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ORAL EXAM > Medical conditions in pregnancy > Flashcards

Medical conditions in pregnancy Flashcards

1
Q

prepregnancy assessment and counselling CF

A

MDT -Phys, obs, diet, DM team, CF nurse, PT, anaeathetis, MW, respiratory physicians
testing for diabetes
monitor nutritional status and weight gain
monitor lung function and tx exacerbations
individualised plan for delivery

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2
Q

Effects of pregnancy on CF

A

generally does not shorten survival, but may in severe disease
inadequate weight gain
deteriorating lung function

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3
Q

Effects of CF on pregnancy

A 
GDM
PTB
HTN
IUGR
fetal anomalies
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4
Q

Crohns risks to pregnancy

A

PTB
IUGR
miscarriage
SB

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5
Q

pregnancy effect on crohns

A

most will not have a flare

most at risk of flare if have active disease at conception or new dx crohns in pregnancy

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6
Q

Risks with obstetric cholestasis

A 
SB
PTB
GDM
PET
intractable itch
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7
Q

when to screen for haemoglobinopathy

A

low MCV
low MCH
Normal iron levels
Ethnicity

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8
Q

Maternal haemoglobinopathy - test to screen in father

A

CBC (MCV, MCH)
Ferritin level
Haemoglobinopathy screen

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9
Q

both parents haemoglobinopathy carriers - what to do

A

arrange genetic counselling and molecular testing

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10
Q

beta thalassaemia management in pregnancy

A 
screen for antibodies
baseline CBC and blood film
ECHO - can have cardiomyopathy
Liver USS - can have cirrhosis or cholelithiasis related to iron overload
HbA1c - risk DM
TFTs - risk hypothyroidism
Vitamin D levels
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11
Q

Epilepsy management at booking

A 
MDT approach
Aim monotherapy
Explain increased risk NTD
HD folic acid
Refer to neurologist
advise medication may need to be increased
advise re monitoring levels
possibility of increased seizure frequency during pregnancy
Advise vit k to bubs to prevent HDN
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12
Q

Cervical cancer in pregnancy management

A

MDT input
Colposcopy - exclude invasive disease, biopsy if suspicious of invasive disease
Staging procedure or MRI, CT if think lung mets
CXR
Consider laparoscopic lymphadenectomy for accurate staging, enabling further fetal maturation
If positive nodes, consider TOP; if continuing CT after first trimester
Treatment of 1A2 and beyond - gold standard is radical hysterectomy and BS; can do just trachelectomy during pregnancy with cerclage - high risk PTB, steroid baby @ 24 weeks
If adenocarcinoma - take ovaries too
Timing of delivery - C/S; prelabour, aim 34-36 weeks, earlier depending on well-being of mother; vaginal delivery not advised due to risk of bleeding, and recurrence at epis site
BF contraindicated with CT
Psychological support

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13
Q

Chemotherapy in pregnancy

A

Avoid in first trimester
Monthly growth scans
Monthly MSUs
Avoid CT 3-4 weeks prior to delivery

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14
Q

Myasthenia Gravis and pregnancy

A

rule of thirds for symptoms
delay pregnancy at least 2 years from outset of disease
risk miscarriage and PTB
can develop transient neonatal MG
C/S only for obstetric indication, may require instrumental delivery
Advise epidural
Ok to continue neostigamine
corticosteroids - increased risk oral clefts
Avoid medications that exacerbate symptoms eg magnesium sulfate
NO mycophenylate

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15
Q

Sickle cell risks in pregnancy

A

acute pain crisis/sickle crisis
infection
IUGR
PTB

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16
Q

Prepreg care sickle disease

A 
UTD immunisations (pneumococcal, Hep B)
Antenatal serology
penicillin propylaxis if splenectomy
High dose folic acid
stop hydroxyurea 3/12 before pregnancy
iron chelators to be stopped 
keep warm and well hydrated to reduce risk of sickle crisis
ECG, ECHO
Retinal screening
renal function (BP and urine checks)
Identify partner status - autosomal recessive
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17
Q

Management sickle in pregnancy

A

Monthly MSUs
VTE prophylaxis from 28 weeks, earlier if other risk factors
CBC, LDH, LFTs checked every two weeks
serial USS
High risk sickle crisis and VTE PP
Consider blood transfusion if anaemic and HCT <0.26
Ferritin check each trimester

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18
Q

Beta thalassaemia pre pregnancy counselling

A

Tests to order: ECHO, LFTs and liver USS, HbA1c, TFTS, infection screen
Stop bisphosphonates
Ensure Vit D and calcium
Test partner - could test cffdna or cordocentesis during pregnancy
Vaccination status (pneumococcal)

