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WH > high risk pregnancy - medical disorders > Flashcards

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
For a VTE score of 2 what is the management ?
prophylactic LMWH at least 10 days post partum
26
For a VTE score of 3 what is the management ?
prophylactic LMWH from 28 weeks and then 6 weeks postnatally
27
for a VTE score of 4 or more what is the management ?
prophylactic LMWH throughout the antenatal period and then 6 weeks postnatally
28
what is the most appropriate initial step in management in a case of suspected VTE ?
LMWH until the diagnosis is excluded by investigation
29
what additional investigation must be performed in ann obstreitics patient who has received unfractionated heparin ?
platelete count monitoring performed every 2-3 days from days 4-14 or until heparin is stopped
30
which anticoagulant is to be avoided during pregnancy ?
warfarin because it passes the placenta
31
what is the best line of management once pulmonary embolism is suspected ?
IV heparinization along with supportive oxygen therapy
32
what are the pregnancy complications associated with Antiphospholipid syndrome ?
pree eclampsia placental abruption fetal growth restriction recurrent pregnancy loss
33
what are the criteria required to make a diagnosis of Antiphospholipid syndrome ?
need both clinical and laboratory criteria
34
What are the clinical criteria for the diagnosis of antiphospholipid syndrome ?
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
what are the laboratory criteria for the diagnosis of antiphospholipid syndrome ?
these results must be at least 12 weeks apart : IgG or IgM anticardiolipin antibodies antibodies to beta glycoprotein Lupus anti-coagulant
36
what is the antepartum management required for APS ?
1. 24 hour urine collection for creatinine clearance and total protein 2. maternal echocardiogram ( to rule out endocarditis ) 3. liver function test
37
how is APS managed ?
low dose aspirin | low molecular weight heparin
38
if pre term delivery is expected should low molecular weight heparin be continued ?
recommended to switch to unfractionated heparin
39
when should an anomaly scan be performed ?
at 18 weeks
40
when shouyld we start monitoring fetal growth in women who are on annticoagulants ?
starting from week 20
41
what does the prognosis of a live birth in a patient with SLE depend on ?
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
what is the association with the presence of Anti-Ro/Anti-La ?
congenital heart block | neonatal cutaneous lupus syndrome
43
how do we investigate for the assessment of disease activity in the pre-pregnancy consultation for patients with SLE ?
cardiac - ECG, echo Respiratory - Chest Xray / CT Renal - renal function test Hematology/immunology - assessment of risk of thrombosis
44
what is the mainstream treatment used for active disease in pregnancy (SLE) ?
prednisone
45
if a pregnant woman with SLE is refractory to glucocorticoid use what should be used as an alternative ?
azathioprine
46
what is significant asymptomatic bacteriuria ?
presence of 100,00 or more bacteria per ml of urine in 2 freshly voided midstream specimens of urine
47
how should asymptomatic bacteriuria caused by e.coli be treated ?
use ampicillin antibiotic
48
what are the predisposing factors to pyelonephritis ?
1. asymptomatic bacteruria 2. urinary stasis 3. atony of the ureter associated with the enlargement and compression of the uterus
49
what is the most common causative organism in pyelonephritis ?
e.coli
50
what are the routes of infection of E.coli ?
blood borne lymphatic spread ascending infection
51
what medication is used for daily prophylaxis of cystitis?
nitrofurantoin
52
what is the primary tool for evaluation of clinical symptoms of DVT ?
compression venous ultrasound
53
what effect does heparin have on APTT ?
prolongs APTT
54
what are the differential diagnosis of pyelonephritis in pregnancy ?
appendicitis acute abdomen other causes of fever and vomiting in pregnancy
55
what is the management of cystitis in pregnant women ?
nitrofurantoin for daily prophylaxis

WH (68 decks)

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