Obstetrics Flashcards

1
Q

Define teratogenesis

A

Dysgenesis of fetal organs structurally or functionally.

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2
Q

What day range is the embryo most vulnerable to teratogenesis? why?

A

Embryo is most vulnerable within days 18-55 as this is when cells differentiate and major organs are formed.

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3
Q

What can happen after the “sensitive” embryo phase? Give example of organs effected.

A

Congenital malformations can occur at day 56 of birth. Organs such as the cerebral cortex and renal glomeruli continue to develop and are susceptible to damage!

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4
Q

The incidence of Tetatogenecity is …

A

Usually dose-dependent.

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5
Q

State 4 roles of the placenta

A
  • Endocrine function
  • Immunity
  • Excretion
  • Nutrition
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6
Q

State 6 major changes that occur during gestation

A

1) Respiratory rate increases
2) Cardiovascular output increases
3) Plasma volume increases
4) Blood flow to the skin increases
5) GFR increases by 50% by the end of first trimester
6) Alterations in metabolic enzymes in the liver

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7
Q

how do most drugs cross the placenta, and what qualities of a drug make it able to pass across the placenta. What qualities render it unable?

A

99% of drugs cross the placenta by diffusion

Drugs that cross the placenta are non-ionised, lipid soluble.

Drugs that tend not to cross are polar, ionised , and have high molecular weight

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8
Q

what four key ways can we minimise risk to baby

A
Safe practices of minimising risk to foetus
Non-drug treatment 
Avoid in first trimester
Avoid teratogens
Lowest effective dose
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9
Q

In what cases do we continue therapy of pregnant women?

A
  • DVT/PE
  • Diabetes
  • HIV
  • Hypertension
  • Asthma
  • Transplant patients
  • Epilepsy
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10
Q

State four key benefits of baby’s receiving breast milk

A
  • less chance of diarrhoea and vomiting
  • Infections
  • constipation
  • Eczema
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11
Q

Benefits for the mother of giving breast milk?

A

Benefits of mother of giving breast milk

  • Reduces risk of breast and ovarian cancer
  • Burns 500 calories per day
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12
Q

What are the 3 criteria for drugs that are SAFE in pregnancy?

A

Drugs regarded as safe in pregnancy are:

  • Highly protein protein bound
  • Drugs which shorter half-life
  • Drugs with a low plasma-to-milk ratio
    The lower the ratio = less drug reaches the milk
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13
Q

What four factors are needed before we prescribe a drug for a mother who has a newborn kid?

A
  • Need for drug
  • Age & Maturity of the baby
  • Volume of breast milk being taken
  • Safety of the drug
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14
Q

What kind of drugs enter breast milk?

A

Drugs that pass into breastmilk

  • Drugs with low plasma protein binding
  • Low molecular weight
  • High lipophilicity
  • Cationic drugs
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15
Q

What factors excluding Mw/Charge/Lipophilicity affect drug diffusion into breast milk?

A
  • Maternal Pharmacokinetics
  • Composition of blood verses milk
  • Characteristics of the drug
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16
Q

What is the Exposure index and whats the equation

A

Exposure index links Mp ratio, milk intake and Infant drug clearance together in an equation:

Exposure index (%): MpRation * A / Cl multiplied by 100 to get a %.

A = Milk intake 
Cl = Infant drug clearance (ml/kg/min)
17
Q

What drugs have high infant exposure?

A

IMPACT drugs have high infant exposure:

Isoniazid
Metronidazole
Propylthiouracil
Amiodarone 
Carbimazole
Theophylline
18
Q

List the 8 essential postnatal medicines classes

A
Analgesics - Morphine
Anti-epileptics - Lamotrigine 
Antibiotics - Metronidazole
Antihypertensives -  Betablockers; ACE inhibitors (Captopril - Enalapril)
Anemic meds - Iron 
Laxatives 
Thromboprophylaxis - LMWH
19
Q

List Anti-hypertensive drugs that are safe in Breastfeeding

A

LAMNEC

  • Labetalol
  • Atenolol
  • Metoprolol
  • Nifedipine
  • Enalapril; Captopril
20
Q

What anti-hypertensives drugs are not that safe in pregnancy?

A

Angiotensin - Receptor Blockers

Amlodipine

21
Q

List the treatments essential in mothers for diabetes and state essential lifestyle changes

A
  • Diet and Exercise
  • Insulin
  • Metformin
  • Glibenclamide (if insulin declined)
22
Q

what anticoagulant drugs are not recommended in pregnancy?

A

DOACs