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19
Q

beta thal during preg

A

stop chelation therapy
follow as per pre preg counselling
?prophylactic antibiotics (if splenectomy)
Review vaccination status
Early diabetes screen
ECHO third trimester is previous one normal
VTE prophylaxis for 6/52 PP; not given antenatally unless personal history
iron chelation therapy ok in BF

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20
Q

alpha thal

A

fetus would be severely anaemic with risk of hydrops and SB

usually also complicated by pre-eclampsia

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21
Q

HbA1c pre diabetes

A

41-49

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22
Q

Pre-existing diabetes pre preg counselling investigations

A 
HbA1c
PET screen
TFTs with antibodies
booking bloods
coeliac screen for Type 1
smear/swabs
MSU/urine PCR
electrolytes
lipids
last eye review
ECG if DM>10yrs
Dietary advice/exercise
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23
Q

glucose targets in pregnancy

A

fasting <5

post prandial <7

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24
Q

Fetal complications with GDM

A 
macrosomia
IUGR
SB
misc
PTL
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25
Q

Maternal complications with Diabetes

A

Birth trauma
UTI
C/S
PET/GTN HTN

26
Q

primary adrenal insufficiency in pregnancy

A 
nausea
vomiting
weight loss
skin darkening
hypoglycaemia
hyponatraemia
hyperkalaemia
27
Q

management acute adrenal crisis in pregnancy

A 
IV line
Hydrocortisione cover in labour
test ACTH, cortisol, glucose and serum electrolytes
Identify cause
tapering steroid once PP
fetal assessment and monitoring
28
Q

Differentiating features of Cushings compared to pregnancy

A 
proximal myopathy
easy bruising
osteopenia/#
hirsuitism
early onset HTN
29
Q

Work up of Cushings

A

urinary cortisol

30
Q

Risks of Cushings in pregnancy

A 
SB
IUGR
PTL
misc
GDM
PET/GTN HTN
wound infection
CCF
psychiatric disorders
neonatal adrenal insufficiency
Infertility
Post op wound dehiscence
31
Q

Treatment Cushings

A

adrenalectomy (unilateral) for adrenal cause
Transphenoidal surgery for pituitary cause
perform in second trimester
or metyrapone or cabergoline

32
Q

Screening for VWD

A

VWD screen

Factor VIII

33
Q

Management of VWD

A

Risk of major APH and PPH
Labour in hospital
Refer/involve haematology and anaesthesia
Obtain/review Factor VIII/vWF levels, aim 50/IU/dL close to delivery.
Have a plan drawn up for antenatal/intrapartum and postpartum care
May need TXA, DDAVP, vWF concentrates recombinant
,vWF + FVIII if severe bleeding
Refer to haematologist, anaesthetist and care ideally through multidisciplinary highrisk pregnancy clinic

34
Q

Thrombocytopaenia screen

A 
FBC 
reticulocyte count
Peripheral blood film
coag screen
U/Es
LFTs
TFTs
Direct Coombs test
APL antibodies
ANA
Hep B, Hep C, HIV
Immunoglobulins
Vitamin B12/folate
H. Pylori
35
Q

Risks with thrombocytopaenia

A

Haemorrhage

Neonatal thrombocytopaenia

36
Q

DDx thrombocytopaenia

A 
ITP
Gestational 
Pregnancy induced - HELLP syndrome
Other - haemotological malignancy
AFLP
HUS
37
Q

Management of thrombocytopaenia antepartum

A 
iron/diet
monitor platelets monthly
IOL by term
MDT approach
further investigations if platelets <70
Treatment if platelets <50
Consider trial of steroids for response +/- immunoglobulin
birth in hospital
38
Q

intrapartum management of thrombocytopaenia

A 
Anticipate PPH
FBC, G&H, platelets
Anaesthetics
Neuraxial issues <70
Avoid instrumental/FBS/clip
Platelets >50 (>20 likely safe)
Stress steroids
IV hydrocortisone 50 mg Q6H from established labour to 6 hours after birth
For CS, give 100 mg IV hydrocortisone at time of anaesthesia, then 6 hours post birth
Neonatal platelets and repeat
Possible platelet transfusion
Active management of third stage
39
Q

Risks of hypothyroidism in pregnancy

A 
miscarriage
PIH/PET
Anaemia
PPH
Abruption
Preterm birth
Cognitive impairment
Developmental delay
Low birthweight
Increased risk of perinatal mortality
40
Q

Treatment of hyperthyroidism in pregnancy

A

prophylthiouracil

41
Q

Risks to fetus in mum on tx hyperthyrodism

A

fetus can be hypothyroid due to mum’s drug crossing placenta

if TRABs, then risk of fetal hyperthyroidism

42
Q

Management of maternal hyperthyroidism

A

treat with meds
Monitor TSH and T4 and TRABs monthly
Fetal USS for signs hyperthyroidism

