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Reproduction SOH > Medical problems during pregnancy > Flashcards

Medical problems during pregnancy Flashcards

1
Q

Hyperemesis gravidarum - definition

A

Excessive, protracted vomiting which starts usually in the first trimester of pregnancy

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2
Q

Hyperemesis gravidarum - clinical features

A 
Vomiting
Dehydration
Ketosis 
Nutritional disturbance 
Weight loss
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3
Q

Hyperemesis gravidarum - management

A

Rehydration
Electrolyte replacement
Parenteral anti-emetics
Vitamin supplements

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4
Q

Hyperemesis gravidarum - name 2 parenteral anti-emetics

A

Cyclizine

Prochloreparazine

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5
Q

What is the most common cause of maternal mortality?

A

Cardiac disease

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6
Q

Hypertension - diagnosis

A

Over 140/90 on 2 separate occasions
OR
Systolic over 160 or diastolic over 110 once

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7
Q

Hypertension - causes

A

Pre-existing
Pregnancy induced hypertension
Pre-eclampsia

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8
Q

When would you suspect pre-existing hypertension?

A

If the patient has hypertension in early pregnancy

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9
Q

Following delivery, at which point should BP return back to pre-existing levels?

A

10 days after delivery

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10
Q

Pregnancy induced hypertension occurs during the FIRST/SECOND half of pregnancy?

A

Second half

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11
Q

Pregnancy induced hypertension should resolve at which point after delivery ?

A

Within 6 weeks

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12
Q

You should not use which 3 common antihypertensive classes in pregnancy?

A

ACE inhibitors
ARBs
Diuretics

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13
Q

What medication should be used to treat hypertension during pregnancy?

A 
Methyldopa 
Labetolol
Nifedipine 
Hydralazine 
Doxazocin
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14
Q 
Which of the following antihypertensive medications cannot be used during breast feeding? 
Methyldopa 
Labetolol
Nifedipine 
Hydralazine 
Doxazocin
A

Doxazocin

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15
Q

Control of BP reduces the risk of developing pre-eclampsia. True or false?

A

False

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16
Q

Pre-eclampsia is a multi-system disorder. True or false?

A

True

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17
Q

Pre-eclampsia - What are the 3 classical findings ?

A

Hypertension
Proteinuria
Oedema

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18
Q

Pre-eclampsia can only be diagnosed if all 3 classical findings are present. True or false?

A

False

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19
Q

Pre-eclampsia - what is the single most significant risk factor

A

Having had pre-eclampsia previously

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20
Q

Pre-eclampsia is more common during the early stages of pregnancy. True or false?

A

False

- more common during later stages of pregnancy

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21
Q

Pre-eclampasia - pathogenesis

A

Placental dysfunction
- failure of trophoblast formation leading to a high resistance circulation as the muscular layer around spiral artery can’t be broken down

Maternal syndrome -
the high resistance in pre-eclampsia causes endothelial damage -> leading to ischaemia and infarction in the placenta -> toxin release into the maternal circulation -> endothelial damage in multiple systems

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22
Q

Pre-eclampsia - potential CNS features

A 
Eclampsia - seizures 
Hypertensive encephalopathy 
Intracranial haemorrhage
Cerebral oedema 
CN palsy
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23
Q

Pre-eclampsia - potential renal features

A

Declining renal function -> salt and water retention -> oedema
Decreased GFR -> leaking protein causes proteinuria

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24
Q

Pre-eclampsia - potential hepatic features

A

Epigastric pain

Abnormal liver enzymes

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25
Q

Pre-eclampsia - potential hepatic features - HELLP syndrome

A

Haemolysis
Elevated Liver Enzymes
Low Platelets

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26
Q

Pre-eclampsia - potential haematology features

A

thrombocytopenia

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27
Q

Pre-eclampsia - potential pulmonary problems

A

Pulmonary oedema

PE

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28
Q

Pre-eclampsia - potential CVS features

A

Hypertension

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29
Q

Pre-eclampsia - potential placental features

A 
Foetal growth restriction
Placental abruption
Intrauterine death (still birth)
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30
Q

Pre-eclampsia - medical risk factors

A

Pre-existing renal disease
Pre-existing hypertension
Diabetes
CTD

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31
Q

Pre-eclampsia - clinical features

A 
Hypertension
Proteinuria 
Oedema 
Abdominal tenderness
Disorientation
SGA
IUD
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32
Q

How do you predict pre-eclampsia ?

A

Maternal uterine artery doppler US at 20-24 weeks

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33
Q

Pre-eclampsia - what abnormal sign is on US

A

Notching

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34
Q

What is the only cure for pre-eclampsia?

A

Delivery (since it is caused by the placenta)

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35
Q

Antenatal screening for pre-eclampsia

A

BP
Urinalysis
Maternal uterine artery doppler US

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36
Q

Pre-eclampsia - management

A

Control hypertension

Low dose aspirin (75mg) - commence before 12 weeks

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37
Q

What is the role of maternal steroids in pregnancy?

A

Reduce the rate of neonatal respiratory distress syndrome by producing surfactant

38
Q

Which groups of women are at high risk of developing pre-eclampsia?

A 
Hypertensive disease in previous pregnancy
Chronic kidney disease
Autoimmune disease
T1 or T2 diabetes 
Chronic hypertension
39
Q

Pre-eclampsia - HIGH/MODERATE/LOW risk women should take 75mg Aspirin daily from 12 weeks gestation until birth of baby?

A

High and Moderate risk women

40
Q

Which groups of women are at moderate risk of developing pre-eclampsia?

