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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
How to monitor for magnesium toxicity
Blood tests. Patellar reflex is first to go.
26
Drugs: Contraindicated anti-hypertensives in pregnancy
``` ACE inhibitors (-pril) ARBs (-artan) ```
27
Drugs: Contraindicated anti coagulants in pregnancy
Warfarin Aspirin Dalterparin Rivaroxiban
28
Features of HELLP syndrome
o Haemolysis o Elevated liver enzymes (indicate liver damage) o Low platelet count
29
What is disseminated intravascular coagulation. Why is it dangerous in pregnancy?
o Small blood clots develop throughout bloodstream o Depletes platelets & clotting factors o Causes excessive bleeding later
30
If a mother has had labetolol , what needs to be monitored in a baby shortly after birth
Blood glucose. Labetolol can cause neonatal hypoglycaemia.
31
Define eclampsia
Tonic-clonic seizure secondary to pre-eclampsia
32
Demographic risk factors for VTE in pregnancy
* Age >36 | * Parity 3 or more
33
Current pregnancy-related risk factors for VTE in pregnancy
* Multiple pregnancy * Pre-eclampsia * Preterm/ stillbirth * Ovarian hyperstimulation syndrome in 1st trimester * Hyperemesis
34
Interpartum risk factors for VTE in pregnancy
* C section * Prolonged labour >24h * Postpartum haemorrhage >1L
35
What drug to use as prophylaxis for DVT in at-risk pregnant women
Daltepartin (LMWH)
36
Who needs increased dose of folic acid throughout pregnancy
- epileptics - diabetics - BMI>30 - sickle cell, malabsorption diseases
37
Drugs: Which anti-epileptic should be avoided during pregnancy
sodium valproate
38
Drugs: Which anti-epileptics are safe for pregnancy
Carbamazepine | Lamotrigine
39
What is used to screen GDM mums for T2DM 6-13 weeks after pregnancy?
Fasting glucose
40
How should women who had GDM with a negative postnatal screening test be managed?
Annual HbA1c test
41
Postnatal drug management of T1DM mums
Resume insulin (regime as before pregnancy) There is increased risk of hypoglycaemia postnatally so must monitor carefully
42
Postnatal drug management of T1DM mums
Stop VRIII (if it was needed) Resume metformin
43
Postnatal drug management of GDM mums
Stop all treatment. Postnatal screen for T2DM
44
Who should get VRIII (variable rate insulin infusion) during labour?
T1DM automatically gets it. T2DM and GDM only get if required.
45
Target HbA1c to maintain mother at during antenatal/intrapartum period
<48mmol/L

Stage 3: EJR - Obstetrics (17 decks)

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