Medical problems in pregnancy

Question 1

what drugs are safe for HTN in pregnancy

Answer 1

labetalol
methyldopa (alpha blocker)
nifedipine ( ca channel antagonist)
hydralazine (vasodilator)

Question 2

HTN in pregnancy BP aim

Answer 2

< 150/80-100

if target organ damage aim for < 140/<90

Question 3

HTN in pregnancy - when should you deliver?

Answer 3

37 weeks

Question 4

pre eclampsia - proteinuria > ?

Answer 4

0.3 g/L

Question 5

diabetic drugs safe in pregnancy

Answer 5

metformin

insulin

Question 6

diabetic control

• BM aim?
• HbA1c aim?

Answer 6

BM 4-6

HbA1c < 6%

Question 7

should diabetic tx for GDM be stopped after delivery

Answer 7

yes, stop and monitor BMs for 48 hrs to ensure return to normal

Question 8

complication of foetal hyperglycaemia

Answer 8

polycythaemia > jaundice, thrombotic effects

Question 9

how is hypothyroid management changed in pregnancy

Answer 9

increase levothyroxine by 25-50 mcg in first trimester

repeat TFTs every trimester

Question 10

does hyperthyroid improve in pregnancy?

Answer 10

gets worse in 1st trimester due to HCG but improves in 2nd and 3rd

Question 11

Ix of DVT

Answer 11

DONT do d dimers

duplex u/s on lower limb

Question 12

DVT tx?

Answer 12

LMWH

continue until 3m after delivery or 6m after tx, whichever longer

Question 13

which is safer in pregnancy: CTPA or V/Q scan?

Answer 13

CTPA - less risk of childhood cancer

Question 14

epileptic taking hepatic enzyme inducing drugs

Answer 14

give vit K from 36 weeks

Question 15

risk of seizures highest in which period?

Answer 15

peri-partum

Question 16

how much folate is given in epilepsy

Answer 16

5mg / day

Question 17

would you encourage to breastfeed in epilepsy?

Answer 17

yes

Question 18

are BZD’s teratogenic

Answer 18

no

Question 19

when is C-section indicated in epilepsy

Answer 19

recurrent generalised seizures i late pregnancy

Question 20

if at high risk of eclampsia, what drug is commenced before 12 weeks?

Answer 20

aspirin

Question 21

main cause of death in eclampsia

Answer 21

pulmonary oedema

Question 22

how are seizures in eclampsia treated

Answer 22

mag sulph

if persistent > diazepam

Question 23

RFs for eclampsia

Answer 23

> 40 yrs 
BMI > 30
renal disease
multi pregnancy 
fam hx 
DM

Question 24

what type of antipsychotics appear to be safe in pregnancy

Answer 24

typicals - haloperidol

Question 25

safest class of antidepressant in pregnancy and breastfeeding

Answer 25

TCAs

Question 26

when does puerperal psychosis usually present

Answer 26

in first 2 weeks

EMERGENCY > admit to specialised mother-baby unit