43
Q

antibodies associated with hypothyroidism

A

TPO

Thyroglobulin

44
Q

fetal thyrotoxicosis

A 
Clinical Presentation:
fetal sinus-tachycardia (around 180-200 bpm)
holosystolic tricuspid insufficiency
IUGR
Goiter
Oligo- or Polyhydramnios
microcephaly
hydrops fetalis
premature delivery
intrauterine fetal demise
Diagnosis:
patient history
biochemical examination (fT4, TSH, TSHR-Ab)
targeted ultrasound examination
45
Q

BPAD risks on pregnancy

A

IUGR
PTB
poor bonding
Psychosis

46
Q

Risk with lithium

A

NTD
Epstein’s anomaly
other cardiac anomalies
GDM

47
Q

Management of lithium use in pregnancy

A

Monthly lithium levels (weekly from 36 weeks), TFTs, U/Es
HD folic acid - ideally preconception
iodine, vit d
early anatomy scan and fetal echo
GDM
?child welfare agency
serial growth scans
active management of the 3rd stage
withhold lithium in labour (high placental transfer)
check lithium level 12 hours post delivery before restarting
Not to be used in BFing

48
Q

Postpartum psychosis

A 
Psych liason
risk of infanticide - ensure baby is safe/remove
Ensure safe from self/risk of self harm
transfer to acute mental health unit
ongoing lithium use
sedation if required
49
Q

Spinal cord injury considerations

A

injury t4 or above - ventilation assessment in pregnancy
injury T6 or above - risk of autonomic dyreflexia - rise in BP 20-40mmHg is indicative
above T10-altered perception of fetal movements, unable to feel labour pains, risk late preterm labour and UTI
above T12 - malpresentation
above L2-L4 - scar tissue in epidural space can make epidural analgesia difficult

50
Q

Effect of pregnancy on spinal cord injury

A

worsening mobility
worsening breathing
possible change of bladder care ?IDC towards end of pregnancy
C/S only if indicated by injury at young age or pelvic trauma

51
Q

pre preg assessment spinal cord injury

A 
support groups
pelvimetry if indicated
Respiratory function assessment if injury T4 or above; chest physiotherapy
avoid constipation (risk AD)
maintain good bladder cares (risk AD)
Baseline CXR
Consider imaging of head and spine
52
Q

Autonomic dysreflexia

A

uncontrolled sympathetic outflow
rise in BP 20-40mmHg
medical emergency
remove noxious stimuli (even constipation, bladder cares)
complication=ICH, death, fetal bradycardia due to paroxysmal HTN episodes
treat with nifedipine sublingual, GTN, or IV labetalol or hydralazine

53
Q

Intrapartum management SCI

A

good bladder care - place IDC
monitor observations - rises from baseline should be flagged
prophylactic epidural
continuous CTG
If AD in second stage - instrumental - if don’t have pain relief, then they must be given some!!!

54
Q

tx of spasticity in pregnancy

A

baclofen (intrathecal)
otherwise oxybutinin for bladder spasms
diazepam

55
Q

Covid in pregnancy risks

A 
Pneumonia, ARDS, resp failure
AKI, VTE, myocarditis
strokes, vasculitis
PTL
IUGR
SB
56
Q

Covid vaccine explanation

A

higher risk in pregnancy due to reduced lung function, , increased oxygen consumpton, and reduced immune function
mRNA vaccine does not contain live virus
may offer passive immunity to baby
vaccination best way to prevent these risks and can be given in any trimester
does not effect miscarriage or fertility rates
does not increase VTE

57
Q

Risks uncontrolled hyperthyroidism in pregnancy

A 
PET
thyroid storm
thyrotoxic heart failure
FGR
prematurity
stillbirth
fetal thyrotoxicosis
fetal hypothyroidism
58
Q

Management thyrotoxicosis

A

PTU - ok in first trimester and BFing, risk maternal liver function damage
carbimazole - risk aplasia cutis, ok in 2nd and 3rd trimester
No radioactive iodine
surgery rarely required - if need to do, aim second trimester

59
Q

Rates of depression and anxiety

A

approx 12-15%

60
Q

Risk of postpartum psychosis with BPAD

A

20-30%

61
Q

Neonatal Adaption syndrome

A

irritability, sleep disturbance, hypoglycaemia
self-limiting, supportive cares
neonate at risk if SSRI use or benzos

62
Q

CF investigations

A

ECHO

baseline lung function tests

ORAL EXAM (20 decks)

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