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Reproduction Pathology > Medical Disorders and Pregnancy > Flashcards

Medical Disorders and Pregnancy Flashcards

1
Q

Can insulin cross the placenta?

A

No

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2
Q

Can glucose cross the placenta?

A

Yes

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3
Q

If the head is delivered but the shoulders aren’t, how quickly do you need to deliver the shoulders and what happens if this is not done?

A

5 minutes

Death due to hypoxia or brain damage due to hypoxia

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4
Q

What can shoulder dystocia result in?

A

Stuck

Erb’s palsy

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5
Q

Effects of T1DM in first trimester

A 
Miscarriage
More prone to developing DKA
Congenital defects
- cardiac
- neural tube
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6
Q

What is the risk of miscarriage in the general population?

A

6 - 8%

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7
Q

What type of condition is pregnancy?

A

Diabetogenic

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8
Q

Which weeks are the second trimester?

A

12 - 28 weeks

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9
Q

Effects of T1DM in second trimester

A

Polyhydramnios

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10
Q

What can be done after 28 weeks gestation to monitor growth?

A

Serial scans

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11
Q

Management of a diabetic woman wanting to get pregnant

A

HbA1c < 48
Folic acid (5mg)
Make sure aware of hypo symptoms

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12
Q

How much time before pregnancy should folic acid be taken?

A

3 months before

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13
Q

Effects of T1DM in third trimester

A

Stillbirth (macrosomic babies)

Placental insufficiency

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14
Q

When are scans done in a normal pregnancy?

A

12 - 14 weeks first scan
20 weeks anomaly scan
28 weeks onwards growth scans

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15
Q

Effects of polyhydramnios

A

Pre term labour
Pre term rupture of membranes
PPH

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16
Q

How does polyhydramnios cause its complications?

A

It stretches the uterus

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17
Q

What can T1DM result in post delivery?

A

Neonatal hypoglycaemia
3 - 5% of the babies develop DM
Usually sugar levels of mum drop
Usually need pre pregnancy levels of insulin

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18
Q

What is used to prevent respiratory distress syndrome of the neonate in DM?

A

Steriods

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19
Q

Effects of DM in pregnancy to the mother

A 
Increased insulin requirments 
Miscarriage 
Worsening of maternal DM 
Infections 
Jaundice
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20
Q

Effects of DM on the foetus

A 
Macrosomnia (foetal hypersinsulinaemia)
Neonatal hypoglycaemia
Resp distress 
Cardiac abnormalities 
Pre eclampsia 
Polyhydramnios 
Stillbirth 
Shoulder dystocia 
Impaired lung maturity of neonate
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21
Q

What do steriods do to sugar levels?

A

Increase them and therefore need increased insulin dose

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22
Q

How many doses of steriods are administered in DM and what steriods can be used?

A

2 doses

Bethamexasone or dexamethasone

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23
Q

In T2DM, when do oral hypoglycaemics affect the foetus?

A

1st and 2nd trimester

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24
Q

What is the only oral hypoglycaemic allowed in pregnancy? What has to be done if the diabetes is not well controlled on this?

A

Metformin

If cannot tolerate then need to be switched to insulin

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25
Q

Risk factors for gestational DM

A 
Multiple pregnancy 
Previous GDM in previous pregnancy 
FH of GDM
FH of T2DM
Obesity
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26
Q

What causes gestational DM?

A

The body cannot cope with the diabetogenic nature of the pregnancy

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27
Q

What 2 things are checked for every pregnant women?

A

BP

Urine dipstick

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28
Q

What things are checked for high risk women for GDM?

A

Bloods

OGTT

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29
Q

When is OGTT done in pregnant women?

A

28 weeks

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30
Q

Treatment of hyperthyroidism

A

PKU / Carbemazole
RAI
Surgery

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31
Q

Possible teratogenic effects of PKU? How common is this?

A

Failure to close scalp properly

Very rare

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32
Q

If the mother is on PKU as a treatment in pregnancy, what is usually done?

A

Change to carbemazole

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33
Q

Is a hyperthyroid mother in pregnancy high risk or low risk?

A

High

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34
Q

Effects of hyperthyroid in pregnancy

A

Hyperemesis more common (itself can also cause hyperthyroisim)
Thyroid more stimulated in pregnancy
If already on medication, requirements may increase
Growth of baby altered
Placental problems

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35
Q

What is a thyroid storm?

A

Once the baby is delivered, there can be drastic changes in hormones which can lead to MI etc

36
Q

What needs to be done in a thyroid storm?

A

Antibodies need to be measured

37
Q

Effects of hypothyroidism in pregnancy

A

Fertility problems

Neural tube problems (low IQ)

38
Q

What is the most sensitive part of the babys body effected by the thyroid?

A

Brain tissue

39
Q

What happens to the required dose of levothyroxine in the 1st trimester?

A

Increases

40
Q

When do babies start producing their own thyroid hormones?

A

16 weeks

41
Q

When is the skeletal form of the baby completed?

A

16 weeks

42
Q

What is the risk of a controlled seziure free woman for 2 years during pregnancy and delivery?

A

Very low - 1 - 5% risk of seziure

43
Q

What are all anti epileptic medications?

