O&G 3 Flashcards
How many pregnancies are affected by hypertensive disorders?
8-10%
what proportion of pregnancies affected by pre-eclampsia?
1.5-7.7%
4.1% in first pregnancy
1.7% in second pregnancy
what % stillbirths is associated with pre-eclampsia?
5%
Red flags in pre-eclampsia
- visual changes (e.g. flashing lights)
- headaches (due to cerebral edema)
- brisk reflexes, clonus (?cause)
- edema
- RUQ pain (due to perihepatic edema)
- decreased urine output
- uterine size small for dates
Is pre-eclampsia familial?
yes
FH is a risk factor
a sister affected is the strongest association
the more severe and the earlier it occurs in pregnancy the more likely it i to be familial
What should you do if a pregnant woman’s urine dip is positive for protein?
send to lab to quantify
send a PCR (protein:Creatinine ratio)
What PCR finding is significant?
> 30 mg/mmol
what level of protein in 24h urine is considered to be significant?
0.3g
(this is equivalent to 300 mg of protein per 24h)
what specimen is used for PCR?
urine
What happens to the GFR in pregnancy?
increases
What happens to ALP in pregnancy and why?
it is raised due to placental production
How does nifedipine lower BP?
it is a calcium channel blocker
causes vasodilation
How does methyldopa decrease BP and what is an associated risk + how is it overcome??
it is an alpha agonist which prevents vasoconstriction
risk of postnatal depression
should be stopped within 2 days of delivery and changed to another agent
how does hydralazine lower BP and what is an associated risk + how is it overcome?
IV drug which causes vasodilatation
can cause rapid hypotension
therefore is often given after a bolus of colloid.
What proportion of pregnancies are affected by eclampsia?
2.7 in 10,000
HELLP
haemolysis
elevated liver enzymes (raised ALT)
low platelets
what are the complications of HELLP?
- capsular liver haematoma
- liver rupture
- DIC
- ………
Incidence of HELLP syndrome
2 in 100,000 pregnancies
Complications of pre-eclampsia
maternal:
- seizures
- acute renal failure
- liver dysfunction
- coagulation abnormalities
- death (causes: include intracranial haemorrhage, cerebral infarction, cerebral oedema, acute respiratory distress syndrome and pulmonary oedema, hepatic rupture, and hepatic failure/necrosis)
fetal: placental abruption, IUGR, preterm delivery, stillbirth, and neonatal death
Which viruses can cause maternal complications in pregnancy?
- influenza
- VZV
- Hep E
Which viruses increase the risk of miscarriage?
rubella
measeles
hep E
Which viruses are teratogenic?
VZV
Zika
Which viruses cause IUGR/prematurity?
rubella
CMV
Which viruses cause congenital disease?
CMV
HSV
Which viruses in pregnancy cause persistent infection?
HIV
Hep B/C
Can you use opioids when breastfeeding?
Codeine - no
can consider weaker opioids like tramadol or dihydrocodeine
Can you take aspirin when breastfeeding?
no
How high is the risk of cord prolapse in footling breach presntation?
5-20%
Can you spread Hep B and HIV via breastfeeding?
HIV - yes
Hep B - no
Questions to ask a pregnant woman with asthma?
- current treatment
- symptoms and sx control
- peak flow record
- any previous hospital admissions? Any requiring ICU?
measure peak flow at appointment
What advice to give pregnant women with asthma?
- avoid triggers
- cease smoking
- don’t stop asthma meds during pregnancy
When is the foetus dependent on mum’s thyroid hormones?
up to 12w
Risks associated with hypothyroidism in pregnancy?
miscarriage
reduced intelligence
neurodevelopment delay
brain damage
Thyroid disease - do you need to monitor TFTs in pregnancy?
Yes, every TM
use pregnancy-adjusted values (they differ in the different trimesters).
What is the commonest cause of hyperthyroidism in pregnancy?
Graves’ disease
What are causes of hyperthyroidism in pregnancy?
Graves disease (95%)
drugs
multinodular goitre
thyroiditis
Drugs for hyperthyroidism in pregnanct
propylthiouracil should be continued
Carbimazole can be used from 2nd TM onwards.
beta blockers may be required.
Surgery is rarely necessary.
Complication (1) of hyperthyroidism in pregnancy to the neonate and how it occurs?
neonatal thyrotoxicosis occurs in 1%
due to transplacental passage of thyroid antibodies.
What causes neonatal thyrotoxicosis?
Transplacental passage of thyroid antibodies.
Sx of neonatal thyrotoxicosis
tahcycardia
arrhythmia
heart failure
systemic and pulmonary HTN
weight loss
diarrhoea
sweating
+/- goitre
mortality 12-20%
What twins can be affected by twin-to-twin transfusion syndrome?
monochorionic
How do conjoined twins form?
later splitting of the inner cell mass (after the formation of the primitive streak?)
if happened before 13d, they would be monozygotic twins
outcomes for monozygotic twins dependent on time of splitting
<3 days will be diamniotic dichorionic
3-8 d will be monochorionic diamniotic
9-12 d will be monochorionic monoamniotic
What mutation is seen in virtually all high grade serous adenocarcinomas of the ovary?
p53
Commonest malignant ovarian cancer
high grade serous adenocarcinoma
BRCA1 and BRCA2 roles
These genes encode proteins that play important roles in DNA repair (homologous recombination).
Mutatation advantage in high grade serous adenocarcinoma (ovary) in terms of BRCA
Current data suggests that BRCA2 mutations confer an overall survival advantage compared with either being BRCA-negative or having a BRCA1 mutation in high-grade serous ovarian cancer.
When is Ca-125 elevated?
CA-125 is used as a tumor marker for epithelial ovarian cancer but can also be elevated in endometriosis, cirrhosis, and malignancies (e.g., uterine leiomyoma).
What is the situation above and below the arcuate line?
Above: the anterior layer of the rectus sheath comprises the fused aponeuroses of the external and internal oblique muscles, whereas the posterior later comprises the fused aponeuroses of the internal oblique and transverses abdominis muscles.
Below: the aponeuroses of all 3 muscles fuse to form the anterior later of the sheath. The rectus muscle rests only on the thin transversalis fascia.
What are the risks associated with BV in pregnancy?
chorioamnionitis
preterm labour
Mx of BV
metronidazole 400 mg BD for 5th-7 days
alt:
intravaginal metronidazole / clindamycin gel
advice: avoid vaginal douching and excessive genital washing should be avoided.
Monitoring in obstetric cholestasis
LFTs and bile acid levels every 1/52 until delivery
measure LFTs 6w PP to ensure resolution
LFTs should be normal 10 d PP
FU @ 8w
success rate of VBAC
72-75%
Increased number of successful VBAC -> greater success with further VBAC
2nd VBAC ~80%
3rd VBAC ~90%
How high is the risk of uterine rupture in VBAC?
1 in 200
increased to 1 in 100 when syntocinon is used.
Down’s syndrome: quadruple test result
↓ AFP
↓ oestriol
↑ hCG
↑ inhibin A
classical triad seen in vasa praevia
rupture of membranes
followed by painless PV bleeding
fetal bradycardia
What are the complications of PPROM?
Maternal: chorioamnionitis
Foetal: prematurity, infection, pulmonary hypoplasia
What does PPROM stand for?
premature prelabour ROM
