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Reproduction and Sexual Health > Medical Conditions in Pregnancy > Flashcards

Medical Conditions in Pregnancy Flashcards

1
Q

Most maternal mortality during pregnancy is from _____ causes of pregnancy

A

Direct

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2
Q

Give examples of some causes of mortality during pregnancy.

A
  • Haemorrhage
  • Sepsis
  • Hypertension
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3
Q

What is the most common cause of mortality during pregnancy?

A

Cardiac disease

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4
Q

Obese + pregnant women are more at risk of?

A

Blood clots

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5
Q

What is the normal HR for a full term pregnant lady?

A

90-100 bmp

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6
Q

Peripheral vascular resistance increases in pregnancy

A

F - it decreases

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7
Q

What should all pregnant women with chest pain get?

A

ECG + CT

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8
Q

** ALL PREGNANT WOMEN WITH CHEST PAIN SHOULD GET AN ECG + CT **

A

T

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9
Q

List reasons of why heart disease in pregnancy is rising

A
  • More obesity
  • More older women having babies
  • More CHD (congenital heart disease)
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10
Q

Palpitations are very common physiologically in pregnancy

A

T

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11
Q

Most palpitations in pregnancy are something to worry about

A

F - most are benign

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12
Q

What often causes the onset of palpitations (physiologiclally) in pregnant women?

A

Rest and when patient is lying on their side

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13
Q

How can pregnant women get rid of physiological palpitations?

A

By getting up and moving around

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14
Q

WARFARIN IS TERATOGENIC

A

T

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15
Q

What anticoagulant should never be prescribed to pregnant women as it is teratogenic?

A

Warfarin

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16
Q

How do women with ectopic beats in pregnancy describe these beats?

A

Thumping

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17
Q

Can ectopic beats be seen on an ECG?

A

Yes

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18
Q

Sinus tachycardia is part of a normal pregnancy BUT must be ____________

A

Investigated

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19
Q

When investigating sinus tachycardia, what are you trying to exclude?

A
  • Sepsis

* PE

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20
Q

What 4 investigations should be done in a pregnant woman with tachycardia?

A

ECG, FBC, TFT, ECHO

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21
Q

If someone has SVT in pregnancy, when is it likely to have occurred?

A

Before pregnancy

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22
Q

What investigations need to be done for a pregnant lady with SVT?

A
  • ECG
  • 24H ECG
  • TFT
  • ECHO
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23
Q

What investigations need to be done for a pregnant lady with SVT? (hint: these are the same as with sinus tachycardia)

A
  • ECG
  • 24H ECG
  • TFT
  • ECHO
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24
Q

Name a thyroid problem that could result in palpitations.

A

Hyperthyroidism

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25
Q

How is hyperthyroidism investigated?

A

ECG, TFT (+ FT4)

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26
Q

How is a pheochromocytoma investigated?

A

24h catecholamines + US

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27
Q

Functional residual capacity of the lungs decreases during pregnancy

A

T

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28
Q

PaCO2 increases during pregnancy

A

F - decreases

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29
Q

Around __ % of women will be breathless during pregnancy meaning this is very common

A

75%

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30
Q

In what trimester is breathlessness most common?

A

3rd

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31
Q

The increased demands for O2 during pregnancy are facilitated via INCREASED VENTILATION

A

T

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32
Q

Breathless during pregnancy is i) made worse by ii) relieved by?

A

i) rest + talking

ii) exertion

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33
Q

What is the commonest medical condition to complicate pregnancy?

A

ASTHMA

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34
Q

__% of women with asthma will have an acute exacerbate during pregnancy

A

10%

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35
Q

During pregnancy asthma can …

A
  • Get better
  • Stay the same
  • Get worse
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36
Q

Why might asthma get worse during pregnancy?

A

Many women when they find out they are pregnant will stop taking their medication for asthma because they think it might harm the baby

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37
Q

Women with severe asthmatic disease are at risk of deterioration, especially in 3rd trimester

A

T

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38
Q

Well controlled asthma …

A

Will not adversely affect the baby

39
Q

Poorly controlled asthma …

A

Worse than the effects of the medication for the baby

40
Q

What kind of birth should mothers with asthma aim for?

