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GOSH > Maternal medicine > Flashcards

Maternal medicine Flashcards

1
Q

What is the definition of maternal death?

A

Death WHILST PREGNANT

OR

WITHIN 42 DAYS OF END OF PREGNANCY

Cause: related to or aggravated by pregnancy or management

*includes birth, ectopic pregnancy, miscarriage or termination of pregnancy

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2
Q

What is the definition of ‘direct’ maternal death?

A

death resulting from obstetric complications, interventions, omissions or incorrect treatment

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3
Q

What is the definition of ‘indirect’ maternal death?

A

deaths resulting from previous EXISTING DISEASE or DISEASE DEVELOPED DURING PREGNANCY

not the results of obstetric cause but AGGRAVATED BY BEING PREGNANT

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4
Q

What is a late maternal death?

A

Deaths occurring between 42 DAYS and 1 YEAR after the end of pregnancy*

direct or indirect maternal causes

*inclused ectopic pregnancy, miscarriage or termination

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5
Q

What is ‘coincidental’ maternal death?

A

Death from UNRELATED causes which happen to occur in pregnancy or puerperium

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6
Q

What cardiac problems would we be concerned about in a pregnant woman?

A

congenital or acquired CHD

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7
Q

What are some symptoms women may experience whilst pregnant, that could indicate cardiac problems?

A 
Fatigue
Fainting
Chest pain
Shortness of breath
Difficulty breathing while sleeping
Palpitations

Have a low threshold to investigate

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8
Q

What would you keep in mind for the monitoring and management of a pregnant woman with cardiac health problems?

A

MDT - obstetrician led care

Consider early delivery (time of delivery is more important than mode of delivery)

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9
Q

What would you keep in mind for the monitoring and management of a pregnant woman with epilepsy?

A

MDT - obstetrician led care?

Patient may/may not require medication

Folic acid 5 mg/day

Postnatal liaison with patient carer

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10
Q

What are the risks associated with being on anti-epileptics during pregnancy?

A

Fetal abnormalities (NTD,cardiac, facial )

Frequent seizures

Status epilepticus

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11
Q

What does essential hypertension during pregnancy increase the risk of?

A

Maternal pre-eclampsia/eclampsia and placental abruption

Maternal morbidity and mortality, especially with very high systolic blood pressure

Intrauterine fetal growth restriction and preterm delivery

Neonatal morbidity and mortality

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12
Q

What drugs should ideally be given for HTN in pregnancy (instead of ACEi)?

A

labetalol

nifedipine

methyldopa

(consider aspirin)

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13
Q

What is worth noting about ACEi (ie. why do they need changing to labetalol, nifedipine and methyldopa)?

A

teratogenic

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14
Q

How would you manage a pregnant woman with essential hypertension?

A

frequent monitoring of both mother and foetus

change teratogenic drugs to labetalol, nifedipine and methyldopa

consider low-dose aspirin from 12 weeks

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15
Q

How does maternal drug abuse effect the mother, pregnancy process and the foetus?

A

Maternal death from overdose

Blood-borne diseases (HBV,HCV,HIV)

Fetal growth restriction and stillbirth

Abruption placenta

Preterm delivery

Difficulty to establish venous access

Neonatal withdrawal syndrome

  • Patients at higher risk of violence
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16
Q

How would you manage a pregnant mother with drug abuse problems?

A

Obstetrician-led care

More frequent monitoring eg. growth scan

encourage mothers to participate in methadone programme

think re. safeguarding issues

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17
Q

How does maternal diabetes mellitus effect the mother, pregnancy process and the foetus?

A

Maternal:
Hypo-/hyperglycemia
Ketoacidosis
Hypertension, pre-eclampsia and eclampsia

Fetal:
Sudden IUD
Congenital abnormalities
Shoulder dystocia
Neonatal hypoglycaemia
18
Q

How would you manage a mother with diabetes mellitus?

A

screening of high risk groups

Might give low-dose aspirin to prevent pre-eclampsia

Need to use 5mg folic acid (pre-conceptually if possible)

MDT care - obstetrician led care

Increased monitoring e.g.. growth scans etc.

planned delivery at term, 39/40

19
Q

Are pregnant women more or less likely to suffer with VTE?

A

more likely - some higher risk groups

20
Q

What makes woman more likely to be at risk of VTE during pregnancy?

A

Obesity
FHx
Smoking

21
Q

How would you manage a suspected VTE in pregnancy?

A

Diagnosis:

Treatment:

Post-natal advice:

22
Q

What can cause maternal psychiatric disorders?

A

pre-existing mental health disorders +/- personal and social demands of pregnancy and caring for new baby
- may recur/worsen in postnatal period

23
Q

What postpartum psychiatric disorder is associated with bipolar effective disorder?

A

early postpartum psychosis

24
Q

Which women need urgent referral to a specialist perinatal mental health team?

A

New thoughts of violent self harm

sudden onset or rapidly worsening mental symptoms

persistent feelings of estrangement for their baby

25
Q

What is normal dose of folic acid given to pregnant women? How is this different in epileptic mothers?

A

400 mcg normal

5mg in epilepsy (try to reduce neural tube defects)

26
Q

What might you need to do to anti-epileptic drugs in a pregnant women? Who would do this?

A

may need to increase or decrease

neurologist

27
Q

What vitamin is given to a mother with epilepsy? When is it given?

A

Vit K

In the last 4 weeks

28
Q

Is breastfeeding encouraged or discouraged if the mother is on anti-epileptics?

A

encouraged

29
Q

What elements of labour ay increase risk of seizures (by lowering threshold)

A

Stress
sleep deprivation
medication

30
Q

How might epilepsy impact contraceptive choice?

A

May need a higher dose of oestrogen in pill (if on anti-epileptics that induce hepatic enzymes)

31
Q

When might you not use methyldopa in pregnancy for HTN?

A

risk of depression

32
Q

When might you not use labetalol in pregnancy for HTN?

A

asthmatic woman

33
Q

Why would you give low dose aspirin (from 12 weeks) in pregnant women with long-term HTN?

A

Reduce risk of: pre-eclampsia

growth restriction

34
Q

Which elicit drug is most likely to cause abruption of placenta?

A

cocaine (due to HTN)

35
Q

How can heroin effect pregnancy?

A

Can lead to miscarriage

36
Q

What is macrosomia?

A

A baby >4.5/5Kg

37
Q

What are some risk facts for shoulder dystocia?

A

Diabetes Mellitus (mascrosomic baby)

macrosomic baby

38
Q

What are babies with diabetic mothers at risk of? hypoglycaemia or hyperglycaemia?

A

hypoglycaemia

39
Q

Which women might need to be screened for gestational diabetes?

A

BMI >30
Ethnicity (afro-carribean, asian)
FHx

40
Q

What effects the mode of delivery in diabetic patient?

A

Depends on size of baby

Risk of stillborn

41
Q

What syndrome increases risk of VTE?

A

May-Thurber syndrome (narrowed L iliac vein by pressure from R iliac vein)

GOSH (33 decks)

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