perinatal healthcare Flashcards by lynne nguyen

What should pregnant women take to avoid neural tube defects and its dose?

Folic acid 500mg

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Which of these is NOT a vitamin pregnant women should consider taking?
A. Vit A
B. Iron
C. Vit D
D. Ca
E. Iodine

Vit A - pregnant women actually shouldn’t take this because high doses has little to no benefit and may cause harm

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What vitamin should pregnant women take to avoid infant neurodevelopment?

Iodine

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What defect in pregnancy is associated with lack of iodine?

Infant neurodevelopment

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Why/when should pregnant women take vit D?

Only if they’re deficient in vit D

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Effects of Ca in pregnancy?

Reduces gestational hypertension and pre-eclampsia

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What supplement should pregnant women take to reduce gestational hypertension and pre-eclampsia?

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What is tested to see if pregnant women need to take iron?

Haemoglobin

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What can the rise in human chorionic gonadotrophin (HCG) cause in pregnancy?

Nausea and vomiting in pregnancy (NVP)

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What is hyperemesis gravidarum (HG)?

Severe form of nausea and vomiting in pregnancy (NVP)

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What is the name given to the severe form of nausea and vomiting in pregnancy (NVP)?

Hyperemesis gravidarum (HG)

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Which is NOT a sx of hyperemesis gravidarum (HG)?
A. Dehydration
B. Electrolyte abnormalities
C. Severe nausea and vomiting
D. Inability to eat/drink properly
E. Inhibition of growth of foetus

E - NVP actually doesn’t harm the baby

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What is used to assess the severity of NVP?

Pregnancy unique quantification of emesis (PUQE-24 or PUQ) score

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What are some non-pharmacological measures for NVP/HG?

Change activities to minimise fatigue
Maintain hydration and nutrients
Acupressure bands
Review multivitamin usage like iodine/folic acid

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Which potentially needed mineral/vitamin can aggravate NVP?

Iron

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Which 2 complementary medications are safe for the indication of NVP and hyperemesis gravidarum (HG)?

Ginger and B6 - pyridoxine

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What is the first-line treatment for NVP or HG?

Doxylamine

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Which pregnancy category is doxylamine?

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What is also a first-line treatment for HVP/HG after doxylamine?

Metoclopramide

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What can doxylamine be combined with for NVP/HG?

B6 - pyridoxine

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What can metoclopramide be combined with for nausea associated with migraines?

Paracetamol

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Why is metoclopramide+paracetamol not recommended for NVP?

Because it is an unnecessary dose of paracetamol. Women can also take other paracetamol tablet without knowing it’s already in the combination, which leads to toxicity

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What is the second-line treatment for NVP/HG?

Ondansetron

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What pregnancy category is ondansetron?

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What is the main side effect of ondansetron?

Constipation

Define antiemetic

Prevents vomiting

What causes reflux and heartburn in pregnancy?

The baby's growing size and hormones putting pressure on oesophageal sphinter

3 drug classes for reflux and heartburn in pregnancy, and which one is first-line?

Antacids (first-line), H2 antagonist, PPI

Rising levels of P in pregnancy cause a reduction in gastric motility and increase gastric transit time. What does this cause for pregnant women?

Constipation

How can pregnant women change their supplementation to fix their gestational constipation?

Replace iron with iodine or folic acid

Which of these is not a management strategy for gestational constipation? A. Increase iron supplements B. Increase fluid uptake C. Increase fibre D. Reduce caffeine E. Regular exercise

A - iron actually induces constipation

What are some medical options for gestational constipation? (3)

- Bulk-forming laxatives (psyllium) - Osmotic laxatives (macrogol, lactulose, sorbitol) - Stimulants

Define haemorrhoids

Enlarged, swollen veins around anus with anorectal bleeding, painful bowel movements, anal pain and itching

What can hormonal changes and pressure changes in blood flow, sometimes from constipation cause?

Haemorrhoids

Medications for haemorrhoids (2)?

Topical steroids and topical anaesthetic

Does E. coli-induced UTI cause harm to baby? What can it cause?

Does pyelonephritis-induced UTI cause harm to baby? What can it cause?

Yes - associated with low birth weight

Which of these is NOT a medical tx for UTI in pregnancy? A. Doxycycline B. Nitrofurantoin C. Cefalexin D. Trimethoprim E. Amoxicillin+clavulanate

A - long term use actually causes harm to baby

What antibiotic is used in gestational UTI when the pathogen is resistant?

