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high risk pregnancy - medical disorders Flashcards

1
Q

what is the most common neurological condition in pregnancy ?

A

epilepsy

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2
Q

what advice should be given regarding folic acid with women who have epilepsy ?

A

5mg of folic acid should be taken daily preconception and for at least 12 weeks after

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3
Q

what advice should be given to epileptic women regarding vitamin K ?

A

prophylactic vitamin K should be taken orally everyday 20mg from 36 weeks until delivery

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4
Q

babies born to women who are taking anti convulsants are more prone to be born with a specific deficiency ..

A

increased risk of HDNB ( hemolytic disease of the newborn) due to vitamin K deficiency

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5
Q

what vitamin should the baby receive after birth ?

A

vitamin K

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6
Q

what medications are contraindicated for women taking anti epileptic drugs ?

A

combined oral contraceptives
progesterone only pills
depo-prova injections

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7
Q

what are the indications for the use of depo-prova injections in women using anti epileptic drugs ?

A

these injections must be taken every 10 weeks instead of every 12 weeks

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8
Q

what are the indications for steroid use inn pregnant women using anti-epileptic drugs ?

A

corticosteroid dosage must be doubled

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9
Q

what event constitutes an indication to take oral vitamin K supplements ?

A

risk of preterm delivery

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10
Q

where is the most appropriate place of delivery for women with epilepsy ?

A

consultant-led unit

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11
Q

should anti epileptic regimen be continued during pregnancy ?

A

yes

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12
Q

How can fits during labour be managed ?

A

intravenous diazepam ( 10 mg bolus followed by 2mg slow infusionn)

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13
Q

what analgesic is contraindicated in pregnant women with epilepsy ?

A

pethidine

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14
Q

What is the best next step inn management if diazepam doesn’t stop the fits ?

A

intravenous phenytoin

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15
Q

what is the problem with using carbamazepine in epileptic women and how is this problem treated ?

A

carbamazepine interferes with folate metabolism , so women who are on carbamazepine should be administered higher doses of folic acid

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16
Q

what risk do multiple seizures impose on the fetus ?

A

anoxia ( extreme form of hypoxia)

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17
Q

when is CS under GA indicated in epileptic women ?

A

in women who have multiple and repeated seizures

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18
Q

what must first be rules out if a pregnant women newly presents with seizures ?

A

eclamptic seizures must be ruled out

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19
Q

why is there an increased risk of thromboembolism during pregnancy ?

A 
due to an increase in the level of coagulation factors 
increased fibrinogen levels 
increased platelete activation 
decreased protein s and antithrombin III
venous stasis
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20
Q

what type of imaging can be used to detect VTE ?

A

compression venous ultrasound

MRI

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21
Q

what are the clinical manifestations of pulmonary embolisms ?

A 
shortness of breath 
chest pain 
tachypnea 
tachycardia 
decreased oxygen saturation
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22
Q

what lab investigation would you ask for if you are suspecting pulmonary embolism ?

A

CBC - leukocytosis

ABG - hypoxia

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23
Q

what imaging can be used to detect pulmonary embolism ?

A
  1. ventilation/perfusion scanning
  2. CTPA
  3. chest x ray
24
Q

in what order should imaging for pulmonary embolism be taken ?

A

first chest x ray if that is abnormal then
V/Q scan if that is abnormal then
CTPA

25
Q

For a VTE score of 2 what is the management ?

A

prophylactic LMWH at least 10 days post partum

26
Q

For a VTE score of 3 what is the management ?

A

prophylactic LMWH from 28 weeks and then 6 weeks postnatally

27
Q

for a VTE score of 4 or more what is the management ?

A

prophylactic LMWH throughout the antenatal period and then 6 weeks postnatally

28
Q

what is the most appropriate initial step in management in a case of suspected VTE ?

A

LMWH until the diagnosis is excluded by investigation

29
Q

what additional investigation must be performed in ann obstreitics patient who has received unfractionated heparin ?

