Liver function tests and bile acids weekly.

Question 20

what are the complications that can come from cholestasis?

Answer 20

if bile acid conc is 40umol/L 1-2% misscarriate rate
if 80umol/L 4-5%
so IOL is offered if bile acids are above 40

Question 21

What is the management for cholestasis?

Answer 21

weekly lfts
IOL offered if BA 40+ umol/L
Offered anyway at 37-38 weeks even if BA normal
to manage bile acid levels aswell as itching- give ursodeoxycholic medication
in addition supplement vitamin K, as absorption is affected.

Question 22

Why does anaemia occur?

Answer 22

haemodilution due to increased volume not being matched by the increase in plasma or RBC decrease in Hb and plasma protein conc= physiological anaemia.

Question 23

normal ferritin range?

Answer 23

12-150ng/ml

Question 24

what is the pathway for treating anaemia?

Answer 24

If Hb <105g/dl for iron supplementation ie ferrous fumarate, ferrous sulphate citron.
if under 90g/dl- obstetric referral
for iv/im iron supplement
FBC to monitor Hb.

Question 25

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

Answer 25

From 5 to 7 litres.

Question 26

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

Answer 26

0.2-4%

Question 27

Complications of cardiac conditions

Answer 27

misscarriage stillbirth, maternal cardiovascular compromise reduced placental perfusion causing fetal growth restriction. Inheritance, maternal death, cyanosis.

Question 28

Care type for cardiac conditions

Answer 28

consultant with pre pregnancy counselling and multidisciplinary care, combined clinic cardiologist.

Question 29

What if the woman has a severe cardiac condition?

Answer 29

Offer TOP before 16/40. commence anticoagulant therapy.

Question 30

How to manage a woman who’s having a heart attack

Answer 30

In community call 999 ask for paramedics with a defib, sit upright, reassure
In hospital, sit upright, reassure, trolley, facial oxygen, document times, events and drugs administered.
Emergency team will insert cannula, obtain blood specimens, provide pain relief and stabilise woman, possible transfer to coronary care.