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Reproduction > Medical Problems in Pregnancy > Flashcards

Medical Problems in Pregnancy Flashcards

1
Q

What is done at the booking visit?

A

general pregnancy advice; identify if low/high risk; info on choices for place of birth; discuss screening; BMI; BP; arrange dating USS; arrange booking bloods

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2
Q

When is the booking visit done?

A

8-12 weeks

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3
Q

When is the dating USS done?

A

11-12 weeks

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4
Q

When is the anomaly scan done?

A

20 weeks

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5
Q

When are anti-D injections given?

A

28 weeks and 24 weeks

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6
Q

How often do women have visits with the midwife between 20-28 weeks?

A

monthly

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7
Q

How often do women have midwife visit between 28 and 26 weeks?

A

fortnightly

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8
Q

How often do women have a midwife visit after 37 weeks?

A

weekly

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9
Q

What is the commonest medical problem in pregnancy?

A

HT

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10
Q

What is chronic hypertension in pregnancy?

A

HT present at booking or <20 weeks

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11
Q

what is gestational hypertension?

A

new HT >20 weeks without signif proteinuria

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12
Q

What is pre-eclampsia?

A

new HT >20 weeks and significant proteinuria

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13
Q

What are the life-threatening complications of hypertension in pregnnacy?

A

HELLP syndrome and eclampsia

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14
Q

What is HELLP syndrome?

A

haemolysis; elevated liver enzymes and low platelets

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15
Q

What anti-hypertensives are used in pregnancy?

A

labetalol; methyldopa; nifedipine; hydralazine

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16
Q

what anti-hypertensives should be stoppped?

A

ACEi and ARBs

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17
Q

What is the target for BP in pregnnacy?

A

<150/80-100

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18
Q

What is the BP target in pregnnacy with end organ damage

A

<140/90

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19
Q

What is the pathophysiology of pre-eclampsia?

A

deficient trophoblastic invasion which prevents development of high flow; low impedence uteroplacental circulation—-dysunfction of vascular endothelial cells–vasconstriction and no insensitivty to vasocontrictors

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20
Q

What are the effects o hypertensive disorders on the fetus?

A

IUGR; abruption; IUD

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21
Q

When should the baby be delivered in pre-eclampsia?

A

37 weeks

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22
Q

What is the effect of pregnnacy on diabetes?

A

poorer control; deterioration of renal function and retionopathy

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23
Q

What are the effects of diabetes on pregnnacy?

A

miscarriage; fetal malformations; IUGR; macrosomia; IUD; PET

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24
Q

What fetal malformations are diabetics more at risk of?

A

cardiac; neural tube defects; caudal regressions syndrome

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25
Q

When should labour be induced by in diabetics?

A

37-38 weeks

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26
Q

What does neonatal hypoglycaemia carry the risk of?

A

CP

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27
Q

Why is there fetal polycythaemia in DM?

A

due to hyperinsulinaemia; increased metabolism so tissue hypoxia which stimulates increased erythopoeitin and polychythaemia

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28
Q

How often should babies of diabetic mother have growth scnas?

A

28,32,36 weeks

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29
Q

When should babies be delivered with pre-existing DM?

A

37-38 weeks

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30
Q

How long after delivery should BMs be monitored with GDM?

A

48 hours

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31
Q

When is C/S recommended in macrosomia?

A

EFW >4000g

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32
Q

What is the effect of polycythaemia on the fetus?

A

thrombotic; jaundice

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33
Q

What is the risk of polyhydramnios?

A

fetal malpresentations and increased risk of preterm labour

34
Q

What is the main direct cause of maternal death in UK?

A

VTE

35
Q

What is thought to be the reason for increased clotting factors in pregnancy?

A

evolutionary to decrease risk of PPH

36
Q

What factors are increased in pregnancy?

A

VII; VIII; X and fibrinogen

37
Q

What are the VTE risk factors?

A

obesity; age >35; parity =>3; smoker; gross varicose veins; current pre-eclampsia; immobility; FHx; multiple pregnancy; IVF

38
Q

How many risk factors means you should give prophylaxis in the 1st trimester?

A

4 or more

39
Q

Who should get prophylaxis from 28 weeks?

A

3 risk factors

40
Q

Which leg do pregnnat women tend to develop DVT in?

A

left >right 8:1

41
Q

What is the difficulty with DVT in pregnancy?

A

50% early DVTs are asymptomatic

42
Q

How is DVT diagnosed in pregnancy?

