Obstetrics

Question 1

Explain the haematological changes in pregnancy.

Answer 1

Plasma volume increases by 50% - this causes dilutional anaemia.
Modest leukocytosis.
Additional demand for iron.

Question 2

Explain the urinary tract changes in pregnancy.

Answer 2

50-60% increase in renal blood flow and GFR - causing increased excretion and reduced levels of urea, creatinine, urate and bicarbonate.
Mild glycosuria and/or proteinuria.
increased water retention.
Bladder smooth muscle relaxes - increased UTI risk.
Enlarged uterus puts pressure on the ureters.

Question 3

Explain the changes in the GI tract in pregnancy.

Answer 3

GORD, nausea and vomiting and constipation are more common in pregnancy.

Question 4

Define pre-eclampsia.

Answer 4

New hypertension in pregnancy with end-organ dysfunction (notably with proteinuria).

Question 5

Triad of pre-eclampsia.

Answer 5

Hypertension.
Proteinuria.
Oedema.

Question 6

Define chronic hypertension.

Answer 6

Hypertension that exists before 20 weeks gestation and is longstanding.

Question 7

Define gestational hypertension.

Answer 7

Hypertension occurring after 20 weeks gestation, without proteinuria.

Question 8

Define eclampsia.

Answer 8

Where seizures occur as a result of pre-eclampsia.

Question 9

Cause of pre-eclampsia.

Answer 9

High vascular resistance in the spiral arteries and poor perfusion of the placenta. Causing oxidative stress in the placenta, causing systemic inflammation and impaired endothelial function in the blood vessels.

Question 10

High risk factors for pre-eclampsia.

Answer 10

Pre-existing hypertension.
Previous hypertension in pregnancy.
Autoimmune conditions, e.g. SLE.
Diabetes. 
CKD.

Question 11

Moderate risk factors for pre-eclampsia.

Answer 11

>40.
BMI >35.
>10 years since last pregnancy.
Multiple pregnancy.
First pregnancy.
Family history of pre-eclampsia.

Question 12

Symptoms of pre-eclampsia.

Answer 12

Headache.
visual disturbance or blurriness.
Nausea and vomiting.
Upper abdo or epigastric pain.
Oedema.
Reduced urine output.
Brisk reflexes.

Question 13

Diagnosis of pre-eclampsia.

Answer 13

BP > 140/90
\+
proteinuria
organ dysfunction
placental dysfunction

Question 14

Prevention of pre-eclampsia in high risk patients.

Answer 14

Aspirin
+ monitoring
(BP, symptoms, urine dip) at every antenatal appointment.

Question 15

General Management of pre-eclampsia

Answer 15

Monitor BP closely.

Ultrasound for fetus, amniotic fluid and dopplers performed 2x weekly.

Question 16

Medical management of pre-eclampsia.

Answer 16

1st: Labetalol
2nd: nifedipine
3rd: methyldopa
If severe: IV hydralazine
Fluid resitriction

Question 17

Prevention of seizures in eclampsia.

Answer 17

IV magnesium sulphate.

Question 18

Define HELLP syndrome.

Answer 18

Combination of features occurring as a complication of pre-eclampsia and eclampsia.

• haemolysis
• elevated liver enzymes
• low platelets