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Pathology - Y5 > Obstetric Haematology > Flashcards

Obstetric Haematology Flashcards

1
Q

What are blood count changes in pregnancy?

A

Thrombocytopenia in pregnancy

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2
Q

What are coagulation changes in pregnancy?

A

Thromboembolic disease

Complications of pregnancy

DIC syndromes

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3
Q

What is the normal full blood count in pregnancy?

A

Mild anaemia: Red cell mass rises (120 -130%), plasma volume rises (150%)

Macrocytosis: Normal, folate or B12 deficiency

Neutrophilia

Thrombocytopenia: Increased platelet size

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4
Q

What is the blood iron requirement of pregnancy?

A
  • 300mg for fetus
  • 500mg for maternal increased red cell mass

RDA 30mg; Increase in daily iron absorption:1-2mg to 6mg

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5
Q

What is the folate requirement of pregnancy?

A

Growth and cell division

Approx additional 200mcg/day required

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6
Q

What may iron deficiency in pregnancy cause?

A

IUGR

Prematurity

Postpartum haemorrhage

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7
Q

What is the importance of folic acid in pregnancy? What is the normal supplementation of folic acid in pregnancy?

A

Advise reduces risk of neural tube defects

Supplement before conception and for ≥ 12 weeks gestation

Dose 400μg/day

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8
Q

What is the definition of anaemia in the first trimester?

A

Hb < 110 g/l

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9
Q

What is the definition of anaemia in the second and third trimesters?

A

Hb < 105 g/l 2nd and 3rd trimester

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10
Q

What is defined as major haemorrhage during labour?

A

Blood loss 1L

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11
Q

What are causes of thrombocytopaenia in pregnancy?

A

Physiological: ‘Gestational’/incidental thrombocytopenia

Pre-eclampsia

Immune thrombocytopenia (ITP)

Microangiopathic syndromes

All other causes: Bone marrow failure, leukaemia, hypersplenism, DIC etc.

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12
Q

What is gestational thrombocytopaenia?

A

Physiological decrease in platelet count ~ 10%

>50x109/l sufficient for delivery (>70 for epidural)

Dilution + increased consumption

Baby not affected

Platelet count rises D2 – 5 post delivery

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13
Q

What is the epidemiology of ITP?

A

5% of thrombocytopenia in pregnancy

TP may precede pregnancy

Early onset

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14
Q

What are treatment options for ITP?

A

IV immunoglobulin

Steroids etc.

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15
Q

How are babies affected with maternal ITP?

A

Unpredictable (platelets <20 in 5%)

Check cord blood and then daily

May fall for 5 days after delivery

Bleeding in 25% of severely affected (IVIG if low)

Usually normal delivery

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16
Q

Which tests are used to identify VTE in pregnancy?

A

VQ perfusion or Doppler

(NOT D-Dimer)

17
Q

What are factors which increase risk of VTE in all pregnant women?

A

Changes in blood coagulation

Reduced venous return: ~85% Left DVT

Vessel wall

18
Q

What are variable factors which increase risk of VTE in pregnant women?

A

Hyperemesis/dehydration

Bed rest

Obesity: BMI>29 3x risk of PE

Pre-eclampsia

Operative delivery

Previous thrombosis/thrombophilia

Age

Parity

Multiple pregnancy

Other medical problems: HbSS, nephrotic syndrome, IVF: ovarian hyperstimulation

19
Q

What is the treatment for VTE in pregnancy?

A

LMWH as for non-pregnant; does not cross placenta.

RCOG recommend once or twice daily

Do not convert to warfarin (crosses placenta)

After 1st trimester monitor anti-Xa

4 hour post 0.5-1.0u/ml

20
Q

How long before an epidural should LMWH be stopped?

A

Wait 24 hours after treatment dose, 12 hours after prophylactic dose

21
Q

What is chondrodysplasia punctata?

A

Abnormal cartilage and bone formation

Early fusion of epiphyses

Nasal hypoplasia

Short stature

Asplenia

Deafness

Seizures

22
Q

Why should warfarin not be given?

A

Warfarin is teratogenic in the 1st trimester

23
Q

What is antiphospholipid syndrome?

A

Recurrent miscarriage + persistent Lupus anticoagulant (LA) and/or antiphospholipid antibodies

24
Q

What are the three potential presentations of antiphospholipid syndrome?

A

Adverse pregnancy outcome: Three or more consecutive miscarriages before 10 weeks of gestation.

One or more morphologically normal fetal losses after the 10th week of gestation.

One or more preterm births before the 34th week of gestation owing to placental disease.

25
Q

What is the potential treatment of antiphospholipid syndrome?

A

Aspirin and heparin

(Better than aspirin alone)

26
Q

What are major risk factors of postpartum haemorrhage?

A

Uterine atony

Trauma

27
Q

All haematological factors are minor variables for post-partum haemorrhage except:

A

Dilutional coagulopathy after resuscitation

DIC in abruption, amniotic fluid embolism etc.

28
Q

What is the relationship between Disseminated Intravascular Coagulation (DIC) and pregnancy?

A

Coagulation changes in pregnancy predispose to DIC.

29
Q

What is decomposition for DIC in pregnancy precipitated by?

A

Amniotic fluid embolism

Abruptio placentae

Retained dead fetus

Preeclampsia (severe)

Sepsis

Pathology - Y5 (59 decks)

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