Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

REPRO > Medical Problems in Pregnancy > Flashcards

Medical Problems in Pregnancy Flashcards

1
Q

75% of direct causes of maternal mortality is d.t ________

A

haemorrhage/ Hypertension/ Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Highest cause of maternal death?

A

cardiac disease

- followed by thrombosis/ thromboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What CVS changes occur in mother during pregnancy?

A
  1. Increase in:
    - blood volume (by 30%)
    - stroke volume
    - plasma volume
    - CO
    - HR (by 15-25%)
  2. Decrease in peripheral vascular resistance ! (15-20%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What cardiac conditions is an expecting mother at risk of?

A
  1. pulmonary hypertension
  2. congenital heart diease
  3. acquired heart disease
  4. cardiomyopathy (peri-partum cardiomyopathy)
  5. artifical heart valves
  6. IHD
  7. Arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is to be observed in a mother with a heart condition?

A
  1. arrhythmia
  2. heart failure
  3. left heart obstruction
  4. aortic root >45mm
  5. myocardial dysfxn (EF <40 )
  6. presence of arrhythmias and cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What heart conditions is usually benign, and is common?

A
  1. palpitations
  2. extra-systoles
  3. systolic murmurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

WHat heart conditions are often FATAL in pregnancy?

A

pulmonary HT

- fixed pulmonary vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What precautions to take with a mother who has a heart condition?

A
  1. pre-pregnancy counselling
  2. if contraindicated, women should receive contraception!
  3. implications of anti-coagulants in women with VALVULAR heart disease
  4. MDT support through preg.
  5. need for support for LABOUR and BIRTH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of palpitations?

A
  1. physiological (when lying down)
  2. ectopic beats
  3. sinus tachycardia (to exclude pathology/ could be normal)
  4. SVT
  5. Hyperthyroidism
  6. Phaeochromocytoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What ivx to confirm hyperthyroidism?

A

ECG
TFT
FT4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What invx to do phaeochromocytoma?

A
  • 24h Catecholamines

- US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why may alkalosis develop in the mother?

A

Maternal hyperventilation incr by 40%, whilst total oxygen consumption incr. only by 20-33%

  • – causes PaO2 to INCR. and PCO2 to FALL
  • —consequent fall in serum bicarbonate!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why does functional residual capacity decr. in pregnancy?

A

d.t diaphragmatic elevation!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What drives the incr. oxygen demands of pregnancy?

A

— caused by the incr. METABOLIC rates met by —-driven by HIGH PROGESTERONE levels (INCR. ventilation (up to 40%) )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What lung fxns increase during pregnancy?

A
  1. INcreased:
    - O2 consumption
    - metabolic rate
    - resting minute ventilation
    - tidal volume
    - PaO2
    - Arterial pH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What lung fxns DECLINE during pregnancy?

A

functional residual capacity

PaCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is physiological palpitations during pregnancy worse?

A
  • when lying down!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How common is breathlessness in pregnancy?

When is it often seen?

A
  • up to 75% of women !
  • —more common in 3RD trimester
  • breathlessness when RESTING and TALKING; improved with exertion!
  • – does not Llimit normal activities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the risk of an un-managed asthmatic mother?

A
  • those who are poorly controlled, may adversely affect fetal devleopment!
  • —greater risk than the medication used to PREVENT the asthma
  • —LOW birth weight babies
  • —PROM
  • –premature delivery —- hypertensive delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is asthma known as a the MOST commonest chronic medical disorder to complicate pregnancy?

A
  • often undiagnosed and under-treated

- –pregnancy is an ideal time to diagnose asthma; because 10% will have an ACUTE exacerbation during pregnancy

21
Q

What does the intra-partum care encompass for asthma?

A
  • aim for VAGINAL birth
  • acute asthma during labour is UNLIKELY d.t endogenous steroids
  • –DO NOT DIScontinue INHALERS during labour (inhaled Beta-agnoists; does NOT impair uterine activity)
  • –IV hydrocortisone if oral steroids >2/52
22
Q

How common is VTE in pregnancy?

A
  • 4-6x the risk in preg

- 1-2 in every 1000 deliveries

23
Q

Where and when does the VTE usually develop?

A
  • 85-90% arise in the LEFT leg
  • > 70% of DVTs in pregnancy are ILIO-FEMORAL

—-5x higher risk of VTE in the puerperium

24
Q

What may cause a VTE?

A
  • imbalance of virchow’s triad
  • incr. vWF
  • incr. in factors VII, IX, X, XII
  • incr. in fibrinogen
  • reduced protein S
  • acquired aPC resistance
  • impaired fibrinolytic activity
25
Q

What is often the cause of VTE to result?