A 
First pregnancy
Age 40+ 
Pregnancy interval of over 10 years 
BMI 35+ 
FH of pre-eclampsia 
Multiple pregnancy
41
Q

Pre-eclampsia - which patients need admitted to hospital? - At which BP level

A

over 170/110
OR
over 140/90 with (++) proteinuria

42
Q

Pre-eclampsia - which patients need admitted to hospital? - at which proteinuria level?

A

Over 300mg/24hrs

43
Q

What is eclampsia?

A

Extreme pre-eclampsia

44
Q

Eclampsia - clinical features

A

Tonic Clonic seizures (due to severe hypertension)

Features of pre-eclampsia

45
Q

Eclampsia - which IV medication can be used to treat BP?

A

IV labetolol

IV hydralazine

46
Q

Eclampsia - what can be given to control seizure?

A

Magnesium sulphate

  • Loading dose: 4g IV over 5 mins
  • Maintenance dose: IV infusion 1g/hr
47
Q

Eclampsia - what can be given if the patient has persistent seizures?

A

Diazepam 10mg IV

48
Q

It is uncommon to have a vaginal birth if you have eclampsia. True or false?

A

False

- aim for a vaginal birth

49
Q

Palpitations - most are benign/pathological?

A

Benign

50
Q

Palpitations - if the patient explains ectopic beats then what investigation do you do?

A

ECG

51
Q

Which benign arrhythmia is common in pregnancy?

A

Sinus tachycardia

52
Q

What is the most common arrhythmia in pregnancy?

A

Supra Ventricular Tachycardia

53
Q

If a women presents with chest pain in pregnancy, what investigation should she get?

A

ECG

CT scan

54
Q

It is common to get an asthma exacerbation during pregnancy. True or false?

A

True

55
Q

Why may asthma deteriorate during pregnancy?

A

If the patient stops taking their asthma medication as the patient may be scared incase her asthma management will affect the foetus

56
Q

In an asthmatic patient, what mode of delivery should you aim for?

A

Vaginal birth

57
Q

Why may epilepsy be difficult to control in pregnancy?

A

Many AEDs are teratogenic

58
Q

Epilepsy - most women get increased seizures in pregnancy. True or false?

A

False

- only 10% get increased seizure frequency

59
Q

Epilepsy - what are the foetal risks from maternal seizures during pregnancy

A

Lower verbal IQ
Hypoxia
Bradycardia

60
Q

It is better to use monotherapy/polytherapy to control epilepsy in pregnancy?

A

Monotherapy

61
Q

If the mother is likely to have epileptic seizures during pregnancy, how do you manage her?

A

Give her AED

- benefits of treatment outweigh risks in most cases

62
Q

Epilepsy management - side effect of sodium valproate?

A

Neural tube defects
- spina bifida
Facial cleft
Hypospadias

63
Q

Epilepsy management - side effect of phenytoin?

A

Cardiac malformations

64
Q

What should all women with epilepsy take prior to conception and through until the end of the first trimester?

A

5mg/day folic acid

65
Q

Obesity - pre-pregnancy problems

A

Menstrual disorders

sub-fertility

66
Q

Obesity - early pregnancy problems

A

Miscarriage

67
Q

Obesity - foetal problems

A

Macrosomia
Birth injury
Perinatal mortality

68
Q

Management of obesity in pregnancy - pre-eclampsia prophylaxis

A

Low dose aspirin

69
Q

Management of obesity in pregnancy - thromboprophylaxis

A

LMWH

70
Q

How do you assess for gestational diabetes?

A

Oral GTT

71
Q

What is the leading cause of maternal death in pregnancy?

A

VTE

72
Q

VTE - pathogenesis

A

Hypercoagulability

Venous stasis

73
Q

VET - management of low risk patient

A

Mobilisation

Adequate hydration

74
Q

VET - management of high risk patient

A

Antenatal prophylaxis with LMWH

75
Q

LMWH is not safe to use in pregnancy. True or false?

A

False

- it is safe

76
Q

At which site of the body do most DVT’s occur?

A

Ileo-femoral area

77
Q

DVT - investigation

A

Compression duplex US

78
Q

DVT - if compression duplex US is normal but clinical suspicion is high, what do you do?

A

Repeat 1 week later

79
Q

There is increased risk of breast cancer in the mother following which investigation?

A

CTPA for PE

80
Q

VQ scan has more negative effects on MUM or BABY ?

A

Baby

81
Q

First line anti-hypertensive in pregnancy

A

Labetolol

82
Q

Which anti-hypertensive is used in pregnancy if woman is asthmatic

A

Nifedipine

Methyldopa

83
Q

Control of blood pressure reduces the risk of pre-eclampsia. True or false?

A

False

84
Q

If a woman is at risk of developing pre-eclampsia, which medication should be given throughout pregnancy?

A

Aspirin 75mg from 12 weeks

85
Q

Which drug promotes foetal lung maturation?

A

Corticosteroids

86
Q

How do you define eclampsia

A

Occurrence of one or more seizures superimposed on pre-eclampsia

87
Q

Name 3 possible symptoms of magnesium sulphate toxicity

A

Absent deep tendon reflexes
Decreased resp rate
Slurred speech

88
Q

Once eclampsia is established, continuation of pregnancy is not an option. True or false?

A

True

- baby must be delivered ASAP

89
Q

When do most eclampsia present?

A

Postpartum

90
Q

How do you assess for gestational diabetes ?

A

OGTT

91
Q

What’s the leading cause of maternal death in pregnancy?

A

VTE

92
Q

Which is safer for baby in utero: CTPA or VQ scan

A

CTPA

Reproduction SOH (50 decks)

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