Brainscape's Knowledge GenomeTM

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


See full index

Complex care 2 > Module 5 > Flashcards

Module 5 Flashcards

1
Q

What is type 1 diabetes

A

Insulin dependent diabetes occurs when beta cells in the islets of Langerhans in the pancreas are destroyed, stopping insulin production.

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

Incidence of thyroid dysfunction

A

Affects 2-3% of pregnant women

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

What is hyperthyroidism (thyrotoxicosis)

A

State of having excess production of free thyroxine and low thyroid stimulating hormone

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

Incidence of hyperthyroidism in pregnancy

A

0.2% of pregnancies

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

What is graves disease

A

An autoimmune condition that causes an overproduction of thyroid hormones. Accounts for more than 95% of hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complications of hyperthyroidism (graves disease)

A
  • Graves ophthalmopathy
  • dermopathy
  • thyrotoxic storm
  • Miscarriage
  • SGA
  • Prematurity
  • FDIU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of hyperthyroidism (Graves disease) in pregnancy

A
  • Treatment is limited to medication, carbimazole or propylthiouracil (PTU)
  • Surgery and radioactive iodine is not recommended in pregnancy, risk of miscarriage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

S/S of hyperthyroidism (graves disease)

A
  • Heat intolerance
  • Weight loss
  • Insomnia
  • Agitation
    _ Tremor
    _Retraction of the upper eyelid
  • Sweating
  • Tachycardia/bounding pulse
  • Diarrhoea
  • Amenorrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hyperthyroidism (graves disease) management

A
  • Referral to obstetrics
  • Regular T4 and TSH testing
  • Serial USS
  • CEFM in labour and alert paed
  • Postnatally check baby’s bloods, baby may require temporary treatment, check maternal serum levels 6 wks pp.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Hypothyroidism

A

A condition where the thyroid gland doesn’t produce enough thyroid hormone.

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

What is Hashimoto disease (Autoimmune thyroiditis)

A

When the immune system attacks the thyroid gland causing preventing the thyroid producing enough hormones. Most common cause of hypothyroidism.

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

S/S of hypothyroidism (Hashimoto’s disease)

A
  • Weight gain
  • Constipation
  • Cold intolerance
  • Alopecia
  • Dry skin
  • Hoarseness
  • Lethargy
  • Ataxia
  • Cognitive impairment
  • Anaemia
  • Bradycardia
  • Sometimes asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations for hyper and hypothyroidism

A

Measurement of the circulating thyroid hormones using thyroid function tests.
- Hyperthyroidism TSH will be lowered and free thyroxine T4 will be elevated
- Hypothyroidism TSH will be lowered and free thyroxine t4 will be reduced

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

Treatment for hypothyroidism (Hashimoto’s)

A

Thyroxine 50-150 mcg daily (safe in BF)

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

Complications of hypothyroidism (Hashimotos)

A
  • Myoedema coma
  • Reduced fertility
  • Pregnancy induced hypertension
  • PND
  • Failure to lactate
  • Increased sensitivity to opioids
  • Low birth weight
  • Psychomotor retardation
  • Anovulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Preconception care Hypothyrodism (Hashimotos)

A
  • Consider fertility care
  • Discuss risk
  • check thyroxine levels
  • Manage medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of Hypothyrodism (Hashimotos)

A
  • Check T4 and TSH at booking, 4-6 weekly throughout the pregnancy
  • adjust the dose of thyroxine to maintain TSH in the lower half of the reference range,
  • serial growth scans if hx IUGR
  • Postnatally reduce dose of thyroxine
  • check T4 and TSH 6 weeks after delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the elements of blood

A
  • red blood cells (Erythropoiesis is the process by which erythrocytes (red blood cells) are formed
  • white blood cells
  • platelets (Platelets are important in preventing blood loss by promoting the formation of clots)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of anaemia

A
  • Inadequate production through diet, bone marrow production
  • Rapid destruction through hypersplenism, liver disease, malaria, lupus and sickle cell disease
  • Blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is beta thalassaemia

