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RACP short cards > 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
Q

Residual volume

26
Q

Total lung capacity in pregnancy

A

Does not change

27
Q

Reason for increased UTI in pregnancy

A

Progesterone mediated ureteric dilation

28
Q

Most common chronic medical condition in pregnancy

29
Q

Preferred anti-epileptic in pregnancy

A

Keppra

+ 5mg/day folate

30
Q

eGFR and fertility

A

Low eGFR, Low fertility (improves with dialysis and transplant)
In normal pregnancy, GFR improves. In CKD pregnancy, GFR declines

31
Q

CNS effects in pre-eclampsia

A 
Seizures
Stroke
ICH
Posterior reversible encephalpathy syndrome (PRES)
Visual changes
Hyperreflexia
Clonus
32
Q

BP targets pregnancy

A

110/85 (no lower than 80 diastolic!)

33
Q

Hyper-emesis Gravidum

A

Emesis with electrolyte disturbance, dehydration, weight loss

34
Q

What hormone drives peripartum cardiomyopathy

A

Prolactin (breast feeding is dangerous!)

Consider bromocriptine as Rx

35
Q

Triad cholestasis of pregnancy

A

Pruritis of palms
Increased Bile acids > 10 (> 40 dangerous) and ALT
Normal USS

36
Q

Breast feeding on anti-epileptics

A

NOT contraindicated. Safe with all anti-epileptics!

37
Q

Safest DMARD for pregnancy

A

Sulfasalazine, Azathioprine and hydroxychloroquine

38
Q

Management Varicella Zoster exposure in pregnancy

A
  1. Check serology for immunity

2. If not immune, give post exposure immunoglobulin

RACP short cards (30 decks)

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