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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
Pre-eclampsia - potential hepatic features - HELLP syndrome
Haemolysis Elevated Liver Enzymes Low Platelets
26
Pre-eclampsia - potential haematology features
thrombocytopenia
27
Pre-eclampsia - potential pulmonary problems
Pulmonary oedema | PE
28
Pre-eclampsia - potential CVS features
Hypertension
29
Pre-eclampsia - potential placental features
``` Foetal growth restriction Placental abruption Intrauterine death (still birth) ```
30
Pre-eclampsia - medical risk factors
Pre-existing renal disease Pre-existing hypertension Diabetes CTD
31
Pre-eclampsia - clinical features
``` Hypertension Proteinuria Oedema Abdominal tenderness Disorientation SGA IUD ```
32
How do you predict pre-eclampsia ?
Maternal uterine artery doppler US at 20-24 weeks
33
Pre-eclampsia - what abnormal sign is on US
Notching
34
What is the only cure for pre-eclampsia?
Delivery (since it is caused by the placenta)
35
Antenatal screening for pre-eclampsia
BP Urinalysis Maternal uterine artery doppler US
36
Pre-eclampsia - management
Control hypertension | Low dose aspirin (75mg) - commence before 12 weeks
37
What is the role of maternal steroids in pregnancy?
Reduce the rate of neonatal respiratory distress syndrome by producing surfactant
38
Which groups of women are at high risk of developing pre-eclampsia?
``` Hypertensive disease in previous pregnancy Chronic kidney disease Autoimmune disease T1 or T2 diabetes Chronic hypertension ```
39
Pre-eclampsia - HIGH/MODERATE/LOW risk women should take 75mg Aspirin daily from 12 weeks gestation until birth of baby?
High and Moderate risk women
40
Which groups of women are at moderate risk of developing pre-eclampsia?
``` First pregnancy Age 40+ Pregnancy interval of over 10 years BMI 35+ FH of pre-eclampsia Multiple pregnancy ```
41
Pre-eclampsia - which patients need admitted to hospital? - At which BP level
over 170/110 OR over 140/90 with (++) proteinuria
42
Pre-eclampsia - which patients need admitted to hospital? - at which proteinuria level?
Over 300mg/24hrs
43
What is eclampsia?
Extreme pre-eclampsia
44
Eclampsia - clinical features
Tonic Clonic seizures (due to severe hypertension) | Features of pre-eclampsia
45
Eclampsia - which IV medication can be used to treat BP?
IV labetolol | IV hydralazine
46
Eclampsia - what can be given to control seizure?
Magnesium sulphate - Loading dose: 4g IV over 5 mins - Maintenance dose: IV infusion 1g/hr
47
Eclampsia - what can be given if the patient has persistent seizures?
Diazepam 10mg IV
48
It is uncommon to have a vaginal birth if you have eclampsia. True or false?
False | - aim for a vaginal birth
49
Palpitations - most are benign/pathological?
Benign
50
Palpitations - if the patient explains ectopic beats then what investigation do you do?
ECG
51
Which benign arrhythmia is common in pregnancy?
Sinus tachycardia
52
What is the most common arrhythmia in pregnancy?
Supra Ventricular Tachycardia
53
If a women presents with chest pain in pregnancy, what investigation should she get?
ECG | CT scan
54
It is common to get an asthma exacerbation during pregnancy. True or false?
True
55
Why may asthma deteriorate during pregnancy?
If the patient stops taking their asthma medication as the patient may be scared incase her asthma management will affect the foetus
56
In an asthmatic patient, what mode of delivery should you aim for?
Vaginal birth
57
Why may epilepsy be difficult to control in pregnancy?
Many AEDs are teratogenic
58
Epilepsy - most women get increased seizures in pregnancy. True or false?
False | - only 10% get increased seizure frequency
59
Epilepsy - what are the foetal risks from maternal seizures during pregnancy
Lower verbal IQ Hypoxia Bradycardia
60
It is better to use monotherapy/polytherapy to control epilepsy in pregnancy?
Monotherapy
61
If the mother is likely to have epileptic seizures during pregnancy, how do you manage her?
Give her AED | - benefits of treatment outweigh risks in most cases
62
Epilepsy management - side effect of sodium valproate?
Neural tube defects - spina bifida Facial cleft Hypospadias
63
Epilepsy management - side effect of phenytoin?
Cardiac malformations
64
What should all women with epilepsy take prior to conception and through until the end of the first trimester?
5mg/day folic acid
65
Obesity - pre-pregnancy problems
Menstrual disorders | sub-fertility
66
Obesity - early pregnancy problems
Miscarriage
67
Obesity - foetal problems
Macrosomia Birth injury Perinatal mortality
68
Management of obesity in pregnancy - pre-eclampsia prophylaxis
Low dose aspirin
69
Management of obesity in pregnancy - thromboprophylaxis
LMWH
70
How do you assess for gestational diabetes?
Oral GTT
71
What is the leading cause of maternal death in pregnancy?
VTE
72
VTE - pathogenesis
Hypercoagulability | Venous stasis
73
VET - management of low risk patient
Mobilisation | Adequate hydration
74
VET - management of high risk patient
Antenatal prophylaxis with LMWH
75
LMWH is not safe to use in pregnancy. True or false?
False | - it is safe
76
At which site of the body do most DVT's occur?
Ileo-femoral area
77
DVT - investigation
Compression duplex US
78
DVT - if compression duplex US is normal but clinical suspicion is high, what do you do?
Repeat 1 week later
79
There is increased risk of breast cancer in the mother following which investigation?
CTPA for PE
80
VQ scan has more negative effects on MUM or BABY ?
Baby
81
First line anti-hypertensive in pregnancy
Labetolol
82
Which anti-hypertensive is used in pregnancy if woman is asthmatic
Nifedipine | Methyldopa
83
Control of blood pressure reduces the risk of pre-eclampsia. True or false?
False
84
If a woman is at risk of developing pre-eclampsia, which medication should be given throughout pregnancy?
Aspirin 75mg from 12 weeks
85
Which drug promotes foetal lung maturation?
Corticosteroids
86
How do you define eclampsia
Occurrence of one or more seizures superimposed on pre-eclampsia
87
Name 3 possible symptoms of magnesium sulphate toxicity
Absent deep tendon reflexes Decreased resp rate Slurred speech
88
Once eclampsia is established, continuation of pregnancy is not an option. True or false?
True | - baby must be delivered ASAP
89
When do most eclampsia present?
Postpartum
90
How do you assess for gestational diabetes ?
OGTT
91
What's the leading cause of maternal death in pregnancy?
VTE
92
Which is safer for baby in utero: CTPA or VQ scan
CTPA

Reproduction SOH (50 decks)

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