Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Case 31 - Concerns During Pregnancy 2 > Medical Problems in Pregnancy > Flashcards

Medical Problems in Pregnancy Flashcards

1
Q

If a woman (reproductive age) is known to have a medical problem, what do you want to do?

A

Discuss if she is planning family?

What contraception she is using?

Review her medication list .

Refer for preconception counselling if essential.

Advice to start folic acid! ( either 400mcg or 5mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

why is folic acid given to women trying to conceive/ or pregnant women?

A

lack of folic acid can result in neural tube defects such as spina bifida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which couples are at high risk of conceiving a child with an NTD?

A

Either partner has an NTD, they have had a previous pregnancy affected by an NTD, or they have a family history of an NTD.

The woman is taking anti–epileptic medication.

The woman has coeliac disease or other malabsorption state,diabetes mellitus,sickle cell anaemia,or thalassaemia.

The woman is obese (defined as a body mass index [BMI] of 30 kg/m2or more).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how much folic acid should women take if they are at a normal risk, and high risk for neural tube defects

How long into their pregnancy should they take it for for each risk category?

A

Normal risk for an NTD: folic acid 400micrograms daily, to continue until the 12th week of pregnancy.

High risk of an NTDto take folic acid 5mg daily , to continue until the 12th week of pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how much Folic acid should women with sickle-cell disease, thalassaemia, or thalassaemia trait take folic acid and for how long?

A

Women with sickle cell disease, thalassaemia, or thalassaemia traitshould takefolic acid 5 mg dailythroughout pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

starting pregnancy at a healthy weight reduces the risk of….. and ……….

it can also result in less risk of

1) F
2) P
3) D
4) C
5) H

A

….diabetes and …….high blood pressure

fetal growth anomalies
preterm birth
death in the womb
caesarean section
haemorrhage after delivery.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Taking folic acid no less than 3 month before getting pregnant could prevent most cases of neural tube defects,such as Spina Bifida, by up to …..%

A

70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stopping smoking before pregnancy can reduce the risk of….

1) E……… Pregnancy
2) M
3) B…….. Defects
4) D…… in the womb
5) P………. A……….
6) L…… B…… W……
7) Pre….. B…….

A 
ectopic pregnancy
miscarriage
birth defects
death in the womb
placental abruption
low birth weight
preterm birth.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Alcohol consumption during pregnancy can cause what?

A

Fetal alcohol syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Drug exposure, including prescribed painkillers during pregnancy increase the risk of what two things?

A

Neonatal Abstinence Syndrome

Sudden Infant Death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What key 5 factors should you discuss with the patient before trying to conceive?

A

Healthy Weight

Folic acid

Quit smoking

Alcohol and drugs

Nutrition and Anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

During pregnancy and labour pre-existing medical conditions may worsen
Is this true or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chronic diseases and the treatment can impact fetal growth, health and development
Is this true or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is asthma treated uncontrolled during pregnancy?

A

No/little modification in medication as benefits outweigh the drawbacks.

Steroids should be used as needed in the usual way and not withheld due to pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are couples that are both carriers of the cystic fibrosis gene managed throughout pregnancy?

A

Preconception counselling and planned pregnancy

Maternal nutrition

control of pulmonary infection

avoidance of hypoxia

fetal surveillance.

Multidiscliplinary management.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

why may aspirin be given to women during pregnancy?

A

women who are at high risk off pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how much aspirin is recommend to women with a high risk of pre-eclampsia?

A

150mg of aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

from what time frame do women with a high risk of pre-eclampsia during pregnancy start taking aspirin and when do they stop?

how often do they take the aspirin?

A

from 12weeks

until the birth of the baby

daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which women are at high risk of developing pre-eclampsia during pregnancy

A

women with the following;

hypertensive disease during a previous pregnancy

chronic kidney disease

autoimmune disease such as systemic lupus erythematosus or antiphospholipid syndrome

type1 or type2 diabetes

chronic hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

which women are at moderate risk of developing pre-eclampsia?

