perinatal healthcare Flashcards
What should pregnant women take to avoid neural tube defects and its dose?
Folic acid 500mg
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
What vitamin should pregnant women take to avoid infant neurodevelopment?
Iodine
What defect in pregnancy is associated with lack of iodine?
Infant neurodevelopment
Why/when should pregnant women take vit D?
Only if they’re deficient in vit D
Effects of Ca in pregnancy?
Reduces gestational hypertension and pre-eclampsia
What supplement should pregnant women take to reduce gestational hypertension and pre-eclampsia?
Ca
What is tested to see if pregnant women need to take iron?
Haemoglobin
What can the rise in human chorionic gonadotrophin (HCG) cause in pregnancy?
Nausea and vomiting in pregnancy (NVP)
What is hyperemesis gravidarum (HG)?
Severe form of nausea and vomiting in pregnancy (NVP)
What is the name given to the severe form of nausea and vomiting in pregnancy (NVP)?
Hyperemesis gravidarum (HG)
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
What is used to assess the severity of NVP?
Pregnancy unique quantification of emesis (PUQE-24 or PUQ) score
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
Which potentially needed mineral/vitamin can aggravate NVP?
Iron
Which 2 complementary medications are safe for the indication of NVP and hyperemesis gravidarum (HG)?
Ginger and B6 - pyridoxine
What is the first-line treatment for NVP or HG?
Doxylamine
Which pregnancy category is doxylamine?
A
What is also a first-line treatment for HVP/HG after doxylamine?
Metoclopramide
What can doxylamine be combined with for NVP/HG?
B6 - pyridoxine
What can metoclopramide be combined with for nausea associated with migraines?
Paracetamol
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
What is the second-line treatment for NVP/HG?
Ondansetron
What pregnancy category is ondansetron?
B3
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?
No
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
Ca
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?
- prostaglandin
- balloon catheter
- artificially breaking the water
- 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
B
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
