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Pathology during Pregnancy Flashcards

1
Q

What are the complications of gestational hypertension?

A

Pre-eclampsia
Chronic hypertension
Inc lifetime CV risk

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2
Q

What disorders put women at high risk of pre-eclampsia?

A 
HTN disease during a prev pregnancy
CKD
Autoimmune disease (SLE, antiphospholipid syndrome)
Type1 &2 DM
Chronic HTN
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3
Q

How should women at high risk of pre-eclampsia be treated?

A

75mg Aspirin daily for 12weeks until the birth of the baby

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4
Q

What is the target BP for uncomplicated chronic hypertension?

A

150/100mmHg

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5
Q

Why should ACE/ARBs not be used in pregnancy?

A

Inc risk of congenital abnormalities

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6
Q

What should be offered to women with pre-eclampsia postpartum?

A

Medical review at 6-8weeks after birth

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7
Q

Define chronic hypertension

A

Hypertension that is present at the booking visit or before 20 weeks or if the woman is already taking antihypertensive medication when referred to maternity services. It can be primary or secondary in aetiology.

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8
Q

Define gestational hypertension

A

New hypertension presenting after 20 weeks without significant proteinuria.

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9
Q

Define pre-eclampsia & eclampsia

A

Pre-eclampsia: New hypertension presenting after 20 weeks with significant proteinuria
Eclampsia: Convulsions in the presence of pre-eclampsia diagnostic factors due to brain hypoxia from oedema & vasospasm

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10
Q

What components make up HELLP Syndrome?

A

Haemolysis, elevated liver enzymes and low platelet count.

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11
Q

What are the symptoms of pre-eclampsia?

A 
Severe headache
Problems with vision: Blurring, flashing
Severe pain below the ribs
Vomiting
Sudden swelling of the face, hands, feet
Hyper-reflexia
Proteinuria
Oliguria 
Spont bleeding
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12
Q

How should chronic hypertension be monitored after birth?

A
  • Daily BP for first 2 days after birth
  • BP at least once between 3-5days after birth
  • Continue antenatal antihypertensives
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13
Q

What risk factors need to be taken into account in gestational hypertension/pre-eclampsia?

A
  • Nulliparity, twins/triplets
  • > 40 OR <20
  • Pregnancy interval >10years
  • FHx/prev Hx of pre-eclampsia
  • BMI >35
  • Multiple pregnancy
  • Pre-existing vascular/renal disease
  • Chronic HTN
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14
Q

How should gestational hypertension be managed?

A

Mild: Conservative
Moderate: Labetalol, measure BP x2/week, measure proteinuria every visit
Severe: Labetalol, measure BP 4/day, measure proteinuria daily

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15
Q

In gestational hypertension what is considered mild, moderate & severe?

A

Mild: 140/90
Moderate: 150/100
Severe: 160/110

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16
Q

When in gestational hypertension would you consider delivery?

A

37weeks

Severe gestational HTN >160/110

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17
Q

When in pre-eclampsia would delivery be considered?

A

Pre-eclampsia at 34-36weeks

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18
Q

What fetal monitoring should be done in a woman with hypertension?

A

Chronic: USS- fatal growth, amniotic fluid vol, umbilical artery doppler between 28-30weeks & 32-34weeks, CTG if activity abnormal

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19
Q

What treatment should be given to a patient with pre-eclampsia who has a convulsion?

A

IV Magnesium Sulphate- continued >24hrs after delivery

Use: Prevention & termination of fit

20
Q

Which antihypertensive medications have no effects on babies receiving breast milk? Describe them

A

Labetalol: 1st line
Nifedipine: CCB & VasoD, used w/Labetalol or if CI
Atenolol
Metoprolol
Methyldopa: Centrally acting stimulates beta adrenergic receptors, dec total peripheral vascular resistance
Hydralazine: Unknown mechanism, vasodilation arterioles & reduce BP

21
Q

Which medications should not be advised in breast feeding or preconceptually?

A

BF: ARBs, Amlodipine, ACEi, Statins (also discontinued in pregnancy)
Pre: Gliclazide, ACEi, ARB, Statin

22
Q

Which complications are more common in women with pre-existing diabetes?

A 
Miscarriage &amp; stillbirth
Pre-eclampsia
Preterm labour
Diabetic retinopathy can rapidly worsen during pregnancy
Macrosomia
Perinatal mortality
Postnatal fetal hypoG
23
Q

What are the glucose targets for a woman with type1 diabetes wanting to conceive?

A

Fasting glucose: 5-7 on waking &

Plasma glucose 4-7 before meals

24
Q

How is gestational diabetes diagnosed?

A 
Oral Glucose Tolerance Test
Usually 2nd trimester
EITHER
Fasting glucose >5.6
2hour plasma glucose >7.8
25
Q

What are the targets for blood glucose in pregnancy regardless of the type of diabetes?

