High risk pregnancy

Question 1

Factors of high risk pregnancy

Answer 1

1. Advanced maternal age >35yrs
2. Grand multigravida (>5preg)
3. Previous CS
4. Poor obs h/o
5. Disadvantage social problem (teenage etc)
6. HTN
7. CKD
8. Obesity
9. DM
10. Short stature
11. Prolonged infertility, drugs, hormones

Question 2

Advanced maternal age

Answer 2

1. > 35yrs
2. Chromosomal abn - *Down’s mc
3. Age - Down’s - Total risk
   20yrs - 1 in 1670 - 1:500
   35yrs - 1 in 365 - 1:180
   40yrs - 1 in 110 - 1:63
   45yrs - 1 in 32 - 1:18
   49yrs - 1 in 12 - 1:7

Question 3

Aneuploidy

Answer 3

Numeric chromosomal abn (monosomy/trisomy)

Question 4

MC trisomy which causes abortion in first trimester and at term

Answer 4

Trisomy 16 - T1
(Downs) Trisomy 21 - at term

Question 5

**Gestational HTN

Answer 5

> 140/90, multiple readings
After 20 wks of preg
For the first time
Resolves in 3months post delivery

Question 6

Preeclampsia

Answer 6

Gestational HTN + proteinuria
+/- edema

Mild: Upto 170/110 not a/w other conditions

Sev: >170/110 + other conditions
kidney/liver impairment, thrombocytopenia,
persistent headache
Epigastric pain
Hyperreflexia with clonus
Haemolysis

Inv-
Urine dipstick - proteins+
Best - urinary alb/creatinine ratio
24hr urinary protein - >300mg/24hrs

Question 7

Mx of preeclampsia

Answer 7

> 160/100 - causes IUFD
Drugs:
B-blockers (labetalol) - in severe
Methyldopa - in mild
Nifedipine

C/I:
ACEI/ARB
Diuretics

*DO NOT SUPRESS <140/80

Question 8

Mx of severe preeclampsia

Answer 8

Avoid eclampsia
1. COntrol BP - IV Hydralazine/Labetalol
2. MgSo4 50% IV over 10-15mins
3. Fetal lung maturity - Steroid IM

Best rx: Termination by CS/NVD if favourable

Question 9

Mx of preeclampsia diagnosed at 32wks

Answer 9

1. Try to maintain preg till 35wks
2. Continuous CTG, USG
3. Hydralazine, MgSo4

Question 10

Mx of preeclampsia diagnosed after 35wks

Answer 10

1. Rapid control and NVD
   or
2. CS

> 37wks preg in preeclampsia - IUFD
Terminate before term

Question 11

Eclampsia, mx

Answer 11

G-HTN + convulsions

Mx:
1. Secure airway, ventilate
2. MgSo4 50% IV/Diazepam, clonazepam IV
3. Strict fluid balance
4. CS compulsory/induction of labour
IV syntocinon after birth

Question 12

HELLP syndrome

Answer 12

In severe preeclampsia
Haemolysis
Elevated liver enz - ALT, AST
Low plt

Jaundice, Rt upper quadrant pain

Question 13

Essential HTN

Answer 13

HTN present before pregnancy

Question 14

*Prevention of preeclampsia

Answer 14

In cases of
Prev sev preeclampsia
Essential HTN
DM type 1

●Aspirin after 14wks of preg
●Calcium supplements

Question 15

MgSo4 dosage

Answer 15

Loading dose:
4gms IV over 5-15mins

Maintenece:
1gm/hr in 5gms/500ml solution

Excreted by kidney
Smooth muscle relaxant

Avoid when taking CNS depressants, cardiac glycosides, digitalis

Question 16

MgSo4 toxicity

Answer 16

Check: normal
1. RR >16/min
2. Tendon reflexes
3. Urine output: >25ml/hr

Antidote - 1gm Calcium gluconate

1. Resp arrest - intubate, stop MgSo4, give cal gluconate
2. Resp depression - O2 mask, stop MgSo4, give cal gluconate
3. Absent patellar reflex -
   ●Resp normal - stop Mgso4 till reflexes return
   ●Resp depression - treat accordingly
4. urine output <100/4hrs - no other signs - reduce MgSo4 dose to 0.5gm/hr
5. Cardiac failure - give furosemide

Question 17

Mcc of miscarriage in T1 and T2

Answer 17

T1 - chr abn
T2 - cervical incompetence