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Obstetrics > Medical disorders in pregnancy > Flashcards

Medical disorders in pregnancy Flashcards

1
Q

Give me an overview of how medical disorders in pregnancy are dealt with.

A

pre conception counselling

med adjustments + vits

MDT

see regularly + plan

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2
Q

What Hb counts as low in preg?

A

<11g/dL

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3
Q

what are Hb units?

A

g/dL

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4
Q

What does pregnancy do to respiratory rate?

A

no change

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5
Q

What does pregnancy do to tidal vol?

A

pregnancy increases tidal vol

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6
Q

For what proportion of women does their asthma get worse in pregnancy?

A

one third

one third better, one third same
(drugs safe)

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7
Q

What is the top indirect cause of maternal mortality?

A

cardiac disease

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8
Q

What does pregnancy do to systemic vascular resistance?

A

pregnancy decreases systemic vascular resistance

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9
Q

What does pregnancy do to cardiac output?

A

pregnancy increases cardiac output

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10
Q

Is it normal to have ejection systolic murmur and altered ECG in preg?

A

yes

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11
Q

Name four heart drugs contraindicated in pregnancy…

A

ACE-I / ARBs
warfarin
statins

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12
Q

what steps might need to be taken for a mother who has at risk of cardiac disease in preg.

A
  • alter meds
  • LMWH
  • monitor echo/ECG
  • epidural / caesarean
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13
Q

what kind of delivery for mother with moderate cardiac risk

A

epidural

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14
Q

what kind of delivery for mother with high cardiac risk

A

caesarean

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15
Q

when is there a big risk of cardiac failure for a pregnant mum who has pre-existing cardiac disease?

A

RIGHT AFTER BIRTH

spike in blood vol and BP once placenta released

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16
Q

Pregnancy lady with thirst, vom, epigastric pain, jaundice. progresses to DIC. What’s this?

A

acute fatty liver of preg (v rare)

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17
Q

ITCHING WITHOUT SKIN RASH AND WITH ABNORMAL LFTs =

A

obstetric cholestasis

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18
Q

obstetric cholestasis presentation?

A

ITCHING WITHOUT SKIN RASH AND WITH ABNORMAL LFTs

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19
Q

Pregnant woman presents with itching. No skin rash. But abnormal LFTs. You suspect obstetric cholestasis. Investigations?

A

NON-INVASIVE LIVER SCREEN (it’s a condition of exclusion)

serum BILE ACIDS (raised)

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20
Q

What is treatment for obstetric cholestasis?

A

ursodeoxycholic acid

vit K @36wks in case haemorrhage
INDUCE @37wks

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21
Q

Does obstetric cholestasis resolve after delivery?

A

yes but high recurrence

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22
Q

What is commonest cause of hypothyroidism in preg?

A

Hashimoto’s (anti-TPO)

thyroid requirement goes up in early preg

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23
Q

Management of hypothyroidism in preg?

A

increase thryoxine dose

monitor TSH weekly

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24
Q

When does neuro dev happen?

A

1st and 2nd trimester

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25
Q

What is commonest cause of hyperthyroidism in preg?

A

Graves disease

often improves in preg!

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26
Q

What is maternal risk of hyperthyroidism in preg?

A

thyroid storm

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27
Q

What is foetal risk of hyperthyroidism in preg?

A

neonatal thyrotoxicosis

anti-T3/4 antibodies cross placenta

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28
Q

What tends to happen with epilepsy in pregnancy?

A

seizures get more frequent, especially in labour.

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29
Q

Maternal epilepsy increases risk of WHAT?

A

neural tube defects

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30
Q

Mothers normally take 400mcg of folic acid a day. What should mothers with epilepsy take?

A

5 mg - risk of neural tube defects

31
Q

Mothers usually take 400mcg of folic acid a day until when?

A

12 weeks

32
Q

Which epilepsy drugs are safest in preg?

A

carabamazepine

lamotrigine

33
Q

Mother has epilepsy. What chance does the newborn have of getting it?

A

3%

34
Q

What happens to GFR in preg?

A

INCREASES
(more leaky)

so urea and creatinine levels decrease

35
Q

Why is there a risk of urinary stasis and bacturia in pregnancy?

A

uterus pressure on ureters

36
Q

If you have chronic renal disease and want to get pregnant…

A

have a transplant first

37
Q

PREGNANCY IS A ___THROMBOTIC STATE.

A

PREGNANCY IS A PROTHROMBOTIC STATE.

38
Q

Give four good reasons why pregnancy is a prothrombotic state plz Kate.

A
  • increased clotting factors
  • decreased fibrinolysiss
  • blood flow obstruction
  • immobility
39
Q

Give me four good ways of preventing PE / DVT in pregnancy.

A
  • LMWH
  • stockings
  • mobilize
  • hydration

if high risk - referral to join obstetric/haematology clinic

40
Q

Give me 2 risk factors that count as HIGH risk for thromboembolism in preg.

