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3 REPRO > medical problems in pregnancy > Flashcards

medical problems in pregnancy Flashcards

1
Q

what is a direct death

A

death caused by complications of pregnancy

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2
Q

what increases the risk of maternal death in the uk

A

comorbidities
ethnicity (asian and black women more 3x more likely)
age
obesity

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3
Q

obese women are at an increased risk of which complication of pregnancy

A

blood clots

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4
Q

what is the leading direct cause of morbidity/mortality in pregnancy

A

venous thromboembolism

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5
Q

cardiovascular changes in pregnancy

A 
blood volume increases
plasma volume increases 
cardiac output increases
stroke volume increases
heart rate increases
peripheral vascular resistance decreases
central venous pressure unchanged
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6
Q

heart disease that can affect pregnancy

A 
pulmonary hypertensio
congenital heart disease
acquired heart disease 
cardiomyopathy 
artificial heart valves 
ischaemic heart disease 
arrhythmias
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7
Q

why are rtes of heart disease in pregnancy increasing

A

increasing age of pregnant women
obesity
congenital heart disease

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8
Q

peri-partum cardiomyopathy

A

heart failure in the third trimester of pregnancy

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9
Q

common cardiac signs in pregnancy

A

palpitations
extra-systoles
systolic murmurs

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10
Q

risks of anticoagulation in pregnancy

A

warfarin is teratogenic

switch to LMWH

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11
Q

the ability to tolerate pregnancy is related to…

cardiac features

A 
pulmonary HTN
NYHA functional classification
presence of cyanosis
TIA/arrythmia 
heart failure 
left heart obstruction 
aortic root >45 mm (increased risk of aortic dissection)
myocardial dysfunction (EF <40%)
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12
Q

characteristics of physiological palpitations during pregnancy

A

occur at rest/lying down

relieved by standing/movement

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13
Q

characteristics of ectopic beats during pregnancy

A

constant ‘thumping’ in chest

relieved by exercise

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14
Q

investigation of sinus tachycardia in pregnancy

A

ECG, FBC, TFT, echo

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15
Q

alternative causes of sinus tachycardia in pregnancy

A

thyroid

cardiomyopathy

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16
Q

signs of phaeochromocytoma

A

rare
associated with sweating, headache, anxiety
hypertension

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17
Q

diagnosis of pheochromocytoma

A 
24 hour urinary catecholamines 
adrenal imaging (US)
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18
Q

lung function during pregnancy

A 
increased O2 consumption
increased metabolic rate 
increased resting minute ventilation 
increase in tidal volume
unchanged respiratory rate 
reduced functional residual capacity
unchanged vital capacity
unchanged FEV1 and PEFR
increased PaO2
decreased PaCO2
increased arterial pH
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19
Q

when is breathlessness most common

A

third trimester

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20
Q

asthma in pregnancy outcome

A

1/3 improve
1/3
deteriorate
1/3 remain unchanged

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21
Q

why might there be a deterioration in asthma control in the first trimester

A

many women stop or decrease their medications during pregnancy

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22
Q

management of asthma in pregnancy

A 
1 - SABA
2 - plus ICS
3 - plus LABA (if no response increase ICS)
4 - high dose ICS/4th drug 
5- oral steroids
23
Q

asthma birth plan

A

aim for vaginal birth
should not discontinue inhalers
IV hydrocortisone if oral steroids >2 weeks
increased risk of C-section with moderate-severe asthma