A

women who;

first pregnancy

age 40years or older

pregnancy interval of more than 10years

PCOS

body mass index (BMI) of 35kg/m2or more at first visit

family history of pre-eclampsia

multi-fetal pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

do you advise pregnant women with 1or more moderate risk factor for pre-eclampsia to take aspirin?

how much would you recommend she take and how often?

specify the duration of how long she will have to take aspirin?

A

YES

take 150mg of aspirin

daily

from 12weeks until the birth of the baby.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

List the diabetic support measures for a pregnant women?

A

routine blood tests are carried out to check HbA1c level - target below 48 mmol/mol

Individualised targets for self-monitoring of blood glucose should be agreed, taking into account risk of hypoglycaemia

Metformin can be used as an adjunct or alternative to insulin in those with type 2 diabetes but other oral hypoglycaemics should be discontinued prior to pregnancy

Many with type 2 diabetes will be converted to insulin during this period.

23
Q

list the support measures put in place for a diabetic women trying to conceive?

A

Planned pregnancy is recommended

Blood glucose targets, monitoring and control should be discussed prior to pregnancy.

Many with type 2 diabetes will be converted to insulin during this period.

24
Q

what should be recommended to a diabetic women trying to conceive who has a HbA1c of more than 86 mmol/mol

A

should avoid pregnancy until better control has been established.

25
Q

what can uncontrolled diabetes during pregnancy lead to in newborns?

A

increases risk of congenital malformation

26
Q

Good blood glucose control before conception and throughout pregnancy will reduce but DOES NOT ELIMIATE the risk of miscarriage, congenital malformation, stillbirth and neonatal death.

A
27
Q

what non pharmaceutical advise and support is given to women who are diabetic and pregnant?

A

Structured educational programmes should be offered where women have not previously attended one.

Provide advice on diet, exercise and weight loss

Joint Obstetric and Diabetic clinics, Fetal growth monitoring, planned delivery by 38 -39 weeks

28
Q

what are the secondary complications of diabetes in pregnancy?

A

retinal and renal complications

29
Q

when is retinal screening done on diabetic women during pregnancy?

is it repeated or done only once?

A

Retinal screening is done every trimester ( 12 weeks)

should be done unless it has been done in the previous six months.

30
Q

when do you refer a diabetic pregnant women to nephrology?

which if any medication is stopped?

A

when eGFR <45 ml/minute, creatinine is abnormal or the urinary albumin:creatinine ratio >30 mg/mmol.

Review concurrent medication

stop angiotensin-converting enzyme (ACE) inhibitors

angiotensin-II receptor antagonists (AIIRAs, commonly known as angiotensin receptor blockers (ARBs)

statins

31
Q

if a pregnant diabetic women has an been referred to nephrology where eGFR <45 ml/minute, creatinine is abnormal or the urinary albumin:creatinine ratio >30 mg/mmol what other investigations would you do?

is this patient at high risk or intermediate risk of the foetus developing NTD?

how would you treat this patient to reduce the risk of NTD?

A

Check for co-existing thyroid disease in those with type 1 diabetes (TSH, free T4 and thyroid peroxidase antibodies).

High risk

Treat as high risk for NTD with a dose of 5 mg folic acid pre-conception and up to 12 weeks.

32
Q

what are the risk factors associated with Hypertension during Pregnancy?

A

Increases the risk of pre-eclampsia during pregnancy

increases the risk of placental abruption and neonatal morbidity and mortality.

High risk for pre-eclampsia, abruption, IUGR, cardiomyopathy

High risk ANC

33
Q

what is the target blood pressure in uncomplicated hypertension during pregnancy?

A

less than 140/90 mm Hg

34
Q

what do you monitor in a women who has Hypertension during Pregnancy?

A

Regular reviews for BP
regular reviews of urine in community and hospital
Closer to term, close monitoring of BP and urine

Now we offer HBPM ( Home Blood Pressure Monitoring)

Fetal growth monitoring

Induction of labour at term

35
Q

what medication are contra-indicated in pregnancy and when should they be changed?

what is the first time of treatment for hypertension during pregnancy?

A

ACE inhibitors and AIIRAs

ideally should be changed prior to pregnancy.