A
  • previous DVT or PE
  • antithrombin III deficiency

(need LMWH and urgent referral to ob/haem)

41
Q

Investigations for suspected PE in preg

A

VQ scan / CTPA

42
Q

Give me 5 risk factors that count as INTERMEDIATE risk for thromboembolism in preg.

A 
sepsis
antiphospholipid syndrome
hyperemesis
any surgery
sickle cell
IVDU

(need LMWH and stockings)

43
Q

Give me some more general risk factors for thromboembolism in preg

A 
smoking
age >35
obesity
pre-eclampsia
multiparity
FHx
long distance travelz
dehydration
44
Q

Anitphospholipid syndrome is an autoimmune hypercoagulable state. What do the antibodies do?

A

“lupus anticoagulant antibodies” - a misnomer, they’re actually prothrombotic.
they make the blood more likely to clot

“lupus anticoagulant antibodies” (misnomer, they’re prothrombotic)
also anti-cardiolipin, and b2 glycoprotein

45
Q

Before administering LMWH to pregnant ladies at risk of thromboembolism, what do you need to check?

A

bleeding risk.

e.g. placenta praevia, epidural soon, thrombocytopenia, etc.

46
Q

Anti-phospholipid syndrome causes PLACENTAL CLOTS and RECURRENT MISCARRIAGES.

A

yes

47
Q

Anti-phospholipid syndrome causes RECURRENT MISCARRIAGES and PLACENTAL CLOTS. Placental clots can result in WHAT TWO THINGS.

A

antiphospholipid:

  • IUGR
  • PRE-ECLAMPSIA.
48
Q

What happens to glucose tolerance in preg?

A

glucose tolerance goes down in preg anyway

bad - gestational diabetes

49
Q

Define gestational diabetes.

A

‘any degree of glucose intolerance with onset or first recognition during pregnancy’.

50
Q

How many pregnancies affected by gestational DM?

A

1 in 5!

51
Q

On average, insulin requirements ___ by ___% in pregnancy.

A

On average, insulin requirements rise by 30% in pregnancy.

52
Q

Give me some risk factors for gestational diabetes.

A 
previous gestational DM lol
previous macrosomic baby
BMI >30
asian 
FHx DM

(poor pancreatic reserve means that increased insulin requirements in preg more likely to tip you over into diabetes)

53
Q

If a lady has one or more risk factors for gestational DM, you do ___ at ___wks.

A

oral GTT @ 28wks.

54
Q

A lady has one or more risk factors for gestational DM, so you do an oral glucose tolerance test at 28wks. What results would prompt you to treat?

A

fasting >5.6 mmol/L

2hrs postprandial > 7.8 mmol/L

55
Q

glucose levels units?

A

mmol/L

56
Q

In what scenario would you offer oral GTT at booking visit?

A

previous gestational DM

57
Q

What % of mums with gestational DM go on to develop type 2 later in life?

A

50%

58
Q

For 2hrs postprandial glucose test (oral GTT), what amount of glucose is given in drink?

A

75g

59
Q

how often should capillary blood glucose measurements be taken in gestational diabetes???

A

4 times a day!

give glucometer

60
Q

what is the management of gestational diabetes?

A

diet + exercise
if bad - metformin
if awful - insulin

plus SERIAL GROWTH SCANS

61
Q

raised foetal blood glucose = hyperinsulinaemia = increased fat deposition. This describes?

A

macrosomia from diabetes

62
Q

4 FOETAL complications of pre-existing / gestational diabetes ?

A

macrosomia
polyhydramnios
preterm
neural tube defects

63
Q

tell me about when delivery should happen in GESTATIONAL diabetes:

a) managed with diet alone
b) on metformin/insulin

A

a) diet - by 40wks

b) meds - 37wks

64
Q

2 MATERNAL complications of pre-existing / gestational diabetes?

A

more @ risk of pre-eclampsia
infections!
more @ risk of instrumental / caesarean

65
Q

how much periconceptual folic acid if mum has pre-existing diabetes?

A

5mg

66
Q

what is important periconceptually if mum has pre-existing diabetes?

A

PERICONCEPTUAL GLUCOSE STABILISATION

+ 5mg folic acid

67
Q

when to deliver by in PRE-EXISTING diabetes?

A

39wks

68
Q

tell me about aspirin to prevent pre-eclampsia …

A

give if they have risk factors (eg diabetes, chronic HTN, heart disease) for pre-eclampsia
75mg OD
12 weeks to birth!!

69
Q

if they have RFs for pre eclampsia give 75mg OD aspirin when??

A

12 weeks to birth!

70
Q

tell me about foetal surveillance in pre-existing diabetes.

A

foetal echos

serial growth scans

71
Q

if mum has pre-existing diabetes, need to screen mum for what complications during preg?

A

nephropathy

retinopathy screening

72
Q

which are the only diabetes which are fine in preg?

A

insulin + metformin

73
Q

explain why smoking causes feotal hypoxia basically

A

more carbon monoxide in blood = less oxygen to baby

74
Q

treat pre-existing diabetes?

A

insulin + glucometer
aspirin
lots of surveillance

Obstetrics (6 decks)

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