A

duplex US on lower limb - not d-dimer

43
Q

What is the dose for heparin in pregnnacy?

A

1mg/kg twice daily

44
Q

How long should LMWH be continued after DVT?

A

3 months after delivery or 6 months after treatment

45
Q

What are the SE of heparin?

A

haemorrhage; hypersensitivity; allergy at injection site; heparin induced thrombocytopenia; oesopenia

46
Q

What may PE cause that can be seen on CXR?

A

atelectasis; effusion; focal opacities; regional oligaemia or pulmonary oedema

47
Q

What is the first line ix for PE in pregnnacy?

A

CXR and ABGs

48
Q

What are the risks of CTPA?

A

less childhood cancer but increased breast cancer

49
Q

Why should warfarin be avoided in pregnancy?

A

teratogenic- miscarriage; neuro problems; still birth

50
Q

When should CTPA done in pregnancy?

A

if CXR is abnormal and high clinical suspicion of PE

51
Q

When should warfarin be used after birth?

A

day 2 or 3

52
Q

Is warfarin safe to use in breastfeeding?

A

yes

53
Q

How is hypothyroidism affected by pregnance?

A

need higher levothyroxine dose- 25-50mcg more;

54
Q

How often should TFTs be checked in hypothyroid pregnnacy?

A

every trimester

55
Q

What happens in the pregnnacy with hyperthyroidism?

A

gets worse in first trimester due to hCG but improves second and thrid trimesters

56
Q

What are the effects of being hyperthyroid on the pregnnacy?

A

IUGR; preterm labour and thyroid storm

57
Q

What is the problem with beta blockers eg propanolol in pregnnacy?

A

IUGR

58
Q

When is the greatest risk of deterioration for severe asthmatics?

A

thrid trimester

59
Q

What is the most common for deterioration of asthma in pregnancy?

A

reduction or cessation of medications due to unfounded safety fears

60
Q

What is the risk of maternal death with epilepsy?

A

aspiration

61
Q

What dose of folic acid should pregnant epileptics be on?

A

5mg folic acid

62
Q

Why is there an increased risk of seizures in epilepsy in the 1st trimester?

A

hyperemesis and haemodilution

63
Q

When is the greatest risk of seizures in pregnnacy?

A

peripartum

64
Q

Why is there a deterioration of control of epilepsy in pregnancy?

A

poor compliance-safety fears; decreased drug levels due to vomiting; decreased drug due to increased volume of distribution and drug clearance; lack of sleep towards term; lack of absorption of drugs during labour; hyperventialtion during labour

65
Q

When is epilepsy a risk to the fetus?

A

status epilepticus- fetus is resistant to short-term hypoxia but not prolonged

66
Q

What are the major malformations with anticonvulsants?

A

neural tube defects; orofacial celfts and cardiac defects

67
Q

What anticonvulsants are implicated in NTDs?

A

valproate (1-2%) and caramazepine (0.5-1%)

68
Q

What anticonvulsants are implicated in orofacial defects?

A

phenytoin especially

69
Q

which anticonvulsants are implicated in cardiac defects?

A

phenytoin and valproate

70
Q

What is fetal anticonvulsant syndrome?

A

dysmorphic features; hypertelorism; hypoplastic nails and distal digits

71
Q

What is hypertelorism?

A

increased distnace between two organs or body parts eg between eyes

72
Q

What are the dysmorphic features seen with fetal anticonvulsant syndrome?

A

V-shaped eyebrows; lowset ears; broad nasal bridge; irregular teeth

73
Q

What is the teratogenic risk with any one anticonvulsant of a major malformation?

A

6-7%

74
Q

What is though to be the mechanism of teratogenesis with anticonvulsants?

A

folate deficiency

75
Q

What should epileptic women take if on an enzyme inducer?

A

vit K from 34-36 weeks

76
Q

Why should women on enzyme inducer take vitamin K?

A

risk of fetal vit K defieicney and haemorrhagic disease of the newborn

77
Q

When should LSCS be done in epileptics?

A

only if recurrent generalised seizures in late pregnancy/labour

78
Q

What pain relief during labour should epileptics be given?

A

early peidural to reduce pain/anxiety

79
Q

What is given to neonate of epileptic mother after birth?

A

1mg IM vit K

80
Q

How does the risk of SUDEP change in pregnancy?

A

increases in pregnnacy and postnatal period

Reproduction (52 decks)

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