A

Hereditary blood disorder categorised as major or minor.
Caused by absent or reduced synthesis in beta chains of haemaglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Symptoms of beta thalassamia

A
  • pallor
  • lethargy
  • poor appetite
  • development delay
  • failure to thrive
  • irritability
  • anaemia
22
Q

What is thrombocytopenia, normal range and diagnostic criteria

A
  • Low platelet level
  • Normal range 150,000 to 450,000 per microlitre
  • Diagnostic <50,000 per microlitre
23
Q

S/S Thrombocytopenia

A
  • Petechiae
  • Bleeding gums
  • Nose bleeds
  • Malaise
24
Q

Thrombocytopenia causes

A
  • Decreased platelet production: Leukaemia, anaemia, viral infections, HIV
  • Increased destruction: Autoimmune disease, lupus, rheumatoid arthritis, Blood borne infection
  • Medication induced
25
Q

What are coagulapathies

A

Impaired clotting ability which be be Inherited or Acquired through chronic disease, infection, heparin use, Vit K deficiency

26
Q

Management of coagulopathies

A
  • Require complete family history/ Detailed medical history
  • Pre-pregnancy counselling/Early pregnancy counselling
  • Referral to haematology specialists
  • Treatment as indicated
27
Q

What is thrombophilia

A

The presence of hypercoagulability that increases the risk of thrombosis.

28
Q

WHAT IS SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A

Systemic lupus erythematosus (SLE) is when the body produces autoantibodies against its own connective tissue. Has some of the most serious consequences for pregnancy.
The body is in a thrombophilic state.
Goes through periods of remission and flares often triggered by infection, exposure to sunlight or oestrogen increase.

29
Q

MANAGEMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A
  • No cure
  • Treatment aims to manage symptoms and prevent progression, survival rate to 15 years
30
Q

COMPLICATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A
  • acute and chronic infection
  • nausea
  • vomiting
  • diarrhea
  • alopecia
  • photosensitivity
  • arthritis
  • ulcers
  • fatigues
  • myalgia
  • renal disease (>50%, 60% hypertension)
  • heart disease
  • hypertension
  • pericarditis
  • anaemia
  • thrombocytopenia
  • increases risk of miscarriage 40-80% (pregnancy loss in 20-30% of cases)
  • FDIU 8%
31
Q

Incidence of systemic lupus erythematosus (SLE) in pregnancy

A

1:1000

32
Q

EFFECT OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) ON PREGNANCY

A

1/3 improve
1/3 stabilise
1/3 deteriorate

33
Q

DIAGNOSIS AND TESTING OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A

Women must fulfil at least one clinical and one laboratory feature at some time during the course of their disease
Clinical features:
- Recurrent pregnancy loss (MORE THAN 3 CONSIDER OBSTETRIC LUPUS ANTIBODY SCREEN)
- fetal death
- venous or arterial thrombosis
- autoimmune thrombocytopenia
- coombs positive
- haemolytic anaemia
Laboratory features:
- ANA, ACA, LAC, Anti-Ro, Anti-La
- Antiphospholipid antibodies are seen in 50% cases

34
Q

PRECONCEPTION CARE FOR SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A

Preconception care:
- discuss complications
- refer to obstetrician and rheumatologist
- discuss conception during a period of remission
- does not appear to affect fertility

35
Q

MANAGEMENT AND TREATMENT SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

A
  • individual to the woman based on condition
  • antibody screening preconception
  • renal function testing
  • serial USS
  • low dose aspirin
  • patient education, preparation for hospitalisation, prem delivery, outcomes,
  • emotional support
  • obstetric involvement
  • assess proteinuria
  • treat flares with steroids
  • review medication
  • consider timing of delivery
  • steroids if preterm
  • CEFM, often can delivery vaginally
  • increased risk of flare postpartum
  • return to prepregnancy drug regime
  • lactation may be suppressed
36
Q

COMPLICATIONS OF ANTIPHOSPHOLIPID SYNDROME AKA HUGHES SYNDROME

A
  • placental insufficiency
  • recurrent miscarriage
  • fetal loss
  • preeclampsia/ HELLP
  • preterm delivery
  • placental abruption
37
Q

ANTIPHOSPHOLIPID SYNDROME AKA HUGHES SYNDROME

A

A disorder in which the immune system mistakenly attacks normal proteins in the blood.
The condition is an acquired thrombophilia (clotting disorder), making women prone to thrombotic disorders.