A

Fasting 5.3
AND
1hour after meal 7.8 OR
2hour after meal 6.4

26
Q

How is a booking appointment different for someone with diabetes?

A

Going diabetes & antenatal care
Optimal glucose control
Maternal retinal assessment
Joint diabetes & antenatal clinic every 1-2weeks
Offer self-monitor BM asap for prev gestational diabetes
Confirm viability at 7-9weeks

27
Q

In someone with diabetes what happens at each scan until birth?

A

20weeks: USS for fetal structural abnormalities (heart & vessels)
28 & 32weeks: USS fetal growth & amniotic fluid vol

28
Q

When should IOL be offered in diabetes?

A

Type 1or2: 37-38weeks

Gestational: <40weeks

29
Q

What postnatal care is given for someone with gestational diabetes?

A

Oral Glucose Tolerance Test 6weeks after birth
Lifestyle advice
Annual HbA1c

30
Q

What are risk factors for gestational diabetes?

A 
BMI >30
Prev macrocosmic baby 
Prev gestational diabetes
Fhx of diabetes
Minority ethnic family origin
31
Q

What are the treatment options for gestational diabetes?

A

Diet & exercise
Metformin
Insulin- always have a fast acting form of glucose available too
Glibenclamide (Metformin CI & not wanting insulin)
Type1-Glucagon

32
Q

How often should blood glucose be measured during labour?

A

Every 1hour & maintained between 4-7
IV Dextrose & Insulin infusion considered in type 1 from onset of labour or if blood glucose not maintained between 4-7

33
Q

What monitoring should be done on a baby born to a diabetic mother?

A

Blood glucose: 2-4hours after birth
Polycythaemia test (with signs)
Hyperbilirubinaemia test (with signs)
hypoCa & hypoMg test (with signs)
ECG (signs of cardioM or congenital heart disease inc murmur)
Do not transfer to community care until 24hours old
Feed baby within 30mins of birth then every 2-3hours

34
Q

What are the indications for admission to the neonatal unit following a diabetic mother?

A 
Respiratory distress
hypoG with clinical signs
Jaundice requiring phototherapy
Born <34weeks
Needs IV fluids/ NG tube
Signs of cardio/encephalopathy/ polycythaemia
35
Q

How is DVT & PE diagnosed?

A

DVT: Compression duplex USS
PE: ECG & CXR, CTPA (or V/Q lung scan)
Bloods: FBC, U&E, LFTs, Coag screen

36
Q

What is the treatment of a VTE in pregnancy?

A

LMWH IM titred against booking/early pregnancy weight
Continue for at least 6weeks postnatally
Discontinued 24hours prior to planned delivery

LMWH given prophylactically to anyone with VTE RF.

37
Q

What are the risk factors for VTE in pregnancy?

A 
Prev VTE
Thrombophilia
Obesity
Immobility/long distance travel
Inc maternal age
Co-morbidities: IBD, heart disease, pre-eclampsia
38
Q

What are the risk factors for VTE in the first trimester of pregnancy?

A

Hyperemesis Gravidarum
Ovarian hyperstimulation
IVF
C-Section

39
Q

What are the main cardiac causes of maternal death?

A 
MI
Ischaemic heart disease
Peripartum cardiomyopathy
Rheumatic HD
Congenital HD
Pulmonary hyperT
40
Q

What are the risk factors for an MI in pregnancy?

A 
Pregnancy itself raises risk by x3-4 
Risk x30 higher in those >40
Chronic hyperT
Pre-eclampsia
Diabetes
Smoking
Obesity &amp; hyperL
Most asymptomatic before pregnancy
41
Q

When does peripartum cardiomyopathy present?

A

Most in late pregnancy/ early puerperium but up to 6months after delivery

42
Q

When should peripartum cardiomyopathy be considered?

A

Pregnant/puerperal woman complaining of:
SOB
esp lying flat/at night
25% also have hyperT

43
Q

What is used in labour for a gestational diabetic whose blood sugar is >7mmol/L?

A

IV Dextrose & Insulin infusion

Difficult to regulate sugars in labour

44
Q

How is pre-eclampsia diagnosed?

A

Urinary protein: creatinine >30 OR 24hr urine protein >300mg

45
Q

What is the treatment for pre-eclampsia?

A

Deliver if appropriate
All: Admitted
Labetalol
Risk of seizure: Magnesium Sulphate

46
Q

What are the signs of a patient at risk of an eclamptic fit? What is their ultimate management?

A

Very high, uncontrolled HTN
Abnormal blood results (impaired LFTs & thrombocytopenia)
Symptoms: Headache, epigastric pain, blurred vision, clonus, hyper-reflexia
DELIVER-only ‘cure’

GOSH (17 decks)

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