Amoxicillin or amoxicillin+clavulanate

What are the 3 first-line drugs for gestational UTI?

- Nitrofurantoin - Cefalexin - Trimethoprim

What deficiencies are a cause of anaemia?

Iron, folate, and B12 deficiency

Why is anaemia common is pregnancy? (2 reasons)

Because there is 3x the demand for iron in pregnancy, particularly in the 2nd/3rd trimester Also because there might be a reduction in iron from the diet due to NVP

What happens when there is pulling of blood on the surface of veins as a result of insufficient valves that normally prevent blood from draining down the back of legs?

Varicose veins

SE of varicose veins? (3)

- Itching - Aching - Swelling in feet/ankles

What is defined as a multi-system disorder involving hypertension + an organ system/the foetus?

Pre-eclampsia

What medication is used in mod-high risk pre-eclampsia?

Low dose aspirin

What supplementation can be used to reduce hypertension and pre-eclampsia

Which BP medications are C/I in pregnancy?

Diuretics, some beta blockers, ACEI, -sartans

Which 2 beta blockers are the only 2 of that class to be safe in pregnancy?

Labetalol and oxprenolol

What meds to use for VTE?

Low molecular weight heparin (LMWH) or SC heparin

When should you stop using heparin for VTE? Why?

Onset of labour to minimise bleeding complications

What meds to use postpartum for VTE that is safe in breast-feeding?

Low molecular weight heparin (LMWH) or warfarin

What is defined as signs and sxs of discomfort and pain around pelvis and lower back that can radiate to upper thighs and perineum?

Pelvic girdle pain

What does OGTT stand for

Oral glucose tolerance test

Which is NOT a GDM risk factor? A. Age B. Family history C. PCOS D. Being overweight E. Previously large baby D. Previous GDM F. Unhealthy diet

F - pretty sure you can have a hectic diet and still get it in pregnancy

What meds can be used for GDM?

Metformin and insulin

What should pregnant women do with drugs they're already using for diabetes prior to pregnancy?

Replace them with insulin or metformin

What is defined as a onset of labour <37 weeks

Pre-term labour

Which of these is NOT a cause of pre-term labour? A. Pelvic girdle pain B. Cervical incompetence C. Maternal bleeding D. Placenta insufficiency E. Infections

A - pelvis girdle pain isn't harmful to mother or baby

Define tocolytics

Drug class used to suppress pre-term labour

What drug class do these drug belong to? Salbutamol IV, nifedipine

Tocolytics

Which tocolytic drug is most preferred?

Nifedipine

MOA of tocolytics

Uterine relaxation in pre-term labour

Why give 1 week of antenatal corticosteroids during pre-term labour?

To promote foetal lung maturity and prevent respiratory distress syndrome (RDS)

What drugs are given to prevent respiratory distress syndrome (RDS)?

Antenatal corticosteroids - betamethasone or dexamethasone

What complementary drugs can be used for pre-term labour?

Mg sulfate

What are the 4 ways to induce labour?

1. prostaglandin 2. balloon catheter 3. artificially breaking the water 4. oxytocin

Which is NOT a way to induce labour? A. Nifedipine B. Balloon catheter C. artificially breaking the water D. Oxytocin E. Prostaglandin

A - its a medication to stop labour (the opposite)

What drug class do these belong to? DinaPPROSTone, gemePROST

Prostaglandin

MOA of prostaglandin

Softens and dilates cervix and induce uterine contraction

How long do you wait before giving oxytocin after already giving prostaglandin?

6 hours in between after water is already broken

Which is NOT a non-medicated pain relief therapy? A. TENS machine B. CPR C. Acupuncture and acupressure D. Birth ball E. Heat packs

What does TENS in TENS machine stand for?

Transcutaneous electrical nerve stimulation

Which of these is NOT a pain medication for labour? A. Nitrous oxide gas B. Non-opioid analgesics C. Opioids D. Epidural

B - there's no evidence on this, so not used

What opioids are used in labour pains and which is preferred over the other?

Morphine (preferred) and pethidine

Where is an epidural injected?

Small space in back near spinal cord

True or False? Epidural and spinal combination gives the most INFERIOR pain relief for labour compared to everything else

False - epidurals are the most superior pain relief for labour

What is a downside to using an epidural and why does this happen?

It can prolong labour because the loss of sensation of contractions causes the pregnant woman to not know when to push