Maternal medicine

Question 1

Renal disease effects on fetus

Answer 1

1st trimester: miscarriage

2nd: fetal death- miscarriage/ stillbirth, preterm labour,

Question 2

renal disease effects on mother

Answer 2

1st: miscarriage
2nd/3rd: hypertension, pre-eclampsia, proteinurea, deterioration in renal function, iti, venous thromboembolism, pre-term delivery,
cesarian

Question 3

pregnany exacerbates

Answer 3

diabetes, heart failure, pituitary adenoma,

Question 4

pregnancy improves

Answer 4

rheumatoid arthritis

Question 5

pregnancy has variable effects

Answer 5

SLE

Question 6

teratogenic medication

Answer 6

sodium valproate, warfarin, lithium, ace inhibitors, retinoic acid

• spina bifida (NTD) from antiepileptics: carbamazepine, sodium valproate, phenytoin, topiramide
• anencephaly (NTD): folic acid deficiency, diabetes, obesity, genetic factors
• ebstein anomaly: secondary to lithium use tricuspid valve displacement to right apex= enlarged RA and small RV

Question 7

meds affecting placenta

Answer 7

beta blockers and antihypertensives

Question 8

meds affecting fetal physiology

Answer 8

warfarin, steroids, indomethacin

Question 9

meds with neonatal effects

Answer 9

tricyclic antidepressants

Question 10

altered symptoms and signs aof pregnancy

Answer 10

symptoms: SOB, headaches, vomiting, site of pain
signs: tachycardia, dyspnoea, oedema
investigations: raised WCC, glycosuria, dilated heart chambers, inverted t waves

Question 11

effects on neonate

Answer 11

metabolic: hyperinsulinaemia in diabetic babies
autoimmune antibodies:
- thyrotoxicosis= thyroid stimulating antibody
- antiplatelet antibodies= thrombocytopenia
- anti-ro antibodies= heart block maternal autoantibodies anti-ro or la cross placenta and damage fetal cardiac conduction system - varying degrees of heart block
- complete AV in 1-5% of women but prev affected child’s risk is much higher (approx 20%)