Maternal complications during pregnancy

Question 1

what is the diagnostic min. BP for hypertension in pregnancy?

Answer 1

140/90

Question 2

what 3 proteinuria tests can be used to diagnose pre-eclampsia?
what values are used to confirm proteinuria?

Answer 2

urine dip strip - > 1+
spot urinary protein:creatinine ratio > 30
24 hr urine protein collection > 300 mg/day

Question 3

mothers with chronic/essential hypertension are at greater risk for what complication during pregnancy?

Answer 3

placental abruption

Question 4

what anti hypertensive drugs are teratogenic?

Answer 4

ACE inhibitors i.e. ramipril
ARB’s
diuretics

Question 5

what anti hypertensives are used in pregnancy?

Answer 5

CCB - Nifedipine
BB - labetolol
Methyldopa
Hydralazine - vasodilator

Question 6

what are the risk factors for developing pre-eclampsia?

Answer 6

first pregnancy
extremities of maternal age
pre eclampsia in previous pregnancy 
BMI > 35
pregnancy interval > 10 yrs
FH of pre eclampsia 
multiple pregnancies
underlying medical conditions:
- chronic hypertension
- renal disease
- diabetes 
- autoimmune i.e. SLE, antiphospholipid antibodies

Question 7

what are the maternal complications of pre eclampsia?

Answer 7

eclamptic seizures
HELP syndrome
disseminated intravascular co-agulation
renal failure
cardiac failure, pul. oedema

Question 8

what is HELP syndrome?

Answer 8

haemolysis
elevated liver enzymes
low platelets

Question 9

what are the foetal complications from pre eclampsia?

Answer 9

impaired placental perfusion causing;
- intrauterine growth restriction
foetal distress
prematurity
increased pre natal mortality

Question 10

what are the signs/symptoms of pre eclampsia?

Answer 10

high BP
proteinuria > 3+ urine dip strip

blurred vision
sudden swelling of hands and face 
headache
photophobia
epigastric pain
right upper quadrant pain 
vomiting
clonus / brisk reflexes,
papiloedema 
reduced urine output 
seizures

Question 11

what biomedical abnormalities occur if there is severe pre eclampsia?

Answer 11

raised liver enzymes
bilirubin
raised urea and creatinine
raised urate

Question 12

what haematological abnormalities occur if there is severe pre eclampsia?

Answer 12

low platelets
low RBC (haemolysis)
features of DIC

Question 13

what is the management for pre eclampsia?

Answer 13

only cure is delivery of the baby
if too soon for delivery then conservative management;
- anti-hypertensives (nifedipine, methyldopa, labetolol)
- steroids for foetal lung growth if < 36 wks
- monitor closely

if foetal distress or mother deteriorates then delivery baby by inducing labour or c-section irrespective of gestation

Question 14

what prophylaxis can be given for pre eclampsia in patient who developed it in their previous pregnancy?

Answer 14

aspirin from 12 weeks till delivery

Question 15

what is the treatment for eclamptic seizures?

Answer 15

magnesium sulphate (IV)

Question 16

what change in the mothers diabetes occurs when she becomes pregnant?

Answer 16

insulin requirements increase during pregnancy because…

b-HCG, human placental lactose, progesterone and cortisol from the placenta have anti-insulin action

Question 17

what are the foetal complications from pre existing maternal diabetes during pregnancy?

Answer 17

macrosomia 
hypoglycaemia
increased risk of respiratory distress
brain and heart defects
sacral agenesis 
polyhydramnios 
increased risk of miscarriage and still birth 
jaundice

Question 18

having pre-existing diabetes when pregnant puts the mother at greater risk of what complications?

Answer 18

pre -eclampsia
worsening of maternal nephropathy, retinopathy and hypoglycaemia
reduced awareness of hypoglycaemia
infections

Question 19

what are the risk factors for developing gestational diabetes mellitus (GDM) ?

Answer 19

BMI > 30
previous macrosomia baby > 4.5kg
previous GDM
FH of diabetes
women from high risk groups for developing diabetes i.e. Asian origin
polyhydramnios or big baby in previous pregnancy
recurrent glycosuria in current pregnancy

Question 20

when is screening for gestational diabetes carried out?

Answer 20

presence or risk factors: HbA1c estimate made at time of booking
if > 43mmol/ml do a OGTT
if OGTT normal then repeat at 24-28 weeks

if significant risk factors i.e. previous GDM then screen at both 16 and 28 weeks

Question 21

why is pregnancy a hypercoaguable state?

Answer 21

increase in fibrinogen
decrease in natural anti coagulants
increase in fibrinolysis

Question 22

how does virchows triad apply to pregnancy and the increased risk of thrombus?

Answer 22

hypercoagulable:

• increase in fibrinogen and fibrinolysis
• decrease in natural anti-coagulants

stasis - progesterone and effects of enlarging uterus

vessel wall damage - due to delivery / c-section

Question 23

what are the risk factors for venous thromboembolism during pregnancy?

Answer 23

older mothers
increasing parity
BMI
smokers
IV drug users
pre- eclampsia
dehydration (hyperemesis gravidarum)
decreased mobility
infections
operative delivery 
PPH 
previous VTE
sickle cell disease

Question 24

what prophylaxis is given for VTE in pregnancy?

Answer 24

TED stocking
hydration
keeping mobile
anti-coagulation prophylaxis if 3 or more risk factors i.e. LMWH

Question 25

what are the symptoms/signs of a VTE?

Answer 25

pain in calf 
tender calf 
increased size of calf 
cough, breathlessness, chest pain
tachycardia, hypoxia, pleural rub

Question 26

wha investigations would you carry out if your suspected a VTE?

Answer 26

CT pulmonary angiogram

V/Q lung scan (ventilation perfusion)

Question 27

what foetal complication can occur due to shoulder dystonia caused by gestational diabetes?

Answer 27

erb’s palsy