36
Q

what is the first time of treatment for hypertension during pregnancy?

A

Labetalol is usually the first-line treatment used.

Drugs of choice are methyldopa, beta-blockers (labetalol, propranolol, metoprolol) and nifedipine.

37
Q

All women with congenital or acquired heart disease should discuss future pregnancies with a GP true or false

A

FALSE

All women with congenital or acquired heart disease should discuss future pregnancies with a CARDIOLOGIST

38
Q

why are statins usually not recommended during pregnancy?

A

Statins are contra-indicated in pregnancy and should be stopped prior to conception.

during early pregnancies can lead to miscarriages

most common anomalies were congenital heart defects and cleft lip with or without cleft palate

39
Q

The risk of foetus having congenital heart disease is lower if mother has CHD.
True or false?

A

The risk of fetus having congenital heart disease is HIGHER if mother has CHD

40
Q

should a women with CHD who is trying to conceive stop taking contraception until she has spoken to a gp about trying to conceive?

A

Advise women to continue contraception until this discussion with GP or cardiologist has taken place.

41
Q

define epilepsy

A

a common neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.

42
Q

epilepsy during pregnancy, how many improve? stay the same ?and deteriorate ?

A

1/3 improve

1/3 remain same

1/3 deteriorate

43
Q

What are the impacts on a fetus when the mother has short episodes of epilepsy?

What are the impacts on a fetus when the mother has recurrent long episodes of epilepsy throughout pregnancy?

A

In general fetus is resistant to short episode of hypoxia

but status epilepticus is dangerous to both mother and fetus.

44
Q

Anti-convulsant medications are safer given to pregnant women during pregnancy?

A

Lamotrigine and Levetiracetam are commonly used and are safe in pregnancy

Main concern – teratogenic potential of the anticonvulsant medications (Sodium Valproate is high risk)

All women with history of epilepsy should take high dose folic acid -5mg
Planned pregnancy and discussion with Neurologist is recommended.
Fetal growth monitoring is recommended if they are on more than two anti convulsant or have seizures in the pregnancy

45
Q

All women with history of epilepsy should take high dose folic acid -5mg
True or false?

A

True

46
Q

for a pregnant woman that has epilepsy and is on two or more anti-convulsant medication or has seizures during pregnancy, is fetal growth monitoring recommended?

A

Yes

47
Q

If a woman has hypothyroidism during pregnancy how much do you increase the dose of thyroxine by?

How often do you repeat TFTS during pregnancy?

How often do you repeat TFTs postnatally?

A

Increase the thyroxine dose by 25mcg at positive pregnancy test

Repeat TFTS every 12 weeks/trimester

Postnatally 6-12 weeks repeat TFT

48
Q

In a woman during pregnancy with hypothyroidism( Grave’s disease) how do you treat her?

A

1) send for Specialist review
2) give her an anti thyroid treatment - both carbimazole and PTU are safe in pregnancy
3) Monitor bloods for TRABs
4) Fetal growth monitoring by USS
5) Cords bloods for TFTs at deliver

49
Q

The use of Radioactive iodine is contraindicated in pregnancy.
True or false?

A

True

50
Q

What are the symptoms Puerperal cardiomyopathy?

A

SOB
poor exercise tolerance
palpitations
peripheral and pulmonary edema

51
Q

The risk factors of Puerperal cardiomyopathy?

A 
Risk factors
maternal age
hypertension
multiparity
multiple pregnancy
52
Q

when during gestation does puerperal cardiomyopathy present?

A

24 weeks of gestation to 6/12 postnatally

53
Q

What 4 examples of inflammatory bowel diseases?

A

Ulcerative Colitis
Crohn’s disease
Nonspecific colitis
Proctitis

54
Q

List five ways patients with inflammatory bowel diseases manage during pregnancy?

A

5mg folic acid throughout the pregnancy

Nutrition

Most of the medications can be continued throughout the pregnancy

MDT

Immunomodulators infusions are stopped by 24 weeks – Neonatal vaccination

Case 31 - Concerns During Pregnancy 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions