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Obstetrics I - OSCE > PET > Flashcards

PET Flashcards

1
Q
A
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2
Q

Def of PET

A
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3
Q

RF for PET

  • Maternal Specific
A
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4
Q

RF for PET

  • Pregnancy Specific
A
  • Vesicular mole
  • Multifetal Pregnancy
  • Polyhydraminos
  • Seasonal variation: More common in winter
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5
Q

Maternal Specific RF for PET

  • Age
A

< 20 or > 35 years.

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6
Q

Maternal Specific RF for PET

  • Gravidity & Parity
A

More in primigravidas specially elderly primigravidas.

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7
Q

Maternal Specific RF for PET

  • Race
A

More in black races

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8
Q

Maternal Specific RF for PET

  • SES
A

Low

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9
Q

Etiology of PET

A

Theories Include:

  • Increased Pressor Effect
  • Abnormal Placentation
  • Genetic Factors
  • Immunological Factors
  • Inflammatory Factors
  • Biochemical Factors
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10
Q

Theories of PET

  • Increased Pressor Effect
A
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11
Q

Complications of PET

A

Maternal & fetal

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12
Q

Maternal Complications of PET

A
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13
Q

Maternal Complications of PET

  • ICH
A

Due to severe HTN.

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14
Q

Maternal Complications of PET

  • Remote Complications
A
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15
Q

Maternal Complications of PET

  • HELLP Syndrome
A
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16
Q

Def of HELLP Syndrome

A

Fatal condition characterized by:

  • Hemolysis: Bilirubin ≥ 1.2 mg/dl.
  • Elevated Liver enzymes: SGOT > 70 IU/L.
  • Low Platelet count: < 100000/mm3.
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17
Q

DDx of HELLP Syndrome

A

 Acute fatty liver in pregnancy.

 Thrombotic thrombocytopenic purpura.

 Hemolytic uremic syndrome.

 Hepatitis (viral or drug induced).

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18
Q

Maternal Mortality in HELLP Syndrome

A

80-90%.

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19
Q

RR in HELLP Syndrome

A

5%

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20
Q

Fetal Complications in PET

A
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21
Q

Prediction of PET

  • Hx
A

High risk factors (from history since 1st antenatal visit).

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22
Q

Prediction of PET

  • Ex
A
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23
Q

Prediction of PET

  • Vascular Reactivity Tests
A
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24
Q

Prediction of PET

  • Labs
A

↑↑ serum uric acid, hypocalciuria & ↑↑ fibronectin levels.

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25
Q

Prediction of PET

  • Uterine Artery Doppler
A

To detect uteroplacental hypoperfusion

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26
Q

Clinical Signs of PET

A

Signs: Preeclampsia is a disease of signs & it has the following 3 cardinal signs:

  • HTN
  • PTNuria
  • Edema
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27
Q

Clinical Signs of PET

  • HTN
A
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28
Q

Clinical Signs of PET

  • PTNuria
A
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29
Q

Clinical Signs of PET

  • Edema
A
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30
Q

Clinical Symptoms of PET

A
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31
Q

Clinical Symptoms of PET

  • Epigastric Pain
A

Due to distension of liver capsule.

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32
Q

Clinical Symptoms of PET

  • Headache
A

Due to HTN & cerebral edema.

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33
Q

Clinical Symptoms of PET

  • Persistent N&V
A

Due to cerebral edema, congestion of gastric mucosa or liver affection.

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34
Q

Investigations for PET

  • Labs
A
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35
Q

Assessment of Severity of PET

A
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36
Q

Def of Imminent eclampsia (preeclamptic state)

A

Worse type of severe preeclampsia which will end in eclampsia if not urgently treated.

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37
Q

Dx of Imminent eclampsia (preeclamptic state)

A
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38
Q

TTT of Imminent eclampsia (preeclamptic state)

A

Immediate control & TOP èin 6 hours.

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39
Q

DDx of PET

A
  • Causes of HTN with pregnancy
  • Causes of proteinuria with pregnancy
  • Causes of edema with pregnancy
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40
Q

DDx of PET

  • Causes of HTN with Pregnancy
A

 Preeclampsia (commonest cause) & eclampsia.

 Gestational HTN

 Chronic HTN.

 2ry HTN: As in chronic nephritis, coarctation of aorta & Cush ing syndrome.

41
Q

DDx of PET

  • Causes of PTNuria with pregnancy
A

 Preeclampsia & eclampsia.

 Contamination of specimen e vaginal discharge (commonest cause) .

 UTI.

 Renal hypoxia: As in CHF & severe anemia.

 Hyperemesis gravidarum: Rarely occurs in severe cