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Repro > Medical Problems In Pregnancy (CVD, Asthma, VTE, Obstetric Cholestasis, Connective Tissue, Epilepsy, Obesity) > Flashcards

Medical Problems In Pregnancy (CVD, Asthma, VTE, Obstetric Cholestasis, Connective Tissue, Epilepsy, Obesity) Flashcards

1
Q

Most common causes of maternal death in pregnancy? (Top 3)

A

Cardiac disease,
Thrombosis/thromboembolism,
Neurological

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2
Q

List 7 types of heart disease that may present/need monitoring during pregnancy

A 
Pulmonary hypertension, 
Congenital heart disease,
 Acquired heart disease,
Cardiomyopathy, (incl. peri-partum cardiomyopathy) 
Artificial heart valves, 
Ischaemic heart disease, 
Arrhythmias
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3
Q

Prevalence of heart disease in pregnancy is rising. Pregnancy with a heart disease is associated with x _ risk oof MI?

A

x3-4 times risk

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4
Q

Most women with heart disease in pregnancy have no previous history so should all receive ECG if present with chest pain. T/F?

A

True

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5
Q

Orthopnoea is associated with what heart disease in pregnancy?

A

Peri-partum cardiomyopathy

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6
Q

If pregnant woman presents with palpitations, what are 6 possible causes and which are normal in pregnancy?

A 
Physiological - normal
Ectopic beat, normal 
Sinus tachycardia - normal, 
SVT, 
Hyperthyroidism, 
Phaeochromocytoma
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7
Q

How do palpitations caused by physiological palps present?

A

Palpitations occur at rest/lying down

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8
Q

How do palpitations caused by ectopic beats tend to occur?

A

Thumping,

Relieved by exercise

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9
Q

How does palpitations caused by phaeochromocytoma present?

A

With headache, sweating and hypertension

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10
Q

What investigation should be carried out in pregnant women with palpitations caused by ectopic beats?

A

ECG

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11
Q

What investigations should be carried out in pregnant women with palpitations caused by sinus tachycardia? (4)

A

ECG,
FBC,
TFT,
Echo

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12
Q

What investigations should be carried out in pregnant women with palpitations caused by SVT? (4)

A

ECG,
24hr ECG, (cos paroxysmal)
TFT,
Echo

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13
Q

What investigations should be carried out in pregnant women with palpitations caused by hyperthyroidism? (2)

A

ECG,

TFT incl FT4

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14
Q

What investigations should be carried out in pregnant women with palpitations caused by phaeochromocytoma? (2)

A

24hr catecholamines,

US

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15
Q

Lung function during pregnancy - which increase and which decrease? O2 consumption, metabolic rate, tidal volume, functional residual capacity, PaO2, PaCO2, arterial pH

A 
O2 consumption - up,
metabolic rate - up, 
tidal volume - up,
functional residual capacity - down, 
PaO2 - up,
PaCO2 - down,
arterial pH - up
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16
Q

Breathlessness in pregnancy is very common/very rare and tends to improve/worsen with exertion?

A

Very common - up to 75% of women, improves with exertion

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17
Q

What is most common chronic medical disorder to complicate pregnancy?

A

Asthma

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18
Q

Asthma affects pregnant women in 1/3s. Explain this?

A

1/3 worsen,
1/3 stay the same,
1/3 improve

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19
Q

5 step management for asthma is same for pregnant women and non-pregnant. What are the 5 steps?

A

1: inhaled SABA,
2: inhaled steroid & SABA,
3: add LABA, if good continue, if ok but not good enough continue LABA and increase steroid, if no response stop LABA and increase steroid,
4: trial inhaled high dose steroid/add 4th drug e.g. leukotriene receptor antagonist, SR theophylline or oral B2 agonist,
5: oral steroids on top of inhaled

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20
Q

Why is acute asthma unlikely during labour?

A

Due to endogenous steroids

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21
Q

Asthma management stays the same during pregnancy as effects of medication less on pregnancy than asthma attack has. T/F?

A

True

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22
Q

In pregnancy there are two main severe clinical pathologies in terms of thrombosis. What are they?

