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Obs & Gynae > Late pregnancy problems > Flashcards

Late pregnancy problems Flashcards

1
Q

Definition of gestational hypertension

A

High blood pressure after 20 weeks gestation with no proteinuria over 0.3g/day

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2
Q

Definition of Pre-Eclampsia

A

High blood pressure during pregnancy plus proteinuria of greater than 0.3g/day. Occurs after 20week gestation.

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3
Q

Definition of eclampsia

A

Convulsions/seizures plus pre-eclampsia

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4
Q

Risk factors for pre-eclampsia

A 
Maternal age over 40yrs
Chronic HTN
CKD
Autoimmune conditions e.g. SLE, antiphospholipid syndrome
Previous pre-eclampsia
First pregnancy
Type 1 or 2 DM
High BMI
Multiple pregnancy
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5
Q

Pathophysiology of pre-eclampsia

A

Inadequate spiral artery invasion in the myometrium. This means less blood can get to the baby and so the mother’s body responds by increases the blood pressure to get more blood there.

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6
Q

Values for high blood pressure during pregnancy

A

HTN in pregnancy = SBP >140mmHg, DBP >90mmHg

Severe HTN = 160/110mmHg or more

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7
Q

Symptoms of pre-eclampsia

A

Severe headaches
Visual disturbance (blurred, double, floating spots)
Persistent epigastric or right upper quadrant pain.
Vomiting
Breathlessness
Swelling of hands, feet, face.
Brisk reflexes

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8
Q

HELLP syndrome

A

Haemolysis, Elevated Liver enzymes, and Low Platelets syndrome.

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9
Q

Treatment of mothers at high risk of pre-eclampsia

A

Daily aspirin (75mg) from 12 weeks gestation until birth and advice on lifestyle.
Those at high-risk =
Previous pre-eclampsia
DMT1 or T2
CKD
Chronic HTN
Autoimmune disease e.g SLE or antiphospholipid syndrome.

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10
Q

Management of established pre-eclampsia

A

Start med if BP over 150/100mmHg –> Labetalol, nifedipine
Monitor mum and baby!
ACEi contraindicated in pregnancy!!!!!
Monitor mum post-natally!

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11
Q

Management of eclampsia

A

ABCDE
IV magnesium sulphate - bolus dose then maintenance dose.
Fetal CTG
C-section delivery

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12
Q

Cut off gestational age for steroid use and commonly used steroid

A

Only use if less than 34 weeks gestation. Dexamethasone.

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13
Q

Complications of pre-eclampsia

A 
Maternal = Intracerebral haemorrhage/stroke, Eclampsia and seizures, pulmonary oedema, acute renal failure and hepatic failure.
Baby = placental abruption, IUGR, premature delivery, intrauterine death, PPH, oligohydramnios
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14
Q

Risk factors for venous thrombosis in pregnancy

A 
Previous VTE
maternal age over 35yrs.
High BMI
Smoker
Multiple pregnancy
Pre-eclampsia
Greater than 4 parity
Immobility
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15
Q

Why is VTE risk increased in pregnancy?

A

More blood stasis and altered protein balance.

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16
Q

Causes of an antepartum haemorrhage

A 
Placenta praevia - painless
Placenta abruption - painful
Vasa praevia - painless
Uterine rupture
Still birth?
Cervical poly
Cervical carcinoma
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17
Q

Definition of an antepartum haemorrhage

A

PV bleeding after 24weeks gestation.

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18
Q

Definition of placenta praevia

A

Placenta is implanted in the lower segment of the uterus, below fetal presenting part.

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19
Q

Types of placenta praevia

A 
Marginal = not covering but encroaching on os.
Major = partially or completly covering os.
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20
Q

Clinical features of placenta praevia

A

Painless and recurrent PV bleeding. Baby usually in abnormal presentation/lie

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21
Q

Diagnosis of placenta praevia

A

Transvag USS. In 2nd scan at 20 weeks, if low lying placenta is seen, book for third trimester (34weeks) scan to follow-up and diagnose.
Cross-match blood type.

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22
Q

Management of placenta praevia

A

Up to 34weeks gestation can offer corticosteroids.
Plan delivery for before 39weeks gestation via c-section
Prepare ant-D immunoglobulins and blood transfusion if appropriate.

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23
Q

Complications of placenta praevia

A

PPH, placenta accreta or percreta.

24
Q

Risk factors for placenta praevia

A 
Previous placenta praevia.
Previous c-section deliveries.
Advanced matermal age (over40).
Smoking.
Previous terminations of pregnancies.
IVF and assisted conception.
25
Q

Placenta abruption definition

A

Premature detachment of placenta from the uterus and blood dissects under the placenta before delivery of the fetus.

26
Q

Risk factors for abruption

A 
Abruption in previous pregnancy.
Pre-eclampsia
IUGR
polyhydramnios
low BMI
Advanced maternal age
IVF
Non-vertex presentation.
Abdo trauma
Substance misuse and smoking.
27
Q

Clinical features of placenta abruption

A

Bleeding PV
Constant abdo pain, pain and shock of mum may be disproportionate to visible loss of blood = concealed haemorrahge.
Woody-hard, tense and tender uterus on palpation.

