Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Obstetrics > Other Medical Disorders in Pregnancy > Flashcards

Other Medical Disorders in Pregnancy Flashcards

1
Q

why is pregnancy diabetogenic

A

decreased glucose tolerance due to the antagonistic effects of lactogen, progesterone and cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the foetal complications of gestational diabetes

A

Foetal hyperinsulinaemia due to islet cell hyperplasia which leads to increased fat deposition, leading to a large baby (macrosomia)

Congenital abnormalities (especially neural tube defects)

Preterm labour

Reduced Foetal lung maturity

Increased birthweight

Dystocia and birth trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how is foetal macrosomia best detected

A

An increase in abdominal width on antenatal scanning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the maternal complications of gestational diabetes

A

Increased insulin requirements

Ketoacidosis

UTI

Wound/endometrial infection

Hypertension and pre-eclampsia

Worsening of pre-existing heart disease

C-section or instrumental delivery more likely due to foetal size

Diabetic nephropathy (5-10%)

Diabetic retinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

why is glucosuria not a reliable physiological sign for gestational diabetes

A

because it is normal in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you diagnose gestational diabetes

A

fasting glucose >5.6mmol/L

OGTT >7.8mmol/L 2 hours after 75g of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the incidence of gestational diabetes

A

16%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how should you manage pre-existing diabetes in pregnant women

A

Precise glucose control and foetal monitoring
Dietary advice, Metformin and insulin are the only appropriate agents for monitoring in pregnancy

Preconceptual care
Glucose levels should be at normal physiological levels at conception, and pregnancy is not advised beyond 10% HbA1c
5mg folic acid
Statins stopped and antihypertensives given instead
Labetolol/methyldopa most commonly used
Renal function, eyes and blood pressure are measured

During pregnancy the aims are <5.3mmol/L fasting and <7.8mmol/L 1 hour post 75g glucose load

Aspirin 75mg is advised >12 weeks to avoid the risk of pre-eclampsia

Foetal monitoring

Foetal echocardiography is indicated

Extra scans at 32 and 36 weeks are indicated for growth/liquor volume

Neonate commonly develops hypoglycaemia initially due to it being used to higher glucose levels, therefore levels should be checked within 4 hours – breast feeding is strongly advised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what factors put women at risk of developing gestational diabetes

A

Previously large baby

Unexplained stillbirth

1st degree relative with diabetes

BMI >30

Minority ethnic origin

Previous gestational diabetes

Persistent glycosuria

Polyhydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what % of women develop T2DM after an episode of gestational diabetes

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the care after birth for a woman whos had gestational diabetes

A

oral glucose tolerance test 6 weeks post birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the physiological changes to the cardiovascular system in pregnancy

A

Cardiac output increases in pregnancy, due to increased blood volume (40%), increased heart rate and increased stroke volume

There is a 50% decrease in systemic vascular resistance, so BP often drops in 2nd trimester but returns to normal by term

90% of women have an ejection systolic murmur and an abnormal ECG (left axis deviation, inverted T waves)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is pre-existing valve disease managed in pregnancy

A

Beta-blockers

valve replacement if serious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the physiological changes to the respiratory system in pregnancy

A

Tidal volume is increased by 40% in pregnancy

There is no corresponding change in respiratory rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what respiratory condition is common in pregnancy

A

asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is required for a woman on long term steroids during labour

A

increased dose of steroids due to chronic adrenal suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

if the mother has epilepsy what is the chance the baby develops it

A

3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the physiological changes to the thyroid system in pregnancy

A

Thyroid status does not change in pregnancy but foetal thyroxine does not get produced until 12 weeks so maternal TSH is increased to cover this deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the implications of maternal hypothyroidism in pregnancy

A 
severe perinatal mortality 
miscarriage
preterm delivery 
increased risk of intellectual impairment 
increased risk of pre-eclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

why is an untreated thyroid disorder in pregnancy rare

A

hypo/hyper causes anovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the foetal risk of maternal hyperthyroidism

A

foetal thyrotoxicosis and goitre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the treatment for maternal hyperthyroidisim