24
Q

what is the increase in risk of VTE in pregnancy

A

4-6x increase

25
Q

where is the most common site of DVTs in pregnancy

A

left leg

ileo-femoral

26
Q

when is the highest risk time for VTE

A

puerperium

27
Q

factors that increase the risk of VTE during/post pregnancy

A 
increased von willebrand factor 
increased factors VII, IX, X, XII
increased fibrinogen 
reduced protein S
acquired aPC resistance 
impaired fibrinolytic activity
28
Q

high risk for VTE

A

previous VTE except a single event related to a major surgery

29
Q

intermediate risk for VTE

A 
hospital admission 
single previous VTE related to major surgery 
high risk thrombophilia 
medical comorbidities 
surgical procedure
OHSS
30
Q

risk factors that may indicate VTE prophylaxis

A 
obesity 
age >35
parity >3
smoker
gross varicose vein
current pre-eclampsia 
immobility
family history of unprovoked or oestrogen-provoked VTE in first degree relative 
low-risk thrombophilia 
multiple pregnancy
IVF/ART
31
Q

criteria for VTE prophylaxis in pregnancy

A

four or more risk factors = prophylaxis from first trimester
three risk factors = prophylaxis from 28-weeks

32
Q

what is used as VTE prophylaxis in pregnancy

A

LMWH (dalteparin)

33
Q

symptoms/signs of DVT in pregnancy

A 
swelling 
oedema 
leg pain or discomfort 
tenderness
increased leg temperature 
lower abdominal pain
elevated white cell count
34
Q

objective testing for DVT

A

compression duplex ultrasound

35
Q

interpretation of compression duplex US

A

normal = vein should be easily compressible

36
Q

why is d-dimer not a useful screening test in pregnancy

A

d-dimers are nearly always raised in pregnancy

37
Q

symptoms/signs of PTE

A 
dyspnoea 
chest pain (pleuritic)
faintness
collapse 
haemoptysis
raised JVP
focal signs in the chest 
symptoms and signs associated with DVT
38
Q

imaging for PTE

A

CTPA or V/Q
CTPA has higher radiation to mother
V/Q higher radiation to fetus

39
Q

signs of warfarin embryopathy

A 
midface hypoplasia 
stipple chondral calcification 
short proemial limbs 
short phalanges 
scoliosis
40
Q

is anti-coagulation a contraindication for breast feeding

A

neither heparin nor warfarin are contraindications

41
Q

why is warfarin started on 5th post-natal day

A

first 5 days have increased risk of haemorrhage

42
Q

which CTD drugs are not safe in pregnancy

A

NSAIDs (>32 weeks)

43
Q

what are the antiphospholipid antibodies

A

anticardiolipin

lupus anticoagulant

44
Q

clinical features of APS

A 
arterial/venous thrombosis 
recurrent early pregnancy loss
late pregnancy loss
placental abruption
severe early onset pre-ecplampsia 
severe early onset fatal growth restriction
45
Q

diagnosis of APS

A

clinical - vascular thrombosis
pregnancy morbidity - >3 miscarriages/>1 foetal loss >10 weeks/>1 preterm birth
lab - IgM/IgG aCL and LA twice 6 weeks apart

46
Q

APS management

no thrombosis/adverse pregnancy outcome

A

LDA

maternal and fatal surveillance

47
Q

APS management

previous thrombosis

A

stop warfarin

LDA and LMWH (treatment dose)

48
Q

APS management

recurrent early pregnancy loss

A

LDA and LMWH (prophylactic dose)

49
Q

APS management

late fatal loss/severe PET/FGR

A

LDA and LMWH (prophylaxis dose)

50
Q

seizure frequency in pregnancy

A

improved or unchanged

51
Q

obstetric complications of epilepsy

A 
spontaneous miscarriage 
ante-partum haemorrhage 
HTN/PET
induction of labour 
c-section 
preterm birth
fatal growth restriction 
post partum haemorrhage
52
Q

fetal risks in epilepsy from maternal seizure

A

maternal abdominal trauma
PPROM
preterm birth
hypoxia/acidosis

53
Q

fetal risks of epilepsy

A 
major congenital malformation 
minor malformations 
adverse perinatal outcomes 
long-term developmental effects 
haemorrhage disease of the newborn 
risk of childhood epilepsy
54
Q

folic acid dose in pregnancy

A

5 mg

3 REPRO (40 decks)

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