Obstetrics Flashcards
LLN of platelets in pregnancy
> 100
ERV change in pregnancy
fall
RV change in pregnancy
Fall
IC change in pregnancy
small rise
TLC change in pregnancy
Overall same (IC rise and FRC fall), maybe small rise
Why do UTIs increase in pregnancy?
Progesterone mediated ureteric dilation
Why does ALP rise in pregnancy?
placenta produces ALP
Normal urine PCR in pregnancy and why
<300, hyperfiltration
Top medical comorbidity affecting pregnancy
Asthma
Main change in respiratory physiologyin pregnancy
increased TV
Safest inhaled steroid in pregnancy
Budesonide
Well controlled asthma reduces the risk of what in a child..
Bronchiolitis and croup
Worst AED for pregnancy
Valproate
Best single agent for pregnancy
Keppra
Anti-epileptic enzyme inducers x4
CBZ, Pheyntoin, topiramate, phenobarb
Relationship between eGFR and fertility in prengnacy
Lower GFR = worse fertility
What occurs with dialysis and fertility
fertility improves
What occurs with transplant and fertility
returns
How long should transplants wait until conception
2 years +
consequence of early conception post transplant
increased graft loss
How much dialysis is needed in pregnancy?
> 36 hours/ week, INTENSE
what occurs to GFR in pregnancy in those with CKD
falls and often doesn’t recover
what to supplement in obese people in pregnancy
folate
potential drug to give to Anti-Ro +ve mothers in pregnancy
HCQ- reduces risk of heart block in future pregnancies
When does CHB manifest in anti-ro/La +ve pregnancies?
16-26 weeks
How to differentiate pre-eclampsia from lupus nephritis
Haematuria/active sediment -> LN
Low complement -> LN
Anti-dsDNA high -> LN
Pre-eclampsia -> raised uric acid, deranged LFTs
Pre-eclampsia definition
HTN and organ involvement
Pre-eclampsia/eclampsia neuro involvement
seizures, hyperreflexia, clonus, stroke/ICH/PRES, persistent visual disturbance
Major medical risk fx for pre-eclampsia
renal disease, obesity, HTN, DM, APLS
Major persona/ Fam risk fx for pre-eclampsia
first degree relative, primip, previous pre-eclamp
Preventative rx of pre-eclampsia
Aspirin and calcium
Which growth factor is thought to be responsible for pre-eclampsia
soluble Flt-1, mopping up PIGF
DDx of MAHA in pregnancy
HELLP, DIC, AFLP, aHUS, TTP
When does HELLP occur in pregnancy?
3rd tri
When does AFLP occur in pregnancy?
3rd tri
When does aHUS occur in pregnancy?
Post delivery
HTN targets in pregnancy
SBP 110-140, DBP approx. 85. NOT <80
3 most commonly used agents for HTN in pregnancy
Methyldopa, labetalol, nifedipine
Best PE imaging modality in pregnancy/ why?
V/Q - less radiation to breasts. Radiation dose to baby actually lower with CTPA
What D-dimer level excludes VTE in pregnancy?
<0.5
Duration of Rx VTE pregnancy
3-6 months until at least 6/52 post-partum
Anticoagulants safe in breastfeeding
LMWH, warfarin
VTE prophylaxis indications in pregnancy
Antenatal and post-partum - prev pregnancy or oestrogen provoked VTE, ATIII mutation irrespective of VTE, previous VTE and any thrombophilia
Post-partum only - non-oestrogen provoked PE and no thrombophilia, thrombophilia without VTE history (homozygotes or compound heterozygotes only)
No prophylaxis - heterozygote thrombophilia with no history VTE
Define hyperemesis gravidarum
Electrolyte abnormality, dehydration or >5% wt loss
Rx mild hyperemesis
Stop iron, continue iodine and folate, pyidoxine and ginger
Rx for severe hyperemesis
Cyclizine, steroids (not <10/40)
Key Ix for hyperemesis gravid
UEC, LFT, TFT, USS (?multiple gestations, GTD)
Putative molecule responsible for peripartum cardiomyopathy
16kDa prolactin fragments
Why does peri-partum CMP deteriorate post delivery?
Auto-transfusion of blood back from placenta
Which Rx works for peri-partum CMP in a small study?
Bromocriptine
When to anticoagulate peri-partum CMP?
EF<35%
When should peri-partum CMP get ICD?
LV dysfunction >6/12 post-partum
Obstetric cholestatis occurs when?
> 30/40
Triad of obstetric cholestasis
Pruritis soles and palms, elevated ALT/bile acids (>10), normal USS
Mechanism of obstetric cholestasis
Defect in bile acid transport in mother, with oestrogen also disrupting transport
Mx obstetric cholestasis
Urso
BA > 40 - deliver 38-39
BA > 100 - deliver 35-36