A

Vaginal

41
Q

Women should stop using inhalers during pregnancy

A

F - during pregnancy women should continue to use their inhalers

42
Q

For a woman with asthma during labour, what is the 1st step that should be done?

A

Increase dose and frequency of inhaled steroids

43
Q

If a woman with asthma has been on oral steroids for more than 2 weeks prior to labour, what should be done? Why?

A

IV hydrocortisone should be given during labour

In labour women cannot make their own steroids

44
Q

Outline the treatment for asthma.

A
  1. Short acting B2 agonist (SABA)
  2. Add inhaled steroid
  3. Add LABA
    - If LABA helps then continue LABA
    - If LABA doesn’t help much then keep LABA and increase steroid dose
    - If LABA helps none then stop LABA and increase steroid
  4. Increase steroid to 2000mg and consider adding leukotriene receptor antagonist
  5. Oral steroid tablet
45
Q

What is the leading cause of maternal mortality?

A

VTE

46
Q

By how much does a woman’s risk of a VTE increase while being pregnant?

A

5 x’s

47
Q

90% of DVT’s during pregnancy occur in the ______ leg

A

LEFT

48
Q

70% of DVT’s in pregnancy are ilii-femoral

A

T

49
Q

How can the pathogenesis of a VTE be explained?

A

Virchows triad

50
Q

Outline virchow’s triad and how it is altered in pregnancy.

A

1 – Stasis (venous)
Secondary to venous compression by pregnant uterus

2 – Hypercoagulability
Effects of pregnancy

3 – Vascular damage - this is the valves (not the wall)
Varicose veins

51
Q

Pregnancy is a hyper-coagulable state

A

T

52
Q

A pregnant lady with a previous VTE is regarded as high risk. What do they need to be prescribed at the start of pregnancy?

A

LMWH

53
Q

In a high risk mother, how long after pregnancy do they need to take LMWH?

A

6 weeks

54
Q

How is a low risk mother managed in terms of preventing VTE risk?

A

Told to keep mobile and hydrated

55
Q

3 VTE risk factors…

A

LMWH for 28 weeks

56
Q

3 VTE risk factors…

A

LMWH from 28 weeks to pregnancy

57
Q

4 VTE risk factors ….

A

LMWH from 1st trimester to pregnancy

58
Q

What signs can help us to diagnose a DVT?

A
  • Swelling
  • Oedema
  • Leg pain or discomfort
  • Tenderness
  • Increased leg temperature
  • Lower abdominal pain
  • Elevated white cell count
59
Q

Why is it difficult not to misdiagnose a DVT during pregnancy?

A

Because all the signs are present in normal pregnancy

60
Q

How would you investigate DVT in a non pregnant person?

A

Do bloods to check for d-dimers

61
Q

Why do you not check bloods for d-dimers in pregnant women?

A

Because d-dimers are elevated in normal pregnancy

62
Q

How is a DVT diagnosed in pregnancy?

A

1st line – IMAGING - compression duplex US

2nd line – if iliac vein thrombosis is suspected (whole leg swollen + back pain) - consider MRI venography

63
Q

Outline the symptoms of a PE.

A
  • Dyspnoea
  • Chest pain
  • Faintness
  • Collapse
  • Haemoptysis
  • Raised JVP
  • Focal signs in the chest
64
Q

How is a PE investigated in pregnancy?

A

ECG + CXR

65
Q

What kind of foetal malformations can Warfarin cause if given to a pregnant lady?

A
  • Midface hypoplasia
  • Stippled chondral calcification
  • Short proximal limbs
  • Short phalanges
  • Scoliosis
66
Q

Warfarin can be teratogenic as it crosses the ________

A

Placenta

67
Q

Prior to pregnancy, if someone is on Warfarin, what should this be changed to and when?

A

LMWH at 6 weeks

68
Q

Can Warfarin and Heparin be used post-natal?

A

YES - none of these affect breastfeeding

69
Q

When following birth, can warfarin be started?

A

5 days after birth

70
Q

What is APS?

