Medical Disorders in Pregnancy

Question 1

What is defined at Hypertension in pregnancy according to NICE?

Answer 1

140/90-159/109 mmHg

Question 2

What is defined as severe HTN according to NICE?

Answer 2

> 160/110mm Hg

Question 3

Define chronic HTN

Answer 3

HTN before 20 weeks in absence of hydatiform mole or persisting 6 weeks postpartum

Question 4

Define pre-eclampsia

Answer 4

HTN after 20 weeks with one of proteinuria, maternal organ dysfunction or fetal growth restriction

Question 5

Define eclampsia

Answer 5

Generalised tonic clonic seizure in women with pre-eclampsia if seizures not attributable to another cause

Question 6

Give 4 risks of pre-eclampsia

Answer 6

• 1st pregnancy
• Fx (mother or sister)
• Extremes of maternal age
• Obesity

Question 7

Give 5 symptoms of pre-eclampsia

Answer 7

Severe headache

Severe RUQ pain

Swelling of face/hands/feet

Visual disturbance

Vomiting

Question 8

Give 5 signs of pre-eclampsia

Answer 8

• HTN
• Proteinuria
• Hyperreflexia
• Raised creatinine
• Decreased platelets

Question 9

What can be used as pre-eclampsia prevention in women with chronic HTN?

Answer 9

150mg aspirin from 12 weeks

Question 10

What is the 1st line management for HTN if systolic 150-160?

Answer 10

Labetalol

Question 11

in severe pre-eclampsia

(systolic>180) give 3 anti-hypertensives which can be used

Answer 11

o Oral/IV labetalol

o Oral nidedipine

o IV hydralazine

Question 12

What can disrupted fluid balance in pre-eclampsia cause?

Answer 12

Too little: renal failure

Too much: pulmonary oedema

Question 13

What is used to treat or prevent eclamptic seizures?

Answer 13

Magnesium sulphate

Question 14

Give 3 maternal complications of pre-eclampsia

Answer 14

• Placenta rupture
• DIC
• HELLP

Question 15

Give 3 fetal complications of pre-eclampsia

Answer 15

• IUGR
• Pre-term delivery
• Perinatal death

Question 16

What is HELLP?

Answer 16

Haemolysis, elevated liver enzymes, low platelets

Question 17

Give 4 risk factors for gestational diabetes

Answer 17

BMI>30
Previous GD
Previous macrocosmic baby
FX diabetes

Question 18

What should be done if one risk factor of gestational diabetes is identified at booking?

Answer 18

Offer 2hr 75g OGTT at 24-28 weeks

Question 19

Give 3 pharmacological treatment options for gestational diabetes

Answer 19

Metformin
Glibenclamide
Insulin

Question 20

In cases of gestational diabetes, when should delivery occur?

Answer 20

No later than 40+6

Question 21

Give 3 effects of thyrotoxicosis on pregnancy

Answer 21

Miscarriage
IUGR
Preterm delivery

Question 22

Up until which point is fetal thyroxine obtained from the mother?

Answer 22

12 weeks

Question 23

Give 2 pharmacological treatments for hyperthyroidism in pregnancy

Answer 23

Carbimazole

Propanolol

Question 24

Give 3 effects of epilepsy on pregnancy

Answer 24

• Seizure activity in 1st trimester
• Decreased drug levels
• Impaired sleep

Question 25

Can placental transmission occur during varicella zoster infection of the mother?

Answer 25

Yes

Question 26

At which level of viral RNA copies/ml would a normal vaginal delivery be considered?

Answer 26

<50 copies = normal delivery

Question 27

How should neonates be treated postnatally if the mother has HIV?

Answer 27

HIV post exposure prophylaxis within 4 hours of birth

Question 28

Give 3 situations in which anti-D would be required to be administered in a Rh negative mother

Answer 28

- After management of ectopic - <12 weeks heavy vaginal bleed - <12 weeks medical/surgical management of miscarriage

Question 29

Which areas of the body does an atopic eruption of pregnancy effect?

Answer 29

Trunk and limbs

Question 30

Give 3 treatment options for atopic eruption of pregnancy

Answer 30

Emollient Topical steroid Antihistamine

Question 31

When and which areas of the body does polymorphic eruption of pregnancy effect

Answer 31

3rd trimester - postpartum Lower abdomen and striae with UMBILICAL SPARING

Question 32

Give 3 treatment options for polymorphic eruption of pregnancy

Answer 32

Emollient Topical corticosteroid Sedating antihistamine

Question 33

Define pemphigoid gestationis

Answer 33

Rare condition of 2nd/3rd trimester caused by AI binding of IgG to basement membrane

Question 34

Give 3 skin features of pemphigoid gestationis

Answer 34

Urticarial lesions Wheals and bullae Umbilical area affected

Question 35

Give 3 management options for Pemphigoid Gestationis

Answer 35

Topical steroid Systemic corticosteroid REFER TO DERM AND OBSTETRICS

Question 36

Give 4 common skin changes which occur during pregnancy

Answer 36

Hyperpigmentation Striae gravidarum Angiomas Greasier skin