A

platelete count monitoring performed every 2-3 days from days 4-14 or until heparin is stopped

30
Q

which anticoagulant is to be avoided during pregnancy ?

A

warfarin because it passes the placenta

31
Q

what is the best line of management once pulmonary embolism is suspected ?

A

IV heparinization along with supportive oxygen therapy

32
Q

what are the pregnancy complications associated with Antiphospholipid syndrome ?

A

pree eclampsia
placental abruption
fetal growth restriction
recurrent pregnancy loss

33
Q

what are the criteria required to make a diagnosis of Antiphospholipid syndrome ?

A

need both clinical and laboratory criteria

34
Q

What are the clinical criteria for the diagnosis of antiphospholipid syndrome ?

A
  1. thrombosis diagnosed by diagnostic imaging
  2. adverse pregnancy outcomes including fetal death at 10 weeks of gestation ( morphologically normal fetus)
  3. 3-1 or more preterm birth prior to 34 weeks due to preeclampsia or placental insufficiency
35
Q

what are the laboratory criteria for the diagnosis of antiphospholipid syndrome ?

A

these results must be at least 12 weeks apart :
IgG or IgM anticardiolipin antibodies
antibodies to beta glycoprotein
Lupus anti-coagulant

36
Q

what is the antepartum management required for APS ?

A
  1. 24 hour urine collection for creatinine clearance and total protein
  2. maternal echocardiogram ( to rule out endocarditis )
  3. liver function test
37
Q

how is APS managed ?

A

low dose aspirin

low molecular weight heparin

38
Q

if pre term delivery is expected should low molecular weight heparin be continued ?

A

recommended to switch to unfractionated heparin

39
Q

when should an anomaly scan be performed ?

A

at 18 weeks

40
Q

when shouyld we start monitoring fetal growth in women who are on annticoagulants ?

A

starting from week 20

41
Q

what does the prognosis of a live birth in a patient with SLE depend on ?

A
  1. the activity of the disease at conception
  2. the occurence of subsequent flares
  3. co-existence of lupus nephritis
  4. development of APA
  5. presence of anti-SSA (Ro) antibodies
42
Q

what is the association with the presence of Anti-Ro/Anti-La ?

A

congenital heart block

neonatal cutaneous lupus syndrome

43
Q

how do we investigate for the assessment of disease activity in the pre-pregnancy consultation for patients with SLE ?

A

cardiac - ECG, echo
Respiratory - Chest Xray / CT
Renal - renal function test
Hematology/immunology - assessment of risk of thrombosis

44
Q

what is the mainstream treatment used for active disease in pregnancy (SLE) ?

A

prednisone

45
Q

if a pregnant woman with SLE is refractory to glucocorticoid use what should be used as an alternative ?

A

azathioprine

46
Q

what is significant asymptomatic bacteriuria ?

A

presence of 100,00 or more bacteria per ml of urine in 2 freshly voided midstream specimens of urine

47
Q

how should asymptomatic bacteriuria caused by e.coli be treated ?

A

use ampicillin antibiotic

48
Q

what are the predisposing factors to pyelonephritis ?

A
  1. asymptomatic bacteruria
  2. urinary stasis
  3. atony of the ureter associated with the enlargement and compression of the uterus
49
Q

what is the most common causative organism in pyelonephritis ?

A

e.coli

50
Q

what are the routes of infection of E.coli ?

A

blood borne
lymphatic spread
ascending infection

51
Q

what medication is used for daily prophylaxis of cystitis?

A

nitrofurantoin

52
Q

what is the primary tool for evaluation of clinical symptoms of DVT ?

A

compression venous ultrasound

53
Q

what effect does heparin have on APTT ?

A

prolongs APTT

54
Q

what are the differential diagnosis of pyelonephritis in pregnancy ?

A

appendicitis
acute abdomen
other causes of fever and vomiting in pregnancy

55
Q

what is the management of cystitis in pregnant women ?

A

nitrofurantoin for daily prophylaxis

WH (68 decks)

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