A

Teratogenic

44
Q

How to change anti epileptic medications in pregnancy

A

Slowly
Contraception until medication is sorted - do not rush pregnancy
Need to have good control of epilepsy on new medication

45
Q

What folic acid requirements do epileptic women trying to get pregnant need?

A

Very high dose

46
Q

What can epilepsy itself increase the risk of?

A

NT defects

47
Q

Effects of epilepsy in the 1st trimester

A

Miscarriage
Foetal abnormalities
Hyperemesis

48
Q

Seizure frequency changes in pregnancy

A

60% remain the same
10% decrease
30% increase

49
Q

Effects of epilepsy in the 2nd trimester

A

Growth restriction

Placenta affected

50
Q

Effects of epilepsy in the 3rd trimester

A

Pre term labour

Placental abruption

51
Q

Is epilepsy an indication for a C section?

A

No

52
Q

What are women with epilepsy more prone to and why?

A

PPH

Can affect vitamin K factors etc

53
Q

Is epileptic medication safe in breast feeding?

A

Yes (benefits > risks)

54
Q

What type of medication can reduce the effectiveness of anti epileptic drugs?

A

COCP

55
Q

What can sodium valproate reduce the effectiveness of?

A

COCP

56
Q

What are the best contraceptive methods for a women with epilepsy?

A

Barrier methods

Coil

57
Q

Post partum thyroiditis can be definitively diagnosed based on what 3 criteria?

A
  1. Patient is within 12 months of giving birth
  2. Clinical manifestations are suggestive of hypothyroidism
  3. TFTs support the diagnosis
58
Q

What is found in 90% of the patients with post partum thyroiditis?

A

Thyroid peroxidase antibodies

59
Q

What are the 3 stages of post partum thyroiditis?

A
  1. Thyrotoxicosis
  2. Hypothyroidism
  3. Normal thyroid function (but high recurrence rate in future pregnancies)
60
Q

Treatment of post partum thyroiditis

A

Thyrotoxic phase - propanolol for symptom control

Hypothyroid phase - levothyroxine

61
Q

What is the main presenting feature of obstetric cholestasis?

A

An intense itch

62
Q

What is the most sensitive marker for obstetric cholestasis?

A

A rise in serum bile acids

63
Q

What is the commonest cause of cardiac abnormality in pregnant women?

A

Mitral valve stenosis

64
Q

What trimester of pregnancy is aortic dissection assosiated with?

A

3rd

65
Q

Differential diagnosis of chest pain in pregnancy

A

Mitral stenosis
Pulmonary embolism
Aortic dissection

66
Q

Most cases of MVS in pregnancy are assosiated with what?

A

Rheumatic heart disease

67
Q

Predisposing factors in pregnancy for aortic dissection

A

HTN
Congenital heart disease
Marfans syndrome

68
Q

What is the first line antihypertensive treatment for pregnant women with severe asthma?

A

Nifedipine

69
Q

Which particular drug to treat UTI is contraindicated in the first trimester of pregnancy?

A

Trimethoprim

70
Q

Treatment for obstetric cholestasis

A

Ursodeoxycholic acid
Vit K supplementation
Induction of labour at 37 weeks

71
Q

When should anti-Xa activity be measured if a pregnant woman is on LWMH due to suspected DVT or PE?

A

Extremes of body weight
Complicating factors e.g.
- renal impairment
- recurrent VTE

72
Q

What does obstetric cholestasis increase the risk of?

A

Stillbirth

73
Q

Another name for obstetric cholestasis

A

Intrahepatic cholestasis

74
Q

Presentation of obstetric cholestasis

A 
Pruritis 
- may be intense
- typically on palms, soles and abdomen 
Jaundice (20%)
Raised bilirubin (90%)
75
Q

Effects of HTN in the eye

A

Diabetic retinopathy

Papilloedema in severe

76
Q

What drugs are used to treat HTN in pregnancy?

A

Labetolol
Nifedipine
Methydopa

77
Q

Contraindications to labetolol

A

Diabetes

Asthma

78
Q

Why is labetolol contraindicated in DM?

A

It masks hypos

79
Q

Why is labetolol contraindicated in asthma?

A

Causes wheeze

80
Q

S/E of methyldopa

A

Depression

81
Q

Side effects of nifedipine

A

Headaches

Oedema

82
Q

Effects of mag sulphate in babies

A

Cerebral protective of the babies

83
Q

How to monitor the treatment of VTE in pregnant women on LWMH if they are at extremes of body weight or have complicating factors (e.g. renal failure, recurrent VTE)?

A

Measurement of peak anti-Xa activity

84
Q

When do pregnancy induced BP problems NOT occur before?

A

20 weeks

85
Q

What should be done if a pregnant women is exposed to chickenpox in pregnancy?

A

Check VZV Antibodies

86
Q

If VZV Abs are -ve during pregnancy, what must be done and in what time frame?

A

Give VZIGs

Only effective up to 10 days post exposure

87
Q

Criteria for post partum thyroiditis

A
  1. Within 12 months of giving birth
  2. Clinical manifestation of hypothyroid
  3. TFTs support diagnosis

Reproduction Pathology (28 decks)

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