Maternal Mortality in Pregnancy

Question 1

How does a peripartum cardiomyopathy present?

Answer 1

can’t lie flat

Question 2

What % die if they have a MI in pregnancy?

Answer 2

1/3rd

Question 3

What % of women get breathless in pregnancy?

Answer 3

75% - esp in 3rd trimester

Question 4

What is a red flag to do with breathlessness?

Answer 4

if they cannot carry out normal activities

Question 5

How should births be managed for those with asthma?

Answer 5

aim for vaginal birth
women should continue inhalers during pregnancy/labour
give IV hydrocortisone if on oral steroids

Question 6

How much does the VTE risk increase in pregnancy?

Answer 6

4-6x increase

Question 7

Why does VTE risk increase in pregnancy?

Answer 7

oestrogen promotes blood cotting and decreases activity of antithrombin 3

Question 8

How do Virchows triad change during pregnancy?

Answer 8

hypercoagulability - increased Von Willibrand factor, increased factors VII, IX, X + XII, increased fibrogen
venous stasis - slowing of circulation
vascular damage - impaired fibrinolytic activity

Question 9

What can cause VTEs?

Answer 9

thrombophillia - anti thrombin deficiency or protein C

Question 10

How does a DVT present?

Answer 10

swelling
oedema
leg pain/discomfort
tenderness
increase in leg temperature
lower abdo pain
increased WCC

Question 11

How are DVTs investigated?

Answer 11

duplex ultrasound

Question 12

How do PEs present?

Answer 12

dyspnoea
chest pain
faintness
haemoptysis 
focal signs in the chest
chest pain 
collapse
raised JVP 
similar symptoms/signs of DVT

Question 13

How are PEs diagnosed?

Answer 13

V/Q perfusion scan

Question 14

How are DVTs and PEs treated?

Answer 14

warfarin then LMWH by 6 weeks

Question 15

How long should anticoagulant therapy be used?

Answer 15

6 weeks post natally and 3weeks post partum

Question 16

Should warfarin be used in pregnancy?

Answer 16

not past week 6

it is tetarogenic - causes Warfarin embryopathy

Question 17

How do autoimmune conditions react to pregnancy?

Answer 17

get better due to immuno suppression

Question 18

What autoimmune drugs are contraindicated in pregnancy?

Answer 18

NSAIDS >32 weeks
cyclophosphamide
methotrexate 
chlorambucil 
gold
penicillamine
MMF
leflumide

Question 19

What is antiphospholipid syndrome?

Answer 19

antiphospholipid antibodies react with the phospholipid component of the cell membrane
causes recurrent and early miscarriages, pre ecclampsia, placental abruption and fetal growth retardation

Question 20

How is APS managed?

Answer 20

LMWH and LDA

Question 21

How do seizures change in epileptics with pregnancy?

Answer 21

stay the same or get better

Question 22

What are the risks to the fetus with an epileptic mother?

Answer 22

2-3x increased risk of malformations for any single anti epileptic drug
long term developmental effects
haemorrhagic disease of the newborn
risk of childhood epilepsy

Question 23

How is the risk reduced for epileptic mothers?

Answer 23

folic acid 5mg

lowest effective dose of anti epileptic drug

Question 24

How is an intrapartum seizure managed?

Answer 24

left lateral tilt
IV lorazepam/diazepam
IV phenytoin

Question 25

What should be given in an intrapartum seizure if there is no history of epilepsy?

Answer 25

magnesium sulphate

Question 26

How are obese mothers managed in pregnancy?

Answer 26

red pathway
folic acid 5mg from 12 weeks
10mg vitamin D from 12 weeks
low dose aspirin from 12 weeks
USS growth at 28 weeks
OGTT 24-28 weeks

Question 27

What should be given at the 3rd stage of labour in an obese mother?

Answer 27

IM syntometrine or IV oxytocin - prevents bleeding and increases contraction of the uterus

Question 28

What should be given to obese mothers post partum?

Answer 28

fragmin for 6 weeks post natally