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Stage 3: EJR - Obstetrics > Maternal medicine > Flashcards

Maternal medicine Flashcards

1
Q

When should women with pre-existing diabetes go for diabetic retinopathy screening

A

16 and 28w

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2
Q

Diabetes: risks to mum

A
  • Miscarriage
  • Pre-eclampsia
  • Diabetic retinopathy
  • Preterm labour
  • Nephropathy
  • Hypoglycaemia
  • UTI, endometrial infx after giving birth
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3
Q

Diabetes: risks to foetus

A
  • Macrosomia
  • NTDs, cardiac defects
  • Birth injury (due to large size)
  • Intrauterine death
  • Increased perinatal mortality
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4
Q

Risk factors for developing gestational diabetes

A
  • BMI >30
  • Previous baby 4.5kg or more
  • 1st degree relative with diabetes
  • High risk ethnicity: South Asian, Caribbean, Middle East
  • Previous stillbirth
  • Polyhydramnios
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5
Q

Who needs a glucose tolerance test at booking

A
  • BMI >40
  • Previous GDM
  • Asian
  • Afro-Carribean
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6
Q

Who needs a glucose tolerance test at 24-28weeks

A
  • BMI >30
  • 1st degree relative with diabetes
  • Previous baby >4.5kg
  • Previous unexplained stillbirth
  • Confirmed polyhydramnios
  • Parity >4
  • PCOS
  • Glycosuria
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7
Q

Glucose levels to diagnose GDM

A

Fasting glucose >5.6mmol

2 hour >7.8mmol

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8
Q

When is neural tube defect scan for diabetic mothers done

A

14-16w

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9
Q

When are growth scans done for diabetic mothers

A

28, 32, 36 weeks

Then every 2 weeks

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10
Q

From what week onwards are CTGs done for diabetic mothers

A

From 34 weeks

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11
Q

Target blood glucose to maintain mother at during antenatal/intrapartum period

A

4-7mmols

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12
Q

Target blood pressure to maintain mother at during antenatal/intrapartum period

A

Systolic <150

Diastolic 80-100

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13
Q

First line drug for treatment of gestational hypertension

A

Labetalol

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14
Q

Labetalol cannot be given to asthmatic patients. Why?

A

Labetalol is an alpha and beta blocker.

Beta blockers cannot be given to asthmatic patients.

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15
Q

Alternative drug to labetalol (for asthmatic patients) to manage gestational hypertension.

What is it’s MoA

A

Hydralazine

Direct-acting smooth muscle relaxant; vasodilator

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16
Q

Definition of gestational hypertension

A

Newly detected hypertension after 20w

without significant proteinuria

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17
Q

Definition of pre-eclampsia

A

Newly detected hypertension after 20w

+ significant proteinuria

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18
Q

Define early onset pre-eclampsia. Is this better or worse for the foetus (compared to late onset)?

A

Onset <34w

Worse as usually growth-restricts foetus.

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19
Q

What level of hypertension would lead to pre-eclampsia

A

ANY level. May be severely ill even with mild hypertension.

20
Q

Signs and symptoms of pre-eclampsia

A
  • Severe headache
  • Visual disturbance
  • Epigastric pain and/or vomiting
  • Rapid onset oedema
21
Q

What dose of aspirin should be given to the following

  • 1 high risk factor for pre-eclampsia
  • 2 moderate risk factors for pre-eclampsia
A

75mg for both

22
Q

High risk factors for pre-eclampsia

A
  • pre-eclampsia in previous pregnancy
  • CKD
  • T1DM, T2DM
  • chronic hypertension
  • autoimmune disease
23
Q

Moderate risk factors for pre-eclampsia

A
  • first pregnancy
  • pregnancy interval >10years
  • age >40
  • BMI >35
  • multiple pregnancy
  • FHx of pre-eclampsia
24
Q

Magnesium sulfate is given to women with severe pre-eclampsia.

What is it for?

What’s the loading dose?

A

Prophylaxis against eclampsia

4g loading dose

25
Q

How to monitor for magnesium toxicity

A

Blood tests.

Patellar reflex is first to go.

26
Q

Drugs: Contraindicated anti-hypertensives in pregnancy

A 
ACE inhibitors (-pril)
ARBs (-artan)
27
Q

Drugs: Contraindicated anti coagulants in pregnancy

A

Warfarin
Aspirin
Dalterparin
Rivaroxiban

28
Q

Features of HELLP syndrome

A

o Haemolysis
o Elevated liver enzymes (indicate liver damage)
o Low platelet count

29
Q

What is disseminated intravascular coagulation. Why is it dangerous in pregnancy?

A

o Small blood clots develop throughout bloodstream

o Depletes platelets & clotting factors

o Causes excessive bleeding later

30
Q

If a mother has had labetolol , what needs to be monitored in a baby shortly after birth

A

Blood glucose.

Labetolol can cause neonatal hypoglycaemia.

31
Q

Define eclampsia

A

Tonic-clonic seizure secondary to pre-eclampsia

32
Q

Demographic risk factors for VTE in pregnancy

A
  • Age >36

* Parity 3 or more

33
Q

Current pregnancy-related risk factors for VTE in pregnancy

A
  • Multiple pregnancy
  • Pre-eclampsia
  • Preterm/ stillbirth
  • Ovarian hyperstimulation syndrome in 1st trimester
  • Hyperemesis
34
Q

Interpartum risk factors for VTE in pregnancy

A
  • C section
  • Prolonged labour >24h
  • Postpartum haemorrhage >1L
35
Q

What drug to use as prophylaxis for DVT in at-risk pregnant women

A

Daltepartin (LMWH)

36
Q

Who needs increased dose of folic acid throughout pregnancy

A
  • epileptics
  • diabetics
  • BMI>30
  • sickle cell, malabsorption diseases
37
Q

Drugs: Which anti-epileptic should be avoided during pregnancy

A

sodium valproate

38
Q

Drugs: Which anti-epileptics are safe for pregnancy

A

Carbamazepine

Lamotrigine

39
Q

What is used to screen GDM mums for T2DM 6-13 weeks after pregnancy?

A

Fasting glucose

40
Q

How should women who had GDM with a negative postnatal screening test be managed?

A

Annual HbA1c test

41
Q

Postnatal drug management of T1DM mums

A

Resume insulin (regime as before pregnancy)

There is increased risk of hypoglycaemia postnatally so must monitor carefully

42
Q

Postnatal drug management of T1DM mums

A

Stop VRIII (if it was needed)

Resume metformin

43
Q

Postnatal drug management of GDM mums

A

Stop all treatment.

Postnatal screen for T2DM

44
Q

Who should get VRIII (variable rate insulin infusion) during labour?

A

T1DM automatically gets it.

T2DM and GDM only get if required.

45
Q

Target HbA1c to maintain mother at during antenatal/intrapartum period

A

<48mmol/L

Stage 3: EJR - Obstetrics (17 decks)

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