Medical Problems in Pregnancy

Question 1

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

Answer 1

heart disease

Question 2

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

Answer 2

offer ECG

Question 3

are ectopic beats ‘thumping’ common during pregnancy?

Answer 3

yes so are palpitation and murmurs and all usually benign

Question 4

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

Answer 4

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

Question 5

should warfarin be given during pregnancy?

Answer 5

if possible no, especially during first an dthird trimesters

Question 6

why is warfarin contraindicated in pregnancy?

Answer 6

can cross placenta with risk of foetal abnormality

Question 7

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

Answer 7

immediate prophylaxis Vit K

(IM phytomenadione)

Question 8

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

Answer 8

no- significant amount not detected in milk so considered safe

Question 9

what is Eisenmenger syndrome?

Answer 9

pulmonary hypertension w left to right shunting

(due to untreated congenital abnormality)

Question 10

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

Answer 10

NYHA- new york heart assoc

if class III/IV advised against pregnancy

Question 11

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

Answer 11

mum not taking them

poorly controlled asthma is worse for baby than any medication given

Question 12

how is a womans asthma affected during pregnancy?

Answer 12

1/3rd stay the same

1/3 improve

1/3rd get worse

Question 13

what medcations are given for asthma?

Answer 13

SABA

ICS

+LABA

ICS trial at higher dose

oral steroid

Question 14

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

Answer 14

vaginal delivery and continue use of inhalers during labour

Question 15

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

Answer 15

if been on oral steroids >2weeks

Question 16

when are women most at risk of developing VTE?

Answer 16

just following birth of baby

Question 17

where do majority of VTE present?

Answer 17

left leg and are ileo-femoral

Question 18

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

Answer 18

LMWH- dose dependant on womens weight

Question 19

which disorder is the biggest risk to thrombosis?

Answer 19

thrombophilia

Question 20

are D-dimers useful in pregnancy?

Answer 20

no as dimers raised in pregnancy anyway

Question 21

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

Answer 21

V/Q scan

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

Question 22

what is needed to diagnose APS?

Answer 22

+ve on 2 occasions, 6 weeks apart

Question 23

how is APS managed?

Answer 23

LMWH and low dose aspirin

Question 24

what antibodies are present in APS?

Answer 24

anti cardiolipin

B2 glycoprotein

lupus anticoagulant

Question 25

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

Answer 25

9 months seizure free before pregnancy

Question 26

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

Answer 26

FMH- foetal maternal haemorrhage bleeding into mums circulation from baby

Question 27

what are the different classifications of hypertension in pregnant women?

Answer 27

pre-existing pregnancy induced pre-eclampsia

Question 28

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

Answer 28

2nd half of pregnancy resolves within 6 weeks of delivery no proteinuria or other features of pre-eclampsia

Question 29

what is present in pre-eclampsia?

Answer 29

hypertension proteinuria oedema

Question 30

what is early and late onset pre-eclampsia?

Answer 30

early \< 34 weeks \> late

Question 31

what can be used to manage pre-eclampsia?

Answer 31

aspirin labetolol hydralazine (add on)

Question 32

who is labetolol contraindicated in?

Answer 32

asthma

Question 33

what is the only 'cure' for pre-eclamspia?

Answer 33

delivery of baby

Question 34

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

Answer 34

two doses of dexamethasone to inc foetal lung development

Question 35

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

Answer 35

tonic clonic seizure

Question 36

what is the management of eclampsia?

Answer 36

control BP Magnesium sulphate to stop/prevent seizures fluid management: run patient dry delivery of baby

Question 37

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

Answer 37

epidural helpful as can drop BP ergometrine is contraindicated

Question 38

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

Answer 38

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

Question 39

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

Answer 39

history of mental health at booking appointment checking in at every following appointment

Question 40

the 'baby blues' affect how many women?

Answer 40

up to 50%

Question 41

what are the baby blues?

Answer 41

brief period of emotional instability tearful irratible anxious w poor sleep

Question 42

how soon do the 'baby blues' often resolve?

Answer 42

within 10 days offer support and reassurance

Question 43

what psychiatric disorder usually occurs within 2 weeks of delivery?

Answer 43

puerperal psychosis

Question 44

what are the ealry symtpoms or peurperal psychosis?

Answer 44

sleep disturbance/confusion irrational ideas delusions hallucinations

Question 45

is peurperal psychosis an emergency?

Answer 45

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

Question 46

how is peurperal psychosis treated?

Answer 46

antidepressant antipsychotics CBT (help in recovery) ECT (v rarely)

Question 47

what are some disorders associated with peurperal psychosis?

Answer 47

bipolar unipolar depression schizophrenia

Question 48

how many women are affected by postnatal depression?

Answer 48

10% 2-6 weeks onset postnatally but lasts months

Question 49

which antipsychotic should be avoided in pregnancy and mothers?

Answer 49

clozapine AGRANULOCYTOSIS

Question 50

what is the lowest risk antidepressant during pregnancy and breastfeeding?

Answer 50

sertraline (SSRI)

Question 51

what mood stabaliser is contrindicated in breast feeding?

Answer 51

lithium

Question 52

what is deficient in wernickes ecephalopathy?

Answer 52

B1 (thiamine deficiency)

Question 53

what is the chronic form of wernickes?

Answer 53

Korsakoffs extreme B1 deficiency

Question 54

what is used to reat respiratory depression second to opiates?

Answer 54

naloxone

Question 55

what is used to reverse magnesium sulphate?

Answer 55

Calcium Gluconate

Question 56

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

Answer 56

pre-existing hypertension (cannot diagnose pregnancy induced until \>20wks)

Question 57

hyperemesis gravidum is due to raised levels of which hormone?

Answer 57

BHCG

Question 58

what is common in hyperemesis gravidum?

Answer 58

5% pre pregnancy wgt loss dehydration electrolyte imbalance

Question 59

what is recommended to treat epilepsy in pregnancy?

Answer 59

lamotrogine | (avoid phenytoin and valproates)