A

Dural vein sinus thrombosis - brain failure,

Pulmonary artery thromboembolism - heart & lung failure

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23
Q

Presentation for dural venous sinus thrombosis and diagnosis?

A

Headache,
Neurological symptoms e.g. dizziness/stroke symptoms, seizure,
Diagnosis on magentic resonance venogram

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24
Q

Why women in pregnancy more prone to VTE?

A

Virchow’s triad - hyper-coagulability, venous stasis, vascular damage

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25
Q

Signs and symptoms of DVT (8)

A 
Oedema & swelling, 
Leg pain/discomfort, 
Groin pain, 
Lower abdo pain, 
Tenderness, 
Increased leg temp,
Elevated white cell count, 
Fever
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26
Q

List 3 types of thrombophilia that makes pregnant patients risk higher for VTE?

A

Antithrombin deficiency,
APS,
Protein c deficiency

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27
Q

How many times more likely is VTE to occur in pregnancy than in non-pregnancy?

A

X4-6 times more likely in pregnancy

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28
Q

85-90% of DVTs occuring during pregnancy arise in the right leg. True/false?

A

False!! LEFT LEG

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29
Q

> 70% of DVTs in pregnancy are ileo-femoral so beware of groin pain. T/F?

30
Q

What period of pregnancy is highest risk of VTE?

A

Puerperium

31
Q

Investigation for VTE in pregnant women?

A

Compression duplex USS of whole leg,
Re-scan in 1 week and treat during that week if clinically suspicious,
May need MRI venogram

32
Q

Prophylaxis for VTE for high/intermediate risk patients?

33
Q

For women with low risk factors (e.g. obesity BMI >30kg, age >35, parity >3, smoker, current pre-eclamspia, multiple pregnancy), women with 4 or more should receive LMWH from when and women with 3 risk factors should receive LMWH from when?

A

4 or more - from first trimester,

3 - from 28 weeks

34
Q

LMWH cross placenta. T/F?

A

False! Does not cross placenta

35
Q

Symptoms and signs of PTE? (8)

A 
Dyspnoea, 
Chest pain, 
Faintness, 
Collapse, 
Haemoptysis, 
Raised JVP, 
Focal signs in chest, 
Symptoms associated with DVT
36
Q

Investigations for PE? (4)

A

CXR,
ECG,
V/Q first in pregnancy as low dose radiation,
CTPA less used as slightly increased risk to breast tissue

37
Q

Warfarin crosses placenta is teratogenic. T/F?

A

True - try to change by 6 weeks if mother already on

38
Q

Treatment for PE should not be delayed for women at high risk of PE, even for investigations. What treatment should be considered? (2)

A

Thrombolysis or,

Surgical embolectomy

39
Q

Post-natal anticoagulation types and for how long?

A

LMWH or warfarin, warfarin commenced on 5th post-natal day. Anticoagulation should be continued until at least 6 weeks post-natal

40
Q

Think of VTE if patient presents with which symptoms? (3)

A

Groin pain!
Fever!
Headache!

41
Q

Obstetric cholestasis presentation? (Commonly and very rare presentations)

A

Commonly: Severe pruritus (w/o rash) particularly palms and soles in second half of pregnancy,
Rarely: dark urine, anorexia and steatorrhoea

42
Q

What are biochemistry findings in obstetric cholestasis?

A

LFTs deranged,

Raised ALT, bilirubin and bile acids

43
Q

Obstetric cholestasis is a diagnosis of exclusion. What investigations are done to rule out other causes? (3)

A

Liver USS,
Viral serology to rule out hepatitis, CMV, EBV,
Liver auto antibodies

44
Q

Risk recurrence of obstetric cholestasis is 50%. However it usually disappears how long after pregnancy?

45
Q

Obstetric cholestasis causes increased risk of what? (4)

A

Fetal distress,
Amniotic fluid meconium aspiration,
IUD,
Need for preterm delivery

46
Q

What treatments for obstetric cholestasis?

A

Ursodeoxycholic acid,
Piriton,
Aqueous cream with menthol

47
Q

What are two managements for babies with mothers with obstetric cholestasis?

