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RACP > Obstetric Medicine > Flashcards

Obstetric Medicine Flashcards

1
Q

Congenital Heart Block

A

Due to neonatal lupus
5% risk with maternal Anti-Ro and Anti-La
Cross placenta and bind to conduction pathways

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2
Q

Renal changes in Pregnancy

A

Increase renal blood flow and GFR
Proteinuria
Glycosuria
Decreased plasma osmolality and haemodilution (due to RAAS activation)

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3
Q

Risk factors pre-eclampsia

A
  1. Condom use as contraception
  2. Anti-phospholipid syndrome
    Chronic HTN
    Obesity
    Proteinuria (CKD stage 1)
    Primip
    FHx, personal Hx
    Diabetes
    Age > 35
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4
Q

Pre-eclampsia definition

A

HTN that develops beyond 20 weeks gestation and involves organ dysfunction without alternative diagnosis

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5
Q

Significant proteinuria in pre-eclampsia

A

PCR > 30

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6
Q

Thyroid function in pregnancy

A

TSH decreases -> rises in later pregnancy with decreased HcG
Increased thyroglobulin binding protein
Increased total T4
Decreased free T3/4

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7
Q

Predictor of neonatal hyperthyroidism in maternal graves disease

A

Higher TSH receptor stimulating Ab correlates with risk of neonatal hyperthyroidism

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8
Q

Anti-hypertensives in pregnancy

A

Methyl-dopa (risk of depression, nightmares)
Nifedipine
Labetolol

ACE and ANG2i contraindicated

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9
Q

Anti-epileptics contraindicated in pregnancy

A

Na Valproate - teratogenic
Topirimate - cleft palate and hypospadias

Oestrogen lowers Lamotrigine levels by 50% so women may need increased doses during pregnancy & may have toxic effects on sugar days of OCP

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10
Q

Most dangerous CVD risk in pregnancy

A

Pulmonary HTN - particularly rom Eisenmenger syndrome; R -> L shunt, Pulm HTN and Cyanosis

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11
Q

Treatment of pre-eclampsia

A

If emergency - for IV Magnesium Sulphate
Anti-HTN; Methyl Dopa, Labetolol, Nifedipine
Low dose Aspirin
Calcium supplementation to deplete patients
Delivery

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12
Q

Most common cause of hyperthyroidism in women of reproductive age

A

Graves disease

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13
Q

Risk of VTE in pregnancy - which trimester?

A

Post-partum

All other trimesters have equal risk

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14
Q

Disorder with highest risk of VTE in pregnancy

A

Homozygous Factor V deficiency

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15
Q

Hepatits B management in pregnancy

A

If HbsAg + (infected)

  • High Viral load - treatment of mother from 32 weeks + HepB IG to baby at birth and then 3 doses/6 months
  • Low viral load - HepB IG to baby at birth and then 3 doses vaccine/6 months

HbsAb - (non-immune)
- Vaccinate mother during pregnancy

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16
Q

Most common cause of maternal death in Australia

A

Amniotic fluid embolism

17
Q

Eisenmenger Syndrome

A

L -> R shunt via ASD/VSD/PDA causing pulmonary hypertension. Pregnancy dangerous and contraindicated.

18
Q

Indications for pre-partum VTE prophylaxis in pregnancy

A
  • Prior pregnancy or oestrogen associated VTE
  • Thrombophilia (i.e. Antithrombin 3, Factor V leide)
  • Prior unprovoked VTE
19
Q

Rx VTE in pregnancy

A

Heparin infusion
LMWH
Avoid Warfarin particularly in first trimester
No evidence for NOAC

Warfarin can commence postpartum and is safe in breast feeding

20
Q

Pre-eclampsia pathophysiology

A

placento-uterine ischaemia

21
Q

LFTs during pregnancy

A

Increased ALP

Decreased ALT, AST, Bilirubin, Albumin

22
Q

Management of HELLP

A

Delivery if > 32 weeks, risk of fetal or maternal demise
HTN management
Platelet transfusion
Analgesia

23
Q

Tidal volume in pregnancy

24
Q

Expiratory reserve volume

25
Residual volume
Decreases
26
Total lung capacity in pregnancy
Does not change
27
Reason for increased UTI in pregnancy
Progesterone mediated ureteric dilation
28
Most common chronic medical condition in pregnancy
Asthma
29
Preferred anti-epileptic in pregnancy
Keppra + 5mg/day folate
30
eGFR and fertility
Low eGFR, Low fertility (improves with dialysis and transplant) In normal pregnancy, GFR improves. In CKD pregnancy, GFR declines
31
CNS effects in pre-eclampsia
``` Seizures Stroke ICH Posterior reversible encephalpathy syndrome (PRES) Visual changes Hyperreflexia Clonus ```
32
BP targets pregnancy
110/85 (no lower than 80 diastolic!)
33
Hyper-emesis Gravidum
Emesis with electrolyte disturbance, dehydration, weight loss
34
What hormone drives peripartum cardiomyopathy
Prolactin (breast feeding is dangerous!) | Consider bromocriptine as Rx
35
Triad cholestasis of pregnancy
Pruritis of palms Increased Bile acids > 10 (> 40 dangerous) and ALT Normal USS
36
Breast feeding on anti-epileptics
NOT contraindicated. Safe with all anti-epileptics!
37
Safest DMARD for pregnancy
Sulfasalazine, Azathioprine and hydroxychloroquine
38
Management Varicella Zoster exposure in pregnancy
1. Check serology for immunity | 2. If not immune, give post exposure immunoglobulin

RACP (17 decks)

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