A

An acquired thrombophilia with variable presentation and severity

71
Q

What do antiphospholipid antibodies in APS do?

A

Autoantibodies that react with the phospholipid component of the cell membrane and cause arterial and venous thrombosis

72
Q

Outline some of the clinical features of APS.

A
  • Arterial / venous thrombosis
  • Recurrent early pregnancy loss
  • Late pregnancy loss - usually preceded by FGR
  • Placental abruption
  • Severe early onset pre-eclampsia (PET)
  • Severe early onset Fetal Growth Restriction (FGR)
73
Q

How is APS diagnosed?

A
  • Vascular thrombosis – arterial, venous, small vessel
    +
  • ≥ 3 miscarriages <10 weeks
  • ≥ 1 fetal loss >10 weeks (morphologically normal fetus)
  • ≥1 preterm birth (<34 weeks) due to PET or utero-placental insufficiency
    +
  • IgM / IgG aCL (medium / high titre)
  • LA
74
Q

How is APS managed if the woman has had no previous thrombosis or adverse pregnancy?

A
  • Low dose aspirin

* Maternal + foetal surveillance

75
Q

How is APS managed if the woman has had a previous thrombosis?

A
  • On warfarin —– Stop warfarin

* LDA + LMWH (treatment dose)

76
Q

How is APS managed if the woman has had a previous early pregnancy loss?

A
  • Low dose aspirin + LMWH (prophylaxis dose)
77
Q

How is APS managed if the woman has had a previous late pregnancy loss?

A
  • Low dose aspirin + LMWH (prophylaxis dose)
78
Q

In a pregnant woman with epilepsy, seizure frequency is either ________ or _________

A
  1. Improved

2. Unchanged

79
Q

In a woman with epilepsy, if no seizure in 9 months prior to pregnancy, up to 92% will remain seizure free

A

T

80
Q

Outline some of the MATERNAL risks if a pregnant lady has a seizure.

A
  • Maternal abdominal trauma – foetomaternal haemorrhage
  • PPROM – premature rupture of membranes
  • Preterm birth
  • Hypoxia/acidosis
81
Q

How can a woman prevent having a seizure in late pregnancy?

A

By having good seizure control in the first trimester

82
Q

Outline some of the FOETAL risks if a pregnant lady has a seizure.

A
  • Major congenital malformations - this is what we worry about as the drugs used to treat epilepsy are teratogenic !!!!
  • Minor malformations
  • Adverse perinatal outcomes
  • Long-term developmental effects
  • Haemorrhagic disease of the newborn
  • Risk of childhood epilepsy
83
Q

Why do we worry about major congenital malformations in a baby whose mother is epileptic?

A

Because most of the drugs used to treat epilepsy are teratogenic

84
Q

Many drugs affect liver enzymes, which affect vitamin K and thus the baby can get a haemorrhagic disorder of the newborn

A

T

85
Q

2-3 x’s increase in risk of teratogenicity with a single AED’s

A

T

86
Q

What should all pregnant women on an AED be offered?

A

All women should be offered a detailed ultrasound scan assessment of fetal anatomy at 18-20 weeks gestation

87
Q

What are the most common congenital malformations with AED’s?

A
  • Neural tube defects
  • Congenital heart disorders
  • Urinary tract
  • Skeletal abnormalities
  • Cleft palate
88
Q

If a woman is having a seizure during pregnancy, what needs to be given ASAP?

A

Benzodiazepines

89
Q

What do we worry about if someone is having a seizure during pregnancy?

A
  • Maternal hypoxia
  • Foetal hypoxia
  • Foetal acidosis
90
Q

Most women with epilepsy will have a normal labour and vaginal birth

A

T

91
Q

What can increase the risk of having a seizure during pregnancy?

A
  • Stress
  • Pain
  • Sleep deprivation
  • Over-breathing
  • Dehydration
92
Q

What can women take to reduce to the risk of having AED related foetal abnormalities?

A

Folic acid

93
Q

What is given as a pre-eclampsia prophylaxis in obese pregnant women?

A

Aspirin

94
Q

What do obese pregnant women get at 34 weeks?

A

Anaesthetic review

Reproduction and Sexual Health (51 decks)

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