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Y3 OBS AND GYNAE > Medical Problems in Pregnancy > Flashcards

Medical Problems in Pregnancy Flashcards

1
Q

List common medical problems in pregnancy

A 
VTE
Diabetes
Hypertension
Cardiac disease
Asthma
CTD (antiphospholipid syndrome)
Epilepsy
Obesity
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2
Q

What are the significant cardiovascular changes that occur in pregnancy?

A

Increased CO

Increased HR

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3
Q

List common cardiac conditions that require management in pregnancy

A 
Pulmonary hypertension
Congenital or acquired heart disease
Cardiomyopathy
Artificial heart valves
Ischaemic heart disease
Arrhythmia
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4
Q

Which emergency condition is a patient with Marfan’s syndrome at risk of during pregnancy?

A

Aortic dissection

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5
Q

Arrhythmia during pregnancy are typically benign. True/ False?

A

True

Palpitations, extrasystoles and systolic murmurs.

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6
Q

When do physiological arrhythmias typically occur?

A

At rest or lying down

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7
Q

State the name for the common arrhythmia described as a ‘thumping’ and is relieved by exercise . How is it diagnosed?

A

Ectopic beats

ECG

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8
Q

Which type of arrhythmia is a part of normal pregnancy?

A

Sinus tachycardia

Exclude other pathology (ECG, FBC, TFT, echo)

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9
Q

What type of arryhtmia is typically detected at pregnancy, but is found to predate pregnancy?

A

Supraventricular tachycardia

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10
Q

O2 consumption and tidal volume increase during pregnancy. What is the anatomical explanation for this change in lung function?

A

Increased level of diaphragm

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11
Q

When is breathlessness in pregnancy most common?

A

3rd trimester

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12
Q

State the most common chronic medical disorder to complicate pregnancy

A

Asthma

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13
Q

Asthma always gets worse during pregnancy. True/ False?

A

False

May improve, deteriorate or remain unchanged

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14
Q

Outline the stepwise management of asthma during pregnancy

A
  1. SABA
    • inhaled steroid
    • LABA
      - If good response, continue
      - If poor response, stop
      - If inadequate response, increase dose of steroid
  4. Trial of increased dose of steroid
    Consider adding 4th drug (LTRA, theophylline)
  5. Oral steroid and continuation of inhaled steroid
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15
Q

When is risk of VTE highest for a pregnant women?

A

Post-partum

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16
Q

What is the most common site of DVT in pregnancy?

A

Left leg

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17
Q

Popliteal DVT is the most common type of DVT in pregnancy? True/ False?

A

False

Ileo-femoral, unlike DVT in non-pregnnacy

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18
Q

What is the leading cause of maternal death in pregnancy?

A

Venous thromboembolism

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19
Q

Outline the pathogenesis of VTE

A

Virchows triad
- Hypercoagulability
Venous stasis
Vascular damage

20
Q

List risk factors for VTE during pregnancy

A 
Previous VTE (not related to surgery)
Thrombophilia
Co-morbidity (cancer, HF, SLE, IBD, DM, nephrotic syndrome, preclampsia)
IVDU, smoker, obesity
Any surgery
Age > 35 or partity > 3
Family history
21
Q

List clinical signs of DVT, which can also be present during normal pregnancy

A 
Swelling
Oedema
Leg pain or discomfort
Tenderness
Increased leg temperature
Lower abdominal pain
Increased WCC
22
Q

List investigations used to diagnose DVT in pregnancy

A

Compression Duplex US

Repeat in 1w if normal to exclude calf vein thrombosis

23
Q

If iliac vein thrombosis suspected after compression duplex US, which investigation should be requested?

A

MRI venography

24
Q

List clinical signs of PE during pregnancy

A 
Dyspnoea
Chest pain
Faintness/ collapse
Haemoptysis
Raised JVP
Focal signs in chest
Signs assoc. DVT
25
Q

A D-dimer test should be carried out in pregnancy to investigate PE. True/False?

A

False

Never do D-dimer in pregnancy, do a CTPA or VQ scan instead

26
Q

What drug is used to combat PE in pregnancy?

A

Heparin

27
Q

List some side effects of heparin

A

Haemorrhage
Hypersensitivity
Thrombocytopenia
Osteopenia

28
Q

Warfarin can be used to manage PE in pregnancy. True/ False?

A

False

Warfarin crosses placenta and is teratogenic, convert to LMWH by 6 weeks

29
Q

Warfarin is suitable for use while breastfeeding. True/ False?

A

True

It is not contraindicated - commence warfarin on 5th post-natal day

30
Q

Which medications used in the treatment of CTD are safe for use in pregnancy?

A 
Steroids
Azathioprine
Sulfazaline 
Hydroxychloroquine 
Aspirin
31
Q

What is anti-phospholipid syndrome and how does it present?

A

Acquired thrombophilia which presents with:
Arterial/ venous thrombosis
Recurrent early pregnancy loss (>2 in <10w)
Late pregnancy loss (preceded by FGR) at >10w
Placental abruption
PET (>1 preterm birth)

32
Q

Outline the pathogenesis behind APS

A

AP autoantibodies react with phospholipid component of CM

33
Q

How is APS diagnosed in the lab?

A

IgM/ IgG aCL (medium/ high titre)
LA
On 2 occassions more than 6 weeks apart

34
Q

How is APS managed?

A

Previous thrombosis: LDA + treatment dose of LMWH

Fetal loss/ severe PET/ FGR: LDA + prophylactic LMWH

35
Q

In a person with epilepsy, during which trimester are they at increased risk of seizures?

A

1st trimester due to hyperemesis and haemodilution

36
Q

What are the risks of seizures during pregnancy?

A 
Spontaneous miscarriage
PPH
Hypertension/ PET
Preterm birth
Fetal growth restriction
Congenital malformation
Childhood epilepsy
37
Q

Which epileptic drug is especially associated with neural tube defects?

A

Sodium valproate

38
Q

Outline management options for epilepsy during pregnancy

A

Use lowest effective dose of AED
Detailed 20w US for fetal anomaly
Folic acid 5mg/day to reduce congenital malformations
Baby safety

39
Q

Outline management optons for epilepsy during labour

A 
Aim for vaginal birth, may need C section
Continuous fetal monitoring
IV lorazepam/ diazepam
IV phenytoin
PR diazepam/ buccal midazolam
40
Q

If no history of epilepsy, how are seizures managed during labour?

A

Magnesium sulphate

41
Q

What are the maternal risks of obesity during pregnancy?

A 
Miscarriage
GDM
Hypertension/ PET
VTE
PPH
42
Q

What are the fetal risks of obesity during pregnancy?

A 
Congenital anomalies
Macrosomia
Shoulder dystocia
Still birth
Neonatal death
43
Q

Outline management options for obesity during pregnancy

A 
Maternal BMI at booking
PET prophylaxis (Aspirin)
Thromboprophylaxis
Detailed US
OGTT
Anaesthetic review
44
Q

List pregnancy-related MSK problems

A

Back pain
Pelvic girdle pain
Diastasis of rectus abdominus muscle (DRAM)
Carpal tunnel syndrome

45
Q

What is diastasis recti?

A

Seperation of the two sides of the rectus abdominus muscle due to stretching of the linea alba

Y3 OBS AND GYNAE (44 decks)

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