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Medical Problems in Pregnancy Flashcards

1
Q

What are the booking bloods

A 
FBC
Blood group
Haemaglobinopahies
Infection screen - hep B, HIV, rubella, VDRL
Random blood glucose
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2
Q

when is booking visit

A

8-12 weeks

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3
Q

when is dating ultrasound

A

11/12weeks

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4
Q

when are monthly visits until

A

28weeks

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5
Q

when is anti d given

A

28 and 24 weeks

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6
Q

when are fortnightly visits

A

28-36 weeks

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7
Q

when are weekly visits

A

37 weeks to deliverly

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8
Q

what is done at each antenatal visit

A 
gestation
BP
urinalysis
FSH
fetal heart
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9
Q

when can you diagnose pre existing hypertension in pregnancy

A

Htn at booking or before 20 weeks

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10
Q

when is gestational hypertension diagnosed

A

new HTN more than 20 weeks without proteinuria

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11
Q

Preeclampsia

A

new HTN after 20 weeks and significant proteinuria

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12
Q

what do you give women with significant risk factors for preeclampsia

A

aspirin

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13
Q

What anti hypertensive medications should be avoided in pregnancy

A

ACE and ARBs

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14
Q

What antihypertensives are used in pregnancy

A

labetalol
methydopa
nifedipine - if monotherapy fails

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15
Q

what are the target BP controls in pregnancy

A

less than 150/80-100
less than 140/90 if organ damage

reduce medication doses if BP less than 130/90

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16
Q

what is there a greater risk of to the baby in hypertension in prgnancy

A

IUGR

placental abruption

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17
Q

when do you deliver in preeclampsia

A

37 weeks

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18
Q

what are the risks to the fetus with diabetes in pregnancy

A 
miscarriage
IUGR
neurol tube defects
macrosommia
polyhydramniois
neonatal hypoglycaemia
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19
Q

what diabetic treatments can be used in pregnancy

A

diet
metformin
insulin

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20
Q

when would you induced in diabetes

A

consider at 37-38 weeks in PRE EXISTING DIABETES

38 weeks in GDM on INSULIN, 41 weeks if just diet and everything else normal

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21
Q

what is there an increased risk of in polyhydramnios

A

malpresentation
preterm labour
cord prolapse

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22
Q

what does macrosomia increase the risk of

A

shoulder dystocia

23
Q

what is the aim HBA1c in pregnancy

A

less than 6 percent

24
Q

what extra scans are done in gestational diabete

A

28, 32 and 36 week growth scan

25
Q

what is there an increased risk of in polycythaemia

A

thrombotic events

jaundice

26
Q

what is the leading cause of maternal death in the uk

A

venous thromboembolism

27
Q

what medication is given to treat VTE in pregnancy

A

LMWH

28
Q

what coagulation changes occur in pregnancy

A

factors seve, eight, ten and fibrinogen levels increased

antithrombin three levels decreased

29
Q

when would you give anticoagulant prophylaxis in pregnancy

A

four or more risk factors - give straight away

three or more rsiks factors- give after 28 weeks

30
Q

what do you give prophylactically in high risk for vte post natally

A

6 weeks postnatal LMWH

give for 10 days in intermediate risk

31
Q

in which leg are DVTs more common in

A

left

32
Q

how should investigations and management be done for a dvt in preganncy

A

not a d dimer
ultrasound
therapeutic heparin
TEDs for up to two yeards

33
Q

name a low molecular weight heparin

A

daltaparin

34
Q

how long should therapeutic doses of heparin be given after a dvt in pregnancy

A

for three months after delivery or 6 months after treatment whichever is longer

35
Q

what are the risk factors of heparin

A

haemorrhage
heparin induced thrombocytopenia
osteopenia

36
Q

how do you manage a potential PE in pregnancy

A

Give heparin!

first do chest x ray then CTPA if abnormal or high clinical suspicion

37
Q

how often is the chest x ray normal in pe

A

half the time

38
Q

what can you see on x ray f there is a pe

A

etelectasis
effusion
oedema

39
Q

what is the worry with CTPA

A

increased risk of breast cancer

40
Q

should heparin be stopped in labour

A

yes

41
Q

how long before an epidural should anticoagulants be stopped

A

24 hours if therapeutic

12 hours if prophylactic

42
Q

is warfarin safe in breastfeeding

A

yes

43
Q

how long should PE therapy be given for

A

at least 6 weeks post natal and 3 months in total

44
Q

is warfarin safe in pregnancy

A

no - particularly avoid in 6-12 weeks as tetatrogenic

if given stop six weeks before labour

45
Q

what should you do in women with hypothyroid in pregnancy

A

increase levothyroxine in first trimester

do tft every trimester

46
Q

what is the effect of pregnancy on hyperthyroidism

A

worsens in first trimester due to hcg

gets better in second and third trimester

47
Q

effects of hyperthyroid on fetus

A

IUGR
preterm labour
thyroid storm

48
Q

what should epileptic women be given in pregnancy

A

high dose folic acid 5mg
vit K from 36 weeks if taking hepatic enzyme inducing anticonvulsants due to risk of fetal vit k deficiency and haemorrhagic disease of the newborn

49
Q

when is the risk of seizures highest in pregnancy in epileptics

A

peripartum period

50
Q

which anticonvulsant should definterly be avoided in pregnnacy

A

phenobarbitone - due to risk of neonatal convulsions

51
Q

what additional scans do epileptic women get in pregnancy

A

anomaly scan detailes 18-20 weeks

cardiac scan 22 weeks

52
Q

what delivery should be done in pts with epilepsy

A

c section only is recurrent seizures in late pregnancy or labour

53
Q

should antiepileptics be continued in labour

A

yes

54
Q

what is the post partum management in epilepsy

A

neonate gets vit K

risk of sudep increased in pregnancy and post natal period

Reproduction (52 decks)

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