Other medical disorders in pregnancy

Question 1

In a woman with gestational or type 2 diabetes, what medication may she continue in pregnancy?

Answer 1

Type 2 diabetes can be managed with metformin alone or with insulin only. Both gliclazide and liraglutide are contraindicated in pregnancy.

Question 2

How many pregnancies does diabetes complicate?

Answer 2

1 in 40

Question 3

What are the risk factors for gestational diabetes?

Answer 3

Women who have a BMI greater than 30, women who have had previous macrosomic babies (>4.5kg), previous gestational diabetes, women who have a first degree relative with diabetes and women from a country where the prevalence of diabetes is high (south-asian, black caribean, middle eastern).

Question 4

What are the diagnostic thresholds for gestational diabetes?

Answer 4

fasting glucose is >= 5.6 mmol/l

2-hour glucose is >= 7.8 mmol/l

Question 5

When is glibenclamide offered?

Answer 5

glibenclamide should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment

Question 6

How much folic acid does a woman with diabetes need, week 1-12?

Answer 6

5mg/day

Question 7

What symptoms do cervical ectropions tend to cause?

Answer 7

Post-coital bleeding and discharge.

Question 8

For troublesome ectropions, what treatment may be used?

Answer 8

Ablation (cold coagulation)

Question 9

What changes happen to blood pressure in pregnancy?

Answer 9

blood pressure usually falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks

Question 10

In women with DVTs in pregnancy, what monitoring should be carried out?

Answer 10

Routine measurement of peak anti-Xa activity for patients on LMWH for treatment of acute VTE in pregnancy or postpartum is not recommended except in women at extremes of body weight (less than 50 kg and 90 kg or more) or with other complicating factors (for example, with renal impairment or recurrent VTE).’ and that ‘Routine platelet count monitoring should not be carried out.’

Question 11

What is primary amenorrhea?

Answer 11

Primary amenorrhoea is diagnosed if the patient if the patient has not had a period by the time they are 14 with no secondary sexual characteristics, or over 16 if secondary sexual characteristics are present.

Question 12

What is the definition of amennorrhea?

Answer 12

Amenorrhoea is the absence of menstruation. It can be primary i.e. menarche has never occurred or secondary i.e. the patient has had no periods for >6 months but has had periods in the past.

Question 13

When does fetal thyroixine production start?

Answer 13

12 weeks, before this it is dependent on maternal thyroixine levels.

Question 14

What is anti-phospholipid syndrome?

Answer 14

This is when the lupus anticoagulant and/or anticardiolopin antibodies (ACA) occue measured on at least 2 occasions at least 3 months apart, in association with adverse pregnancy complications

Question 15

What is the treatment for APS?

Answer 15

aspirin and LMWH

Question 16

How does APS usually present?

Answer 16

recurrent miscarriage, placental thrombosis, IUGR and early pre-eclampsia.

Question 17

How much does the eGFR increase by in pregnancy?

Answer 17

40%

Question 18

When is the risk of VTE highest?

Answer 18

It increases 6 fold in pregnancy with the highest risk in the post-natal period.

Question 19

Where are DVTs more common?

Answer 19

Left iliofemoral vein

Question 20

What would a high haemoglobin be associated with in pregnancy?

Answer 20

Preterm baby, IUGR possibly because it reflects low blood volume, as found in pre-eclampsia because of its association with smoking.

Question 21

What does a T sign mean?

Answer 21

Monochorionic twins

Question 22

What does a lamda sign mean?

Answer 22

Dichorionic twins

Question 23

What happens if the split time is at 0-4 days?

Answer 23

Dichorionic diamnionic

Question 24

What happens if they split time is at 5-8 days?

Answer 24

Monochorionic diamniotic (MOST COMMON)MCDA

Question 25

What happens if the split time is at 9-14 days?

Answer 25

mono chorionic monoamniotic

Question 26

What happens if the split time is after 15 days?

Answer 26

conjoined twins

Question 27

Who is twin-twin transfusion more common in?

Answer 27

monochorionic (T sign)

Question 28

When should twins be delivered?

Answer 28

37-38 weeks

Question 29

When should triplets be delivered?

Answer 29

32-34 weeks

Question 30

How many mls blood loss is a PPH in vaginal?

Answer 30

500mls

Question 31

How many mls blood loss from c-section is a PPH?

Answer 31

> 1000mls

Question 32

What is considered a primary PPH?

Answer 32

PPH up to 24 hours after birth, after that it is secondary.

Question 33

Why should a catheter always be put in, concerning PPH?

Answer 33

Put catheter in to avoid pressure on uterus which might cause PPH

Question 34

Why does uterine atony lead to a PPH?

Answer 34

Failure to contract and clamp the placental arteries results in prolonged bleeding/blood loss.

Question 35

What is the leading cause of PPH?

Answer 35

Uterine atony

Question 36

How can you treat uterine atony?

Answer 36

Fundal massage

Question 37

If the bleeding is in a hidden location within the uterus what can happen?

Answer 37

Haematoma, pain with red bleeding despite fully contracted uterus.

Question 38

What is the tissue cause of PPH?

Answer 38

Placental retainment preventing uterine contraction due to top much traction/placenta accreta and leading to uterine atony.

Question 39

What is the leading cause of maternal morbidity and mortality?

Answer 39

PPH

Question 40

What metabolic is metformin associated with?

Answer 40

Lactic acidosis, build up of lactate. If you have liver problems, met forming prevents the liver taking up lactate leading to an increased amount in free lactate and if you have kidney problems then it can’t be excreted adequately.