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Repro > Medical disorders in pregnancy > Flashcards

Medical disorders in pregnancy Flashcards

1
Q

what are the booking bloods

A

FBC and blood group and ABs
harm-globulins
infection screen - hep B, HIV, rubella, VDRL
RBG

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2
Q 
when is the booking visit 
dating USS
anomaly scan 
monthly visits are till when
anti D (2)
fortnightly visits when
weekly visits till when
A 
8-12 weeks
11-12 weeks
20 weeks
till 28 weeks
28 and 34 weeks
28-36 weeks
37 weeks - delivery
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3
Q

what should be checked/asked at every antenatal visit

A 
document gestation
BP
urinalysis 
SFH (FSH)
fetal kicks/heart
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4
Q

incidence of hypertension in pregnancy
PET
severe PET
eclampsia

A

10-15%
3-5%
5/1000
5/10000

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5
Q

what is chronic (essential) ht
what is gestational ht
what is pre eclampsia

A

HTN present at booking or <20 weeks

new HTN> 20 weeks with proteinuria

new htn >20 weeks and significant proteinuria

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6
Q

what can lead to an increased risk inPET

A

chronic hypertension in mothers

or gestational hypertension

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7
Q

hypertension has what effects on the kidneys during pregnancy

A 
increased GFR
proteinuria 
serum uric acid
cr/k/urea
oliguria/anuria
acute renal failure
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8
Q

hypertension has what effect on liver

A

epigastric/RUQ pain
abnormal liver enxymes
hepatic capsule rupture
HELP

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9
Q

what is HELP synd

A

type of pre eclampsia - haemolytic, elevated liver enzymes, low platelets

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10
Q

placental and hypertension

A

IUGR
placental abruption
intra uterine death

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11
Q

investigations for htn

A 
u&amp;es
serum urate
LFTs
FBC
coag screen
CTG
US
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12
Q

management at booking

A

if there are risk factors for pre eclampsia -> put on aspirin

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13
Q

management of htn

A

labetalol
methyldopa
nifedipine (if the other two fail)

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14
Q

what should be stopped in preg

A

ACE and ARBs

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15
Q

what should be used in severe hypertension

A

labetalol PO/IV
hydralzaine IV
nifedipine PO

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16
Q

target BP

A

<150/80-100
organ damage <140-90
if <140/90 consider reducing dose
if <130/90 reduce dose

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17
Q

effects of hypertension on pregnancy and management of that

A

gestational htn
PET
eclampsia

monster BP, bloods, protein

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18
Q

planning of delivery in htn

A

vaginal

deliver at 37 weeks if PET

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19
Q

effects of pregnancy on DM

A

poorer control
deterioration of renal function
deterioration of ophthalmic disease
gestational DM

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20
Q

effects of medical condition on pregnancy

A 
miscarriage 
fetal malformations cardiac/NTD/caudal regression syndrome
IUGR/macrosomia
unexplained IUD
PET
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21
Q

medications in DM

A

diet
metaformin
insulin

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22
Q

planning of delivery in DM

A

vaginal

induce labour at 37-38 weeks

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23
Q

what does having diabetes lead to in the baby

A

fetal hyperinsulinaemia which leads to increased fetal growth

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24
Q

what 4 things does increased fetal growth lead to and whats a risk for each one

A

fetal macrosomia - risk of birth injury/shoulder dystonia

polyuria/polyhydramnios - risk of preterm labour/malpresentation/cord prolapse

increased oxygen demands/polycytheamia - risk of unexplained term stillbirth

neonatal hypoglycaemia - risk of cerebral palsy

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25
Q

risk factors for gestations DM

A 
previous GDM
FH - one first degree relative or two second degree relatives
poor obstetric history
significant glycosuria
polyhydramnios
macrocosmic infant in this pregnancy 
PCOS
weight>100kn or BMI >30
south asian, muddle eastern or african origin
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26
Q

BM target
HBA1C target
retinal screening when

A

4-6
<5%
every trimester

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27
Q

growth scans in DM
monitoring for what
elective delivery

A

serial growth scans at 28, 32, 36 weeks

PET

37-38 weeks in pre existing DM
38 weeks in GDM on insulin, may be 41 weeks if GDM on diet with normal Bfs and fetal growth

28
Q

neonatal in DM

A

surveillance at delivery monitor BMs to ensure no neonatal hypoglycaemia

29
Q

post natal management for mum in DM

A

return to pre pregnancy insulin/oral HG regime

GDM: stop treatment and monitor BM for 48 hours to ensure return to normal and no persistence

30
Q

macrosmonia can lead to what

A

increased risk of birth injury/shoulder dystocia
obstetric litigation major cause
LSCS recommended in DM where macrosomia and EFW>4000g

