Obstetrics 2

Question 1

Why do you get DVTs in pregnancy?

Answer 1

increase pro coagulants like factor 5 and 7
reduce anticoag activity of protein C, S

Compression LEFT iliac vein by uterus

Question 2

Can you give warfarin in breast feeding?

Answer 2

Yes

Question 3

How to anticoagulate in preg?

Answer 3

LMWH then switch to UFH 4 weeks pre delivery

Question 4

What does warfarin do to baby>

Answer 4

T1 fetal chondroplasia punctata

T2,3 fetal optic atrophy, mental retardation

Question 5

What things go up in normal pregnancy?

Answer 5

cardiac output
plasma volume
GFR

Question 6

What things go down in normal pregnancy?

Answer 6

plsma protein and albumin
plasma creatinine
SVR
plasma urea

Note sodium and osmolality stay the SAME

Question 7

If hep B viral load high, give what in third trimester?

Answer 7

Tenofovir

Question 8

Indications for delivery in diabetes in pregnancy?

Answer 8

Proliferative diabetic retinopathy
Worsening renal function
Usual indications for delivery

Question 9

Risk of developing diabetes long term if have gestational?

Answer 9

40% in first 10 years

Question 10

Obesity in pregnancy increase risk of

Answer 10

still birth
congen malformation
pre eclampsia
UTI
post date delivery 

following bariatric surgery - wait one year

Question 11

What happens to your thyroid hormone in normal preg?

Answer 11

Increase TBG so increase total T4, T3 but normal free portion.

Question 12

What to use for T1 thyrotoxicosis?

Answer 12

PTU- crosses placenta less

By T2, T3 use carbimazole as crosses the placenta more but less associated with liver failure

Question 13

Goal for TSH in pregnancy?

Answer 13

Keep in normal range

Kids of women with high TSH have lower neurocog scores

Question 14

Headache with sixth nerve palsy in pregnancy?

Answer 14

Think idiopathic IC hypertension

Question 15

What happens to MS risk in pregnancy?

Answer 15

Reduce flare in preg

Increase flare post preg

Question 16

What do meningiomas do in preg?

Answer 16

Grow

Question 17

bells palsy in preg?

Answer 17

More common

Treat with steroids as for non preg

Question 18

Meralgia parasthetica?

Answer 18

reduces post partum

Question 19

Carpal tunnel?

Answer 19

More common in preg

Question 20

What does amniotic fluid embolism look like?

Answer 20

anaphylactoid reaction
often postpartun after traumatic delivery
bleeding ++ all sites
hypotensive
cyanosed
high mortality 
squames out of central line

use fluid bolus via CVC

Question 21

How is CPR for pregnant women different?

Answer 21

CPR at 30 decrees to keep uterus off IVC
Glottic pressure to prevent reflux
if no success at 5 mins, LSCS

Question 22

If mother has had thyroidectomy for graves, how might this affect baby?

Answer 22

Might STILL have circulating Ab- need to monitor baby HR for tachy

Question 23

What should you do if the mother had more than 20mg steroids for more than three weeks in the year leading up to pregnancy?

Answer 23

cover with hydrocort intrapartum and give short pred post partum