38
Q

DAIGNOSIS OF ANTIPHOSPHOLIPID SYNDROME AKA HUGHES SYNDROME

A

Diagnosis on one clinical and one laboratory criteria
Clinical criteria:
- vascular thrombosis
- one or more unexplained death of a normal fetus after 10 wks
- one or more preterm birth before 34 weeks due to preeclampsia or placental insufficiency
- three or more unexplained miscarriages before 10 wks.
Laboratory criteria:
- LA, aCL, IgG, IgM, Anti-B2 present on at least two occasions at least 12 weeks apart

39
Q

PRECONCEPTION CONSIDERATIONS FOR ANTIPHOSPHOLIPID SYNDROME AKA HUGHES SYNDROME

A
  • women with a history of SLE, thrombosis, recurrent miscarriage, severe IUGR, early onset pre-eclampsia, FDIU or prem delivery associated with IUGR should be offered screening for antiphospholipid antibodies,
  • discuss risks and pregnancy care
  • confirm antibody levels
  • advise aspirin, commence heparin, discontinue warfarin
39
Q

MANAGEMENT OF ANTIPHOSPHOLIPID SYNDROME AKA HUGHES SYNDROME

A
  • obstetrician involvement
  • regular growth USS, dating scan,
  • aspirin
  • monitor of signs of pre-eclampsia
  • blood tests
  • heparin.
  • CEFM
  • review by anaesthetist early
  • in labour adequate hydration, TED stockings, encourage mobility, active management, prompt suturing
  • Postpartum, increased risk of thrombosis,
  • admission to NICU if associated complications occur.
40
Q

What is multiple sclerosis

A

Inflammatory disease of the CNS that mostly affects women and those in the childbearing age group
Characterised by plaques of tissue in the brain and spinal cord and a variety of classification types

41
Q

S/S of multiple sclerosis

A
  • diplopia
  • vertigo
  • bladder incontinence
  • loss of vision
  • fatigue
  • muscular weakness
42
Q

Complications of multiple sclerosis

A
  • optic neuritis
  • transverse myelitis
  • increase chance of relapses postnatally when physical and emotional stressors are greater
43
Q

Effect of pregnancy on multiple sclerosis

A

pregnancy has a protective benefit against relapses

44
Q

Treatment for multiple sclerosis

A
  • Treatment aimed at symptoms and improving everyday life rather than the disease itself,
  • acute episodes treated with high dose corticosteroids
45
Q

Preconception care of multiple sclerosis

A
  • fertility is not affected
  • plan pregnancy during remission
  • review medications and discontinue where appropriate 3 months prior to conception
  • continuity of care
  • obstetric involvement
46
Q

Management of multiple sclerosis

A
  • Immunomodulatory agents are not recommended in pregnancy and lactation
  • Spinal epidural and GA can be used in MS
  • Exclusive breastfeeding and concomitant suppression of menses significantly reduces the risk of postpartum relapses in MS
  • Pregnancy does not affect the long term course or progression of the disease
  • Postnatal support should be available
47
Q

WHAT IS INTRAHEPATIC CHOLESTASIS

A
  • Characterised by increased serum bile acid and gestational pruritus
48
Q

COMPLICATIONS OF INTRAHEPATIC CHOLESTASIS

A
  • stillbirth
  • preterm delivery
  • MSL
  • fetal distress
  • asphyxia
  • increased risk where serum levels are above 100umol
49
Q

MANAGEMENT AND TREATMENT OF INTRAHEPATIC CHOLESTASIS

A
  • symptomatic relief with topical ointments and lukewarm bath,
  • timing of delivery 36-40 wks
  • close fetal monitoring
  • CEFM in labour
  • Treatment using ursodeoxycholic acid - a naturally occurring bile acid derivative with an anti cholestatic effect in the human body.

Complex care 2 (9 decks)

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