A

CTG in labour,

IM Vit K after birth

48
Q

What are 3 drugs commonly used for CTD that are contraindicated in pregnancy?

A

NSAIDs contraindicated >32 weeks,
Cyclophosphamide,
Methotrexate

49
Q

What is APS?

A

Syndrome caused by acquired thombophilia where antiphospholipid antibodies react with phospholipid component of cell membrane

50
Q

Clinical features of APS? (6)

A 
Arterial/venous thrombosis, 
Recurrent early pregnancy loss, 
Late pregnancy loss usually preceded by FGR, 
Placental abruption, 
Severe early onset-preeclamspia, 
Severe early onset FGR
51
Q

What are clinical parameters for diagnosing APS?

A

Vascular thrombosis,
Pregnancy morbidity e.g. >3 miscarriages <10 weeks, >1 fetal loss >10 weeks with normal feotus, >1 preterm birth due to PET or utero-placental insufficiency

52
Q

What lab tests are used to diagnose APS? (2)

A

IgM/IgG anticardiolipin antibody,
Lupus anticoagulant
Tested twice >6 weeks apart

53
Q

APS management if no thrombosis/adverse pregnancy outcome?

APS management if previous thrombosis/adverse fetal outcome?

A

If no previous: LDA + close surveillance,

If previous: LDA + LMWH

54
Q

For most women with epilepsy, seizure frequency can be both improved or unchanged. >50% of pregnant women with epilepsy will have no seizures during pregnancy. T/F?

55
Q

Good seizure control in epileptic patients in first trimester is associated with what?

A

Associated with less seizures in late pregnancy

56
Q

Risks to fetus from maternal seizure? (4)

A

Maternal abdo trauma,
PPROM,
Preterm birth,
Hypoxia/acidosis

57
Q

Risks to fetus from mother with epilepsy? (5)

A 
Major/minor congenital malformations, 
Adverse perinatal outcomes, 
Long-term developmental effects, 
Haemorrhagic disease of the newborn, 
Risk of childhood epilepsy
58
Q

anti-epileptic drugs increase risk of teratogenecity by how much?

A

X2-3 times - so scan offered at 18-20wks

E.g. cleft lip, spina bifida, heart defect

59
Q

Sodium valproate is ok to give pregnant women. T/F?

A

False!! Only give it absolutely have to

60
Q

Drug management for women with epilepsy during pregnancy? (4)

A

5mg folic acid,
Lowest effective dose of AEDs,
Avoid sodium valproate,
Avoid polytherapy

61
Q

What aspects of labour may increase risk of intra-partum seizures? (5)

A 
Stress, 
Pain, 
Sleep deprivation, 
Over-breathing, 
Dehydration
62
Q

Treatment for intra-partum seizures? (4)

A

Left lateral tilt,
IV lorazepam/diazepam OR PR diazempam/buccal midazolam,
IV phenytoin,
May need to expedite delivery

63
Q

Obesity increases risk of what pre-pregnancy? (2)

A

Menstrual disorders,

Subfertility

64
Q

Obesity increases risk of what in early pregnancy? (1)

A

Miscarriage

65
Q

Obesity increases risk of what in antenatal period? (4)

A

Fetal anomalies,
PET,
GDM,
VTE

66
Q

Obesity causes and increased risk of what during labour? (3)

A

IOL,
Dysfunctional labour,
Operative delivery

67
Q

Obesity increases risk of what during post-natal period? (4)

A

Haemorrhage,
Infection,
VTE,
Breastfeeding difficulty

68
Q

Obesity causes increased risk of what to fetus? (4)

A

Macrosomia,
Birth injury,
Perinatal mortality,
Congenital anomaly

69
Q

Obesity causes increased risk of what during post menopausal period? (3)

A

Endometrial hyperplasia/cancer,
Prolapse,
Urinary incontinence

70
Q

Obesity in pregnancy management considerations? (6)

A 
Anaesthetic review, 
PET prophylaxis - aspirin, 
Thrombophylaxis, 
Detailed US, 
OGTT, 
MDT plan for labour & birth

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