A
  1. failure to recognise symptoms
  2. inadequate thromboprophylaxis
  3. delayed ivx/dx
  4. lack of consultant input
  5. delayed and inadequate rx
26
Q

Why is the use of heparin not c.i in preg.?

A
  • neither UFH nor LMWH cross the placenta
  • –heparins are NOT secreted in breast milk

LMWH is safer for use and as effective than UFH

27
Q

Name LMWH drugs,

A

Dalteparin

Tinzaparin

28
Q

How does a DVT appear?

A
  • swelling
  • oedema
  • leg pain
  • tenderness
  • incr. LEG temperature
  • lower abdominal pain
  • elevated white cell count
29
Q

How to screen for DVT>

A
  • compression duplex ultrasound

- if normal, but HIGH clinical suspicion, test should be repeated in 1/52

30
Q

What to do if iliac vein thrombosis is suspected?

A
  • whole leg and back pain

- MRI venography

31
Q

What are the symptoms of PTE?

A
  • dyspnoea
  • chest pain
  • faintness
  • collapse
  • haemoptysis
  • raised JVP
  • focal signs in chest
  • symptoms and signs a.w with dvt
32
Q

What are 2 diagnostic procedures than can be conducted for dx Pulmonary embolism?

A
  1. CTPA- ct pulmonary angiogram

2. V/W perfusion scan (nuclear imaging - examines airflow and bloodflow)

33
Q

Which gives a higher cancer risk for PTE; CTPA or V/Q scan?

A
  1. perfusion scan (1 in 280,000)

2. CTPA (1 in 1, 000,000)

34
Q

What are the advs of CTPA?

A
  • readily available
  • detects other pathology
  • better sensitivity and specificity
  • LOW radiation to fetus
35
Q

What are the advs of V/Q Perfusion scan?

A
  • high negative predictive value in pregnancy

- low radiation dose to maternal breast tissue

36
Q

Risk of warfarin use in pregnant lady?

A
  • its teratogenic!

- —embryopathy (midface hypoplasia/ stippled chondral calcification/ short proximal limbs/ short phalanges/ scoliosis)

37
Q

Is warfarin $ risk dose dependant?

A

YES

  • – >5mg/day
  • —SWITCH TO LMWH by 6 weeks
38
Q

Are warfarin and Hepain c.i for breast-feeding?

A

NO

—-can start warfarin 5th post-natal day !

39
Q

How lonog should anti-coagulant therapy be continued?

A
  • until at least 6 weeks post-natal and at least 3 months post-partum
40
Q

What complications may connective tissue disease bring about?

A
  1. miscarriage
    - PET
    - ABRUPTION
    - FGR
    - stillbirth
    - preterm birth
    - labour/ delivery
    - postnatal
41
Q

What should NOT be given to a pregnant lady with CONNECTIVE TISSUE DISEASE?

A
  1. NSAIDs (>32weeks)
  2. cyclophosphamide
  3. methotrexate
  4. chlorambucil
  5. Gold
  6. penicillamine
  7. MMF - mycophenolate
  8. leflunamide
42
Q

What is APS?

A
  • anti-phospholipid syndrome
  • –> acquired thrombophilia with variable pres. and severityd.t antiphospholipid antibodies; autoantibodies that react with the phospholipid component of the cell membrane
43
Q

What are the fts of APS?

A
  1. arterial/ venous thrombosis
  2. recurrent early pregnancy loss
  3. late preg. loss (preceded by FGR)
  4. placental abruption
  5. severe early onset PRE-ECLAMPSIA (PET)
  6. FGR
44
Q

When to suspect APS?

A
  1. hx of vascular thrombosis
  2. hx of pregnancy morbidity:
    - > 3 Miscarriages (<10 weeks)
    - >1 fetal loss (10-34 weeks) —normal fetus !
    - > 1 preterm birth (<34 weeks)
45
Q

Preterm birth often result in _____ % of APS pregnancies.

Preterm loss of baby usually occurs d.t ________

A

35%

PET or Utero-placental insufficiency

46
Q

Lab findings for APS?

A

IgM/ IgG aCL (medium/ high titre)

- LA

47
Q

What are some causes of false postive for lab findings in APS?

A
  1. acute infections

2. chronic infections ( PERSISTENT +ve) - Hep C/ HIV/ Malaria/ Syphilis

48
Q

How to manage APS?

A

LDA + LMWH (prophylaxis)
3 scenarios where the above is given:

  1. previous thrombosis (STOP warfarin)
  2. recurrent early pregnancy loss
  3. Late fetal loss/ Severe PET/ FGR
49
Q

What is done as prophylaxis if the pt is +ve of anti-phospholipid abs but has no thrombosis of hx of adverse preg. outcome?

A
  • LDA +maternal and fetal surveillance

REPRO (55 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions