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11- Reproduction > Medical Problems in Pregnancy > Flashcards

Medical Problems in Pregnancy Flashcards

1
Q

what is the leading cause of maternal mortality in the UK?

A

heart disease

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2
Q

if a woman experiences new chest pain during pregnancy what should be done?

A

offer ECG

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3
Q

are ectopic beats ‘thumping’ common during pregnancy?

A

yes so are palpitation and murmurs and all usually benign

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4
Q

if a woman with valvular heart disease is on anticoagulation what should be done with her medication during pregancy?

A

try to switch from warfarin to LMWH before pregnancy or within 6 weeks

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5
Q

should warfarin be given during pregnancy?

A

if possible no, especially during first an dthird trimesters

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6
Q

why is warfarin contraindicated in pregnancy?

A

can cross placenta with risk of foetal abnormality

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7
Q

if a woman is on warfarin when she gives birth what must be given immediately?

A

immediate prophylaxis Vit K

(IM phytomenadione)

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8
Q

are anti-coagulants such as warafrin contraindicated in breast feeding?

A

no- significant amount not detected in milk so considered safe

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9
Q

what is Eisenmenger syndrome?

A

pulmonary hypertension w left to right shunting

(due to untreated congenital abnormality)

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10
Q

what is used to class risk in women with heart disease?

A

NYHA- new york heart assoc

if class III/IV advised against pregnancy

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11
Q

what is more likely to harm baby, drugs used to control asthma or mum not taking them at all?

A

mum not taking them

poorly controlled asthma is worse for baby than any medication given

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12
Q

how is a womans asthma affected during pregnancy?

A

1/3rd stay the same

1/3 improve

1/3rd get worse

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13
Q

what medcations are given for asthma?

A

SABA

ICS

+LABA

ICS trial at higher dose

oral steroid

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14
Q

what mode of delivery should we aim for with asthamtic mothers?

A

vaginal delivery and continue use of inhalers during labour

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15
Q

when would IV hydrocortisone be given to an asthamtic woman during labour?

A

if been on oral steroids >2weeks

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16
Q

when are women most at risk of developing VTE?

A

just following birth of baby

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17
Q

where do majority of VTE present?

A

left leg and are ileo-femoral

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18
Q

if a woman is higher risk with previous VTE what is given prohylactically?

A

LMWH- dose dependant on womens weight

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19
Q

which disorder is the biggest risk to thrombosis?

A

thrombophilia

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20
Q

are D-dimers useful in pregnancy?

A

no as dimers raised in pregnancy anyway

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21
Q

what is the preffered investigative tool in mothers CTPA or V/Q scan?

A

V/Q scan

(CTPA can inc risk of breast cancer within 10 years)

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22
Q

what is needed to diagnose APS?

A

+ve on 2 occasions, 6 weeks apart

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23
Q

how is APS managed?

A

LMWH and low dose aspirin

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24
Q

what antibodies are present in APS?

A

anti cardiolipin

B2 glycoprotein

lupus anticoagulant

25
Q

how many months seizure free prior to pregancy indicates mum will likely stay seizure free throughout?

A

9 months seizure free before pregnancy

26
Q

what complication could occur following trauma i.e fall from seizure?

A

FMH- foetal maternal haemorrhage

bleeding into mums circulation from baby

27
Q

what are the different classifications of hypertension in pregnant women?

A

pre-existing

pregnancy induced

pre-eclampsia

28
Q

when would pregnancy induced hypertension present and when does it resolve?

A

2nd half of pregnancy

resolves within 6 weeks of delivery

no proteinuria or other features of pre-eclampsia

29
Q

what is present in pre-eclampsia?

A

hypertension

proteinuria

oedema

30
Q

what is early and late onset pre-eclampsia?

A

early < 34 weeks > late

31
Q

what can be used to manage pre-eclampsia?

A

aspirin

labetolol

hydralazine (add on)

32
Q

who is labetolol contraindicated in?

A

asthma

33
Q

what is the only ‘cure’ for pre-eclamspia?

A

delivery of baby

34
Q

what can be given to help with development if baby needs to be delivered early in pre-eclampsia?

A

two doses of dexamethasone to inc foetal lung development

35
Q

other than further inc in BP what is feature of eclampsia not seen in pre-eclamspia?

A

tonic clonic seizure

36
Q

what is the management of eclampsia?

A

control BP

Magnesium sulphate to stop/prevent seizures

fluid management: run patient dry

delivery of baby

37
Q

what medications can be used and what is contraindicted in helping with delivery of baby?

A

epidural helpful as can drop BP

ergometrine is contraindicated

38
Q

what are red flags of mental health issue in new mum?

A

recent significant change in mental state/ emergence of new symptoms

new thoughts or acts of self harm

estrangement from their baby/ new and persistent thoughts of incompetency as a mother

39
Q

what screenign is there for mental health issues in pregant women?

A

history of mental health at booking appointment

checking in at every following appointment

40
Q

the ‘baby blues’ affect how many women?

A

up to 50%

41
Q

what are the baby blues?

A

brief period of emotional instability

tearful

irratible

anxious w poor sleep

42
Q

how soon do the ‘baby blues’ often resolve?

A

within 10 days

offer support and reassurance

43
Q

what psychiatric disorder usually occurs within 2 weeks of delivery?

A

puerperal psychosis

44
Q

what are the ealry symtpoms or peurperal psychosis?

A

sleep disturbance/confusion

irrational ideas

delusions

hallucinations

45
Q

is peurperal psychosis an emergency?

A

yes- needs admission to hospital preferably specialised Mother Baby Unit (MBU)

46
Q

how is peurperal psychosis treated?

A

antidepressant

antipsychotics

CBT (help in recovery)

ECT (v rarely)

47
Q

what are some disorders associated with peurperal psychosis?

A

bipolar

unipolar depression

schizophrenia

48
Q

how many women are affected by postnatal depression?

A

10%

2-6 weeks onset postnatally but lasts months

49
Q

which antipsychotic should be avoided in pregnancy and mothers?

A

clozapine

AGRANULOCYTOSIS

50
Q

what is the lowest risk antidepressant during pregnancy and breastfeeding?

A

sertraline (SSRI)

51
Q

what mood stabaliser is contrindicated in breast feeding?

A

lithium

52
Q

what is deficient in wernickes ecephalopathy?

A

B1 (thiamine deficiency)

53
Q

what is the chronic form of wernickes?

A

Korsakoffs

extreme B1 deficiency

54
Q

what is used to reat respiratory depression second to opiates?

A

naloxone

55
Q

what is used to reverse magnesium sulphate?

A

Calcium Gluconate

56
Q

if hypertension in pregnancy presents before 20wks what is this diagnosed as?

A

pre-existing hypertension

(cannot diagnose pregnancy induced until >20wks)

57
Q

hyperemesis gravidum is due to raised levels of which hormone?

A

BHCG

58
Q

what is common in hyperemesis gravidum?

A

5% pre pregnancy wgt loss

dehydration

electrolyte imbalance

59
Q

what is recommended to treat epilepsy in pregnancy?

A

lamotrogine

(avoid phenytoin and valproates)

11- Reproduction (19 decks)

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