Medical Problems in Pregnancy

Question 1

How should ectopic beats be investigated?

Answer 1

ECG (thumping and relieved by exercise)

Question 2

How should sinus tachycardia be investigated?

Answer 2

ECG, FBC, TFTs, Echo (physiological but need to exclude pathology)

Question 3

How should SVT be investigated?

Answer 3

ECG, 24hr ECG, FBC, TFTs (paroxysmal and usually predates pregnancy)

Question 4

How should hyperthyroidism be investigated?

Answer 4

TFTs, ECG

Question 5

How should phaechromocytoma be investigated?

Answer 5

ECG and 24hr catecholamines (presents with increased HR, hypertension, sweating and headache)

Question 6

What is the most common breathing problem in pregnancy?

Answer 6

Asthma (around 10%)

Question 7

What is the course of asthma like in pregnancy?

Answer 7

1/3 will get worse, 1/3 will stay the same, 1/3 will get better

Question 8

What is the risk of asthma treatment to foetal development?

Answer 8

No known risk - it is a lot more deterimental to the foetus to have poorly controlled asthma

Question 9

What is the main reason for poorly controlled asthma in pregnancy?

Answer 9

Cessation of medication due to health concerns - needs appropriate counselling

Question 10

What is the risk of VTE in pregnancy and why?

Answer 10

4-6x the population norm - due to the hypercoagulable state (increased oestrogen, VWF etc) and stasis.

Question 11

How long does it take for VTE risk to return to baseline?

Answer 11

6 weeks post-partum

Question 12

What is the indication for VTE prophylaxis?

Answer 12

Previous VTE/PE, medical comorbidities, high risk thrombophillia

Question 13

What is the VTE prophylaxis given in pregnancy?

Answer 13

LMWH

Question 14

Does LMWH cross the placenta/breast milk?

Answer 14

No - warfarin does cross the placenta but it is safe in breastmilk

Question 15

How do you diagnose a PE in pregnancy if there are clinical indicators?

Answer 15

ECG and CXR then CTPA/V/Q scan
if CXR is normal then a CTPA is preferred over a VQ scan
never do a D-Dimer as these are already elevated in pregnancy

Question 16

How is VTE diagnosed in pregnancy?

Answer 16

Compression duplex USS

Question 17

How long should LMWH be continued for?

Answer 17

6 weeks postnatal or 3 months postpartum

Question 18

Which drugs can be used in treatment of connective tissue disease during pregnancy?

Answer 18

Steroids, azathioprine, sulphasalazine, hydroxychloroquine, rituximab

Question 19

Which drugs should be avoided in the treatment of CTD during pregnancy?

Answer 19

NSAIDs, methotrexate, cyclophosphamide, gold

Question 20

What is APS?

Answer 20

this is anti-phopholipid syndrome and is an acquired thrombophilia

Question 21

What are the lab markers of APS?

Answer 21

anti-phospholipid, anti-cadiolipin, lupus anticoagulant

Question 22

What are the clinical indicators of APS?

Answer 22

> 3 miscarriages <10weeks
1 late miscarriage >10 weeks
1 preterm with evidence of early severe PET or FGR

Question 23

How is APS treated?

Answer 23

If diagnosis but no history of thrombosis then LDA and monitoring
If previous thrombosis then LDA and therapeutic LMWH
If history of recurrent miscarriage, late miscarriage, severe PET or FGR then LDA and prophylactic LMWH

Question 24

How does epilepsy behave in pregnancy?

Answer 24

> 50% will have an improvement in epilepsy

if seizure free for 9 months prior to pregnancy then 92% will be free during pregnancy

Question 25

How likely is it that a seizure will occur during labour?

Answer 25

unlikely due to the presence of endogenous steroids being released

Question 26

…, …, and … seizures are unlikely to affect the foetus

Answer 26

focal, abscence and myoclonic

Question 27

Which seziures do pose a threat to the foetus?

Answer 27

GTC but also loss of consciousness does expose risk of trauma

Question 28

What risks does GTC pose to foetus?

Answer 28

Trauma, PROM, foetal hypoxia and acidosis

Question 29

How should epilepsy be treated in pregnancy?

Answer 29

Avoidance of sodium valproate (risk of NT defects and orofacial clefts) but lamotrigine, levetiracetam and carbamazepine are all fine
monotherapy is better than polytherapy