A

propyluracil - not carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what happens to graves disease post partum

A

gets worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are features of post-partum thyroiditis

A

Common (5-10%)

May lead to post-natal depression

Risk factors are antithyroid antibodies and T1DM

There is usually a 3 month transient, subclinical hyperthyroidism followed by a 4 month period of hypothyroidism – in 20% this is permanent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is acute fatty liver + what are some of its features
rare obstetric complication causing acute hepatorenal failure, DIC and hypoglycaemia ``` malaise vomiting jaundice vague epigastric pain preceding thirst weeks earlier ```
26
how do you treat acute fatty liver of pregnancy
early identification key correction of clotting defects and hypoglycaemia first ``` supportive treatment: dextrose blood products careful fluid balance occasional dialysis recurrence rates low ```
27
what is obstetric cholesatasis and what are some common features
obstetric intrahepatic cholestasis of unexplained origin Unexplained pruitis Abnormal LFTs Raised bile acids Resolution post-delivery
28
if a patient has had obstetric cholestasis previously what is the chance of recurrence
50%
29
what are the complications of obstetric cholestasis
Stillbirth (bile acid toxicosis) Early meconium passage Postpartum haemorrhage
30
what is the treatment for obstetric cholestasis
No main treatment Ursodeoxycholic acid (UDCA) may relieve itching Vit K given after 36 weeks due to risk of post-partum haemorrhage - 10mg/day Induction is offered 38 weeks if bile acids are high 40 weeks otherwise 6 week follow up mandatory to check liver function returns to normal
31
what physiological changes occur in pregnancy due to the renal system
GFR increases by 40% in pregnancy causing creatinine and urea to drop
32
what is the threshold for CKD in pregnancy
creatinine >200mmol/L
33
what are some foetal complications of CKD in pregnancy
Preterm delivery Pre-eclampsia IUGR Polyhydramnios
34
whats the management for CKD in pregnancy
USS for foetal growth Renal monitoring Hypertension control If necessary – dialysis
35
what are the complications of a UTI in pregnancy
Preterm labour Anaemia Increased perinatal morbidity and mortality
36
what are complications of antiphospholipid syndromes in pregnancy
Placental thrombosis IGUR Pre-eclampsia Recurrent miscarriage
37
how should you manage a woman with antiphospholipid syndrome in pregnancy
Serial USS Induction at term Aspirin + LMWH Postnatal anticoagulation
38
what are prothrombotic conditions that must be screened for in pregnancy
Antiphospholipid syndrome Prothrombin gene mutation Factor V leiden heterozygosity Protein S or C defiency Antithrombin deficiency
39
what is hyperhomocysteinemia associated within pregnancy and how do you treat
increased pregnancy losses increased risk of preeclampsia high dose folic acid
40
how is SLE managed in pregnancy
if there is no lupus anticoagulation/anticardiolipid antibodies, the main risk comes with the organ associated damage from active disease
41
what physiological change occurs to the hematological system in pregnancy
pregnancy is a pro-thrombotic condition clotting factors are increased, fibrinolytic activity is decreased, blood flow is altered by obstruction
42
what is the leading cause of obstetric related maternal death in the UK
pulmonary embolism
43
how does a central venous thrombosis present in pregnancy
headache/stroke
44
whats the treatment for a central venous thrombosis in pregnancy
LMWH (depending on thrombophilia screen and anti-factor Xa level) More needed in pregnancy as clearance is increased If possible, treatment should be stopped around labour Warfarin is teratogenic and may cause foetal bleeding so seldom used antenatally Warfarin and LMWH are safe for breastfeeding women More general measures Mobilisation Hydration Compression stockings (especially if LMWH contraindicated)
45
what are the risks of obesity in pregnancy
``` Thromboembolism Pre-eclampsia Diabetes C-section Wound infection Postpartum haemorrhage Difficult surgery Death Higher rates of congenital abnormalities Death due to complications of diabetes and pre-eclampsia ```
46
what extra management is required for obesity in pregnancy
high dose folic acid (5mg) Vitamin D close monitoring of blood pressure
