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obstetrics > medical disorders of pregnancy > Flashcards

medical disorders of pregnancy Flashcards

1
Q

What is the general approach to medical disorders?

A

Always think what of the effect of pregnancy on the disease and what is the effect of the disease on pregnancy

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2
Q

If someone presents with fatigue in pregnancy what should you check for?

A

Anaemia- do FBC and haemitinics

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3
Q

What is anaemia’s affect on the fetus?

A

low birth weight and prematurity

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4
Q

Are the values for anaemia the same as in non-pregnancy?

A

No

There are lower values as the blood is more “diluted” due to increased plasma volume –Hb <105

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5
Q

What kind of anameias are iron deficient and folate deficient anaemias?

A

Remember iron deficient is microcytic with serum ferritin low and B12/folate deficient is macrocytic.

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6
Q

What respiratory changes happen in pregnancy?

A

Increased metabolic rate so there is more oxygen consumption
Increased ventilation due to increase in tidal volume
Arterial pO2 increases and pCO2 decreases
RR stays the same

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7
Q

What risks are associated with asthma in pregnancy?

A

Risk of prematurity and FGR due to inadequate placental perfusion

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8
Q

Does asthma get worse in pregnancy?

A

no

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9
Q

What high-risk cardiac problems in pregnancy?

A

aortic stenosis, coarction of the aorta, prosthetic valves and those with disease severe enough to be cyanosed

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10
Q

Why do cardiac problems generally get worse in pregnancy?

A

Cardiac output rises due to increased SV (CO=HRxSV)

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11
Q

What is the most common abdo complication in pregnancy?

A

Obstetric cholestasis

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12
Q

How does obstetrics cholestasis present in pregnancy?

A

presents with an itch without rash,
jaundice 20% pts
abnormal LFTs and high bilirubin
can lead to complications in fetus due to high bile acids

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13
Q

What is the management of obstetric cholestasis?

A 
Management with ursodeoxycolic acid 
early delivery (37-38 weeks)
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14
Q

What should you rule out in abdo pain during pregnancy?

A

Think risk factors for hepatitis
HELLP
Gallstones or acute fatty liver
appendicitis

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15
Q

How does appendicitis present in pregnancy?

A

Remmeber due to large uterus other organs move around so appendicitis can present outside its ormal quadrant

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16
Q

What must you consider with hyperthyroidism in pregnancy?

A

can have a thyroid crisis –> cardiac failure

Risk of thyrotoxicosis in fetus due to transfer of thyroid stimulating Ab

17
Q

what do you need to consider with hypothyroidism in pregnancy?

A

If left untreated can lead to poor neurodevelopment

Increase thyroxine dose

18
Q

What is the diagnostic levels for gestational DM?

A

Fasting glucose of over 5.6 and random of over 7.8

19
Q

How do you manage gestational DM?

A

Can use insulin, metformin and glipalamide NO other hypoglycaemics
Stop ACE-I and statins
screening for retinopathy or renal impairment

20
Q

Why are you more likely to get a UTI in pregnancy?

A

Pelvicalyceal system dilates so is more likely to get infection

21
Q

Why do seizures occur more in pregnancy?

A

There is a lower seizure threshold due to lack of sleep and pain caused by pregnancy

22
Q

What needs to be considered in management of epilepsy in pregnancy?

A

All anti-convulsant are associated with fetal abnormalities- worst is sodium valproate eg ASD, spina bifida, cleft palate
but
During a tonic clonic seizure baby is hypoxic so need to weigh up

23
Q

What is the management of epilpesy in pregnancy

A

Management: folic acid (spina bifida decreases), is medication required, screen fetal abnormalities, avoid prolonged labour and pain relief important
don’t forget to exclude pre-eclampsia

24
Q

why are women in pregnancy more likely to get VTEs?

A

haematological changes in pregnancy pre-dispose as there is increased thrombus formation due to higher levels of fibrinogen and prothrombin

25
Q

Where do the VTEs tend to develop?

A

Are more iliofemoral than femoral popliteal then in non-pregnant population

26
Q

What else increases the risk of VTEs?

A

BMI, age, c-section

27
Q

What are the investigations for VTE?

A

DVT- do doppler U/s

PE- do VQ scan or CTPA

28
Q

What is the management for VTEs?

A

LMWH is management choice as warfarin can cross placenta and cause fetal abnormalities and intracranial bleeding

29
Q

What is a Bartholins cyst?

A

Bartholin’s glands are a pair of glands located next to the entrance to the vagina. These are normally about the size of a pea, but can become infected and enlarge - forming a Bartholin’s abscess.

This can be treated by antibiotics, by the insertion of a word catheter or by a surgical procedure known as marsupialization.

obstetrics (11 decks)

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