31
Q

polycythaemia effects on baby

A

thrombotic effects

jaundice

32
Q

effects of pregnancy on VTE/PE

medications

A

increased risk of it

LMWH

33
Q

what is the main cause of maternal death

A

VTE

34
Q

pregnancy is a what state in terms of coagulability

A

pro coagulable

35
Q

what are there increased levels of and decreased levels of in terms of clotting factors

A

increased factor 7,8,9,10,12 and increase in fibrinogen and number of platelets

decrease in factors 11 and antithrombin 3

36
Q

what are the risk factors for VTE and what should be done if there are < or 3 or 4 present

A 
obesity 
age >35
parity 3
smoker
gross varicose veins
current PET
immobility
FH of unprovoked or oestrogen provoked VTE in first degree relative 
low risk thrombophillia
multiple preg

<3 - mobilisation and avoidance of dehydration
3 - prophylaxis from 28 weeks
4 or more - prophylaxis from first trimester

37
Q

any previous VTE is managed how

A

antenatal prophylaxiss with LMWH

38
Q

how many DVTs are asymp

which leg more common

A

50%

L>R

39
Q

ix of DVT

A

D dimer not done in preg
duplex US
therapeutic heparin

40
Q

management of DVT

A

FBC, clotting factos, Uns, LFTs
antixa levels
platelet levels
thrombophilia screen - not routine and controversial

TEDs

41
Q

LMWH in DVT preg

A

once daily
outside preg 1.5mg/kg
therapeutic dose 1mg/kg twice or once daily
continue till 3 months after delivery or 6 months after treatment

42
Q

SE of heparin

A 
haemorrhage 
hypersensitivity 
allergy at injection site
HIT - heparin induced thrombocytopenia
osteopenia - osteoperosis on prolonged use
43
Q

HIT

A

1-30%
early in 5 days, usually mild
late >5 days
with unfractionated heparin

44
Q

PE ix

A 
ABGs
CXR
ECG
duplex US
ventilation/perfusion scans
CTPA
45
Q

CXR - who should it be done on

of negative what should be done

A

all women

bilateral compression duplex dopplers

46
Q

duplex of lower limbs - useful or no

A

indirect way
limits further tests
if negative - doesn’t help much

47
Q

CTPA

A

less childhood cancer risk compared to VQ

increased breast cancer risk

48
Q

labour and delivery in VTE/PE

A

stop heparin in labour in vaginal delivery

stop therapeutic anaesthesia 24 hours before planned surgery
stop prophylactic 12 hours before

49
Q

what should be given post natally in VTE/PE

A

6 weeks or for a total of 3 months warfarin or LMWH

50
Q

what should warfarin be avoided in

A

avoided in pregnancy 6-12 weeks - teratogenic, miscarriage, neurological problems, stillbirth
stop 6 weeks before labour

51
Q

effects of pregnancy on hypothyroid women

A

increase levy by 25-5-mcg in first trimester and repeat TFTs every trimester

52
Q

effects of pregnancy on hyperthyroid women

A

gets worse due to HCG in first trimester

improves in second and third trimester

53
Q

effects of hyperthyroid on pregnancy

A

IUGR
preterm labour
thyroid storm

54
Q

medications in hyperthyroid

A

carbimazole/PTU
propanolol for IUGR
growth scans

55
Q

respiratory changes in pregnancy

A

increase resp rate which can cause respiratory alkalosis

changes in PFTs

56
Q 
what happens to the tidal volume 
the inspiratory capacity 
FEV1 and PEFR
residual volume 
expiratory reserve 
functional residual capacity
A 
increases
increases
stay the same 
decreases
decreases
reduction in it
57
Q

effects of pregnancy on asthma

A

can improve, deteriorate or stay the same

58
Q

management of asthma

A

same

59
Q

how many women of child bearing age have epilepsy

A

0.5%

60
Q

what seizure types may be affected by pregnancy

A

all

61
Q

what is epilepsy associated with

A

risks for maternal death due to aspiration

62
Q

epilepsy in preg management

A

5mg folic acid

vit k from 36 weeks if taking hepatic enzyme inducing anti convulsants

63
Q

effects of pregnancy on epilepsy

A

increase seizure frequency in some

64
Q

effects of epilepsy on pregnancy

A

fetus resistant to short term hypoxia during seizures
no increased risk of miscarriage or obstetric cx
teratogenicity of drugs

65
Q

pre conceptually in seizures

A

take folic acid 5mg/day at least 12 weeks prior to conception

66
Q

epilepsy during pregnancy

A

continue folic acid
continue current drugs if well controlled - unless phenobarbitone
detailed fetal scan at 18-20 weeks with fetal cardiac scan at 22 weeks
vit k 10-20 mg orally from 34-36 weeks

67
Q

post partum management in epilepsy

A

neonate should have 1mg IM vit K

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