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Reproduction and Sexual Health > Medical Conditions in Pregnancy (OLD NOTES) > Flashcards

Medical Conditions in Pregnancy (OLD NOTES) Flashcards

1
Q

What things are done at a normal ANC booking visit?

A
  • General pregnancy advice is given.
  • Identify if low/high risk.
  • Information on choices for place of delivery.
  • Discuss screening.
  • Check height and weight (BMI).
  • Check BP.
  • Arrange dating USS at 12 weeks.
  • Arrange ‘booking’ bloods.
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2
Q

What bloods are taken at booking, and what is screened for via blood testing?

A
  • FBC and Blood Group and Antibodies (Rh status)
  • Haemaglobinopathies
  • Infection Screen - Hep B, HIVm rubella, VDRL
  • Random Blood Glucose - screen for diabetes
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3
Q

When is the first USS done?

A

11-12 weeks

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4
Q

When is the anomaly scan done?

A

20 weeks

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5
Q

Up to how many weeks are monthly visits done?

A

28 weeks

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6
Q

When is anti D checked?

A

28 weeks + 34 weeks

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7
Q

When are weekly visits done?

A

37 weeks until delivery

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8
Q

What is done at every antenatal visit?

A
  • Accurately document gestation.
  • BP.
  • Urinalysis.
  • SFH (FSH).
  • Referral of any problems to Consultant Unit.
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9
Q

What is the commonest medical problem in pregnancy?

A

HYPERTENSION

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10
Q

What is defined as chronic essential hypertension in pregnancy?

A

HTN present at booking or <20weeks

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11
Q

What is gestational hypertension defined as?

A

New HTN >20weeks without significant proteinuria.

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12
Q

What is pre-eclampsia defined as?

A

New HTN >20weeks + significant proteinuria.

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13
Q

What 5 factors do you need to consider in someone with suspected hypertension?

A
  1. Effect on pregnancy.
  2. Pregnancy effect.
  3. Medications.
  4. Delivery.
  5. Post-partum.
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14
Q

Outline 3 factors which contribute to decreased blood flow to organs.

A
  1. Vasoconstriction
  2. Pro-coagulation
  3. Intravascular thrombosis
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15
Q

What happens to GFR? (in pregnancy-induced renal disease)?

A

It decreases

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16
Q

What happens to serum uric acid? What may be associated with this? (in renal disease in pregnancy)

A

It increases

There is also placental ischaemia

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17
Q

What 3 things increase in renal disease in pregnancy?

A
  1. Creatinine
  2. Potassium
  3. Urea
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18
Q

What happens to urine output in a pregnancy lady with renal disease?

A

There is oliguria/anuria (small amounts of urine or no urine)

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19
Q

What 2 categories can acute renal failure be divided into?

A
  1. Acute tubular necrosis.

2. Renal cortical necrosis.

20
Q

What symptoms may a pregnant woman with liver disease experinece?

A

Epigastric/RUQ pain

21
Q

What – on investigation – may be abnormal, in a pregnant lady with liver disease?

A

Liver enzymes

22
Q

What serious condition can arise from liver disease in pregnancy?

A

HEPATIC CAPSULE RUPTURE

23
Q

What may hepatic capsule rupture/ liver disease in pregnancy lead to?

A

HELLP Syndrome – haemolysis, elevated liver enzymes, low platelets.

24
Q

Give 3 problems associated with placental disease.

A
  • IUGR.
  • Placental abruption.
  • Intrauterine death.
25
Q

What investigations should be done for hypertension in pregnancy?

A
  • Urea and electrolytes.
  • Serum urate.
  • LFT’s.
  • FBC.
  • Coagulation screen.
  • CTG.
  • Ultrasound – biometry, AFI, Doppler.
26
Q

At what points in the pregnancy journey should the mx of HT be considered?

A
  • Pre-conception.
  • Booking.
  • Antenatal.
  • Intrapartum.
  • Postpartum.
27
Q

If, on assessment at booking or at any other point antenatally, there are risk factors for pre-eclampsia, what should be done?

A

GIVE ASPIRIN

28
Q

If, on assessment at booking or at any other point antenatally, there are risk factors for pre-eclampsia, what should be done?

A

Surveillance

  • Scans.
  • BP monitoring.
  • Urine testing.
  • Staff: medical, midwives, community
29
Q

If a woman has hypertension at < 20 weeks, what should you do?

A

Check for a secondary cause - it is VERY likely that she already had hypertension

30
Q

What medications are used to treat HT in pregnancy? (list these in order of 1st, 2nd line etc)

A
  1. Labetalol.
  2. Methyldopa.
  3. Nifedipine (usually if monotherapy fails ie. top up).
31
Q

What anti-hypertensive medication should be stopped in pregnancy?

A

ACEI’s and ARB’s

32
Q

What can be used for severe hypertension in pregnancy?

A
  • Labetalol (oral or IV).
  • Hydralazine (IV).
  • Nifedipine (oral).
33
Q

165/110 would be classified as ______ hypertension in pregnancy

A

severe

34
Q

What is the target BP in pregnancy?

A

150/80-100mmHg

35
Q

If there is target organ damage, e.g. renal damage, causing proteinuria or retinal damage, what BP should you aim for?

A

<140/90mmHg.

36
Q

If BP is i) <140/90 ii) <130/90mmHg, what should you do?

A

i) Consider reducing dose.

ii) Reduce dose.

37
Q

What are the effects of pregnancy on diabetes?

A

Pregnancy is DIABETOGENIC

  • poorer control
  • deterioration of renal function
  • deterioration of ophthalmic disease
  • GDM
38
Q

What are the effects of diabetes on pregnancy?

A
  • Miscarriage.
  • Foetal malformations: cardiac, neural tube defects, caudal regressions syndrome.
  • IUGR/Macrosomia.
  • Unexplained IUD.
  • PET.
39
Q

How can diabetes in pregnancy be managed?

A

Diet, metformin or insulin

40
Q

What type of delivery should be aimed for in diabetes?

A

Vaginal delivery – induce labour at 37-38 weeks

41
Q

What type of diabetes can present in pregnancy?

A
  • Pre-existing Type 1.
  • Pre-existing Type 2. (increasing)
  • Gestational Diabetes. (increasing).
42
Q

Outline the effects of diabetes on the foetus.

A
  1. Maternal diabetes – hyperglycaemia
  2. Foetal hyperinsulinaemia
  3. Increased foetal growth  foetal macrosomia  shoulder dystocia
  4. Polyuria + Polyhydramnios, Increased O2 demands  risk of preterm labour, malpresentation and cord prolapse
  5. neonatal hypoglycaemia  risk of cerebral palsy
43
Q

Outline risk factors for GDM.

A
  • Previous GDM.
  • FHx: one first degree, or two second degree relatives.
  • Poor obstetric history, esp. death of previous macrosomic baby.
  • Significant glycosuria.
  • Polyhydramnios.
  • Macrosomic infant in this pregnancy.
  • Polycystic ovary syndrome.
  • Weight >100kg or BMI>30.
  • South Asian, Middle Eastern or African origin.
44
Q

HbA1C should be kept below what?

A

6%

45
Q

What should be done every trimester in a woman with hypertension?

A

Retinal screening

46
Q

When should serial growth scans be done in a pregnancy lady with hypertension?

A

At 28, 32 and 36 weeks.

47
Q

What should be monitored for in pregnant ladies with hypertension?

A

PET

Reproduction and Sexual Health (51 decks)

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