47
what is required when a pregnant woman has a BMI >40
Formal anaesthetic assessment required Antenatal thromboprophylaxis should be used
48
when is mental illness most affected in pregnancy
in the puerperium
49
what are some red flags relating to mental illness in the puerperium
Recent significant change in mental health Emergence of new symptoms New thought Acts of violence/self-harm New and persistent expressions of incompetency as a mother Estrangement from the infant
50
what is the guidance surrounding the use of SSRIs in pregnancy/post pregnancy
they are generally safe, some neonates may go through withdrawal so its important to watch out for that
51
what antipsychotics are safe to use in pregnancy
most 2nd generation however olanzipine/quitiapine are associated with weight gain and arent recommended for high BMI/gestational diabetes
52
which of the common recreational drugs are definitely teratogenic
cocaine ecstasy benzodiazepines
53
what is the use of recretional opiates associated with in pregnancy
Stillborn Preterm delivery Developmental delay IUGR SIDS neonatal withdrawal/convulsion post-delivery
54
what treatment is required for opiate addiction in pregnancy
methadone maintenance
55
what is the use of cocaine associated with in pregnancy
IUGR Stillbirth SIDS Preterm delivery Placental abruption
56
what teratogenic features is ecstasy associated with
cardiac defects | gastroschiasis
57
whats associated with benzodiazepine use in pregnancy
foetal clefts Maternal hypotonia Withdrawal symptoms
58
whats associated with alcohol intake in pregnancy
early miscarriage IUGR Foetal Alcohol syndrome
59
whats associated with smoking during pregnancy
Stillbirth IUGR Preterm birth Placental abruption SIDS Childhood illnesses - namely increased risk of asthma
60
why is anaemia common in pregnancy
The 40% increase in blood volume in pregnancy is much more of a serum increase than a red cell increase, therefore there is a dilutional anaemia that occurs in pregnancy Therefore the normal Hb in pregnancy is as low as 11.0 g/dl
61
what is a high Hb associated with in pregnancy
IUGR and preterm birth
62
what is the differences between adult and foetal Hb
adult Hb has 2 alpha and 2 beta chains Foetal has 2 alpha and 2 gamma chains foetal Hb has more affinity to oxygen meaning they're better saturated at the same oxygen pressure
63
what are the maternal complications of sickle cell disease in pregnancy
Acute painful crises (35%) Pre-eclampsia Thrombosis
64
what are the foetal complications of sickle cell disease
IUGR Miscarriage Preterm labour Death
65
how do you manae sickle cell disease in pregnancy
Sickle cell specialist Hydroxycarbamide is teratogenic and stopped Penicillin V continued High dose folic acid Aspirin + LMWH indicated Monthly urine culture Iron used to prevent overload Crises management Hydration Analgesia Antibiotics/anticoagulation USS every 4 weeks, induce by 38/40
66
what are maternal complications of thalassaemia in pregnancy
Diabetes Reduced fertility Hepatic dysfunction Cardiac failure
67
what are foetal complications of thalassaemia in pregnancy
Growth restriction Foetal death
68
what should be arranged in preconceptual planning of pregnancy with women with sickle cell disease
Chelation is teratogenic and avoided in 1st trimester Deferrioxamine may be used USS is used 4 weekly
69
what are the 4 types of fmale genital mutilation
Type 1 – clitoridectomy Type 2 – excision Partial/total removal of the clitoris and labia minora +/- labia majora Type 3 - Infibulation Partial closing of the opening of the vagina via repositioning of the labia +/- removal of the clitoris Type 4 Other
70
what are common regions for female genital mutilation
Africa Middle east Malysia Indonesia
71
what are some common reasons cited for female gential mutilation
'fertility' Hygeine Adherence to cultural norms Religion - although not condoned in the bible or koran
72
what are short term complications of female genital mutilation
Pain Bleeding Infection Urinary retention Damage to pelvic organs Death
73
what are longer-term complications of female genital mutilation
Failure to heal UTI Pain during sex Infertility Difficulty menstruating Fistula Severe perineal trauma during childbirth Chronic pelvic dysfunction Vulval pain due to cysts and neuromas

Obstetrics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions