Obs - Diseases of Pregnancy

Question 1

what is defined as hypertension during pregnancy?

Answer 1

≥140/90 twice
≥160/110 once
change of >30/15 to first trimester

Question 2

risk factors for hypertension during pregnancy?

Answer 2

FHx
BMI
first born 
multiple preg 
birth interval >10yrs
age >40yrs
CM
CTD
Renal disease

Question 3

features of pre eclampsia?

Answer 3

HT
proteinuria
oedema
headache
vision changes
papilloedema
hyperreflexia
disorientated
oliguria
epigastric/RUQ pain

Question 4

complications to the fetus if there is pre eclampsia?

Answer 4

fetal growth restriction
death
placental abruption

Question 5

difference between hypertension and pre eclampsia?

Answer 5

pre eclampsia is HT + proteinuria

Question 6

what CVS changes happen during pregnancy?

Answer 6

CO increases, drops in last 8 weeks due to IVC compression
HR and SV increases
BP drops in 2nd sem then rises until term
PV increases

Question 7

how does pre eclampsia occur?

Answer 7

failure of vascular remodelling due to abnormal trophoblast invasion

Question 8

Ix for pre eclampsia?

Answer 8

BP
U+Es, GRF, creatinine
FBC
LFTs
urinalysis 
CTG
US

Question 9

who is classified as high risk at booking?

Answer 9

Hx 
CKD 
autoimmune disease
DM
chronic HT

Question 10

who is classified as moderate risk at booking?

Answer 10

more than one of the following

first pregnancy 
≥40yrs
pregnancy interval of 10yrs
BMI >35
FHx
multiple pregnancy

Question 11

how to manage pre eclampsia during pregnancy?

Answer 11

labetalol
nifedipine
methyldopa

Question 12

what is the BP aim for those with pre eclampsia?

Answer 12

<150/80

140/90 if proteinuria

Question 13

what do those with high risk of pre eclampsia get given?

Answer 13

75mg aspirin from 12wks

Question 14

what do those with moderate risk of pre eclampsia get given?

Answer 14

75mg aspirin from 12wks

Question 15

what should be involved in the delivery plan for mums with pre eclampsia?

Answer 15

IM steroids if <36wks
IV magnesium sulphate
IV labetalol + hydralazine

Question 16

what 3rd stage management drug should be avoided in those with pre eclampsia? why?

Answer 16

ergometrine

can cause BP spike (risk of stroke)

Question 17

complications of pre eclampsia?

Answer 17

stroke
VTE
PO
DIC

Question 18

what is eclampsia?

Answer 18

tonic clonic seizures with pre eclampsia

Question 19

Tx for eclampsia?

Answer 19

BP control
roll on left side
IV magnesium sulphate
fluids
delivery baby

Question 20

who is at risk of hyperemesis gravidum?

Answer 20

first pregnancy
young
molar pregnancy

Question 21

what can happen as a consequence of hyperemesis gravidum?

Answer 21

ketosis
electrolytes altered
LFTs
B1 deficiency

Question 22

Ix for hyperemesis gravidum?

Answer 22

FBC
U+Es
LFTs
urinalysis
clinically dehydrated

Question 23

Tx for hyperemesis gravidum?

Answer 23

fluids
cyclizine/ondansetron/metoclopramide
steroids
thiamine (pabrinex)
PPI for reflux

Question 24

what can occur as a result of B1 deficiency?

Answer 24

wernicke’s encephalopathy

Question 25

risk factors for gestational diabetes?

Answer 25

``` FHx PCOS BMI old age Hx macrosomic baby ```

Question 26

features of gestational diabetes?

Answer 26

polyuria | polydipsia

Question 27

what changes with regards to blood sugar during pregnancy?

Answer 27

wks 1-20 mum is insulin resistant so glycogen is stored | after the reserves are used

Question 28

what Ix is done for gestational diabetes? aim?

Answer 28

OGTT 5 6 7 8 at start < 5.6 2 hours after < 7.8 (same as post prandial goal)

Question 29

what extra scan do those with DM get?

Answer 29

fetal anomoly (18wks)

Question 30

what should pre existing diabetics be treated with during pregnancy? what extra screening is done?

Answer 30

diet metformin insulin retinopathy

Question 31

HbA1c aim during pregnancy?

Answer 31

48mmol (<60%)

Question 32

what size of baby should get a CS?

Answer 32

>5kg

Question 33

what fetal complications does gestational diabetes cause?

Answer 33

``` miscarriage pre term cord prolapse IUGR macrosomia malformations shoulder dystocia still birth cerebral palsy ```

Question 34

risk factors for VTE?

Answer 34

``` Hx thrombophilia FHx age BMI parity smoker pre eclampsia prolonged labour ```

Question 35

what haem changes happen during pregnancy?

Answer 35

pro thrombotic increased platelets, fibrinogen, VII, VIII, X

Question 36

Ix for VTE?

Answer 36

``` FBC, U+Es, LFTs, clotting duplex US V/Q scan ECG CXR ABGs ```

Question 37

who gets postnatal LMWH? how long?

Answer 37

high risk - 6wks | intermediate - 30days

Question 38

if a pregnant women gets a DVT, what is the Tx?

Answer 38

LMWH for 3 months after delivery/6 months after Tx

Question 39

is warfarin safe when breastfeeding? pregnancy?

Answer 39

yes | not in weeks 6-12