28
Q

Investigations for placenta abruption

A

Fetal monitoring via CTG

Maternal TV USS, cross-match blood, FBC for anaemia, monitor urine output, urinalysis.

29
Q

Management of placenta abruption

A

ABCDE
Anti-D antibodies if appropriate and blood transfusion.
Steroids may be given if below 34weeks gestation.
If fetal distress C-section, if no distress vaginal delivery possible.

30
Q

Vasa praevia definition

A

Fetal blood vessels lie on the membranes that cover the internal cervical os.

31
Q

Complications of vasa praevia

A

When membranes rupture vessels can haemorrhage and rupture too - fetal blood loss!

32
Q

Presentation and management of ruptured vasa praevia

A

Painless, PV beeding on membrane rupture. Fetal bradycardia. URGENT C-SECTION but fetal mortality is high

33
Q

treatment of VTE in pregnancy and time of highest risk

A

Low molecular weight heparin. Warfarin can cross placenta.
Monitor anti-Xa
Most occur post-partum

34
Q

Polyhydramnios defintion

A

Too much amniotic fluid in the amniotic sac

35
Q

Pathophysiology of polyhydramnios

A

Poor swallowing of fluid by fetus, poor absorption of fluid inside baby, increased secretion of fluid by placenta.

36
Q

Causes of polyhydramnios

A 
Fetal malformation - spina bifida, atresia of GI tract in fetus. 
Multiple pregnancy
Maternal diabetes mellitus.
Fetal anemia.
Infections such as rubella, CMV.
37
Q

Clinical features of polyhydramnios

A

Over distended uterus
Symphyseal-fundal height larger than dates
Faint or indistinct fetal heart rate.
Maternal dyspnoea, oedema.

38
Q

Treatment of polyhydramnios

A

Amniocentesis (removing fluid)

Laser ablation of communicating vessels for twins.

39
Q

Complications of polyhydramnios

A

Preterm labour
Premature rupture of membranes
Umbilical cord prolapse
PPH

40
Q

Oligohydramnios

A

Too little amniotic fluid in amniotic sac. Less than 500ml in 32-36weeks gestation.

41
Q

Causes of oligohydramnios

A 
Rupture of amniotic membranes.
Fetal urinary tract malformations.
IUGR
Placenta abruption
Maternal dehydration
42
Q

Management of oligohydramnios

A

Delivery baby if poss.
Consider prophylactic erythromycin.
Amnioinfusion (only special circumstances!)

43
Q

Complications of oligohydramnios

A

Pulmonary hypoplasia - wry neck, club foot.

Amniotic band syndrome.

44
Q

Normal fundal height growth

A

After 24 weeks you would only expect the fundal height to increase by 1cm a week.

45
Q

Antidote for magnesium sulphate induced respiratory depression

A

Calcium gluconate is first-line treatment

46
Q

DIC

A

Disseminated intravascular coagulation

47
Q

Causes of DIC in pregnancy

A 
Placenta abruption
Pre-eclampsia
HELLP
Amniotic fluid embolism
Retained products of a dead fetus (after 20weeks gest)
Placenta accreta
Hydatidiform mole
48
Q

Pathophys of DIC in pregnancy

A

Intravascular clotting consumes platelets and fibrin. Pathogenic release of thrombin and thromboplastin into circulation.

49
Q

Investigations and results for DIC in pregnancy

A 
Long APTT
Long prothrombin time
Low platelets
Low fibrinogen
High D-dimer and products of fibrin breakdown.
50
Q

Management of DIC in pregnancy

A 
O2
Blood crossmatch
Blood transfusion (fresh)
Platelet transfusion
Consider calcium gluconate
51
Q

Routine investigations for pre-eclampsia mum

A

Blood pressure (obvs)
Urinedip (proteinuria)
FBC (low platelets and haemolysis in HELLP)
Renal function = U+E, protein-creatinine ration, GFR
LFT (AST and transaminase for HELLP)

52
Q

Pathophysiology of Rhesus disease

A

If mother is Rhesus -ve and father is Rhesus +ve then offspring can be Rhesus +ve.
First pregnancy with a Rhesus +ve fetus in mother allows memory cells for Rhesus +ve antigen to be produced. These are IgG so can cross the placenta and affect future babies. However in first pregnancy the immune system only uses IgM antibodies which wont cross placenta.

53
Q

What happens to babys with Rhesus disease

A

RBC haemolysis causes anaemia.

54
Q

Prophylaxis for Rhesus disease

A

Anti-D. This destroys the anti-rhesus +ve antibodies in mother. Given at 28-34 weeks and after birth/

55
Q

What does asymmetrical intrauterine growth restriction (normal head circumference with reduced abdominal circumference) suggest?

A

Placenta insufficiency however, if both the head circumference and abdominal circumference are low then more likely chromosomal abnormality.

56
Q

Causes of antepartum haemorrhage

A

Placenta abruption
Placenta praevia
Vasa praevia
Morbidly adherent placenta (accreta, increta, percreta)

57
Q

Pathophysiology behind the seizures in pre-eclampsia

A

Proteinuria leads to hypoalbuminaemia. This causes oedema and fluid leves vessels (hypovolaemia). Brain is not adequately perfused = seizures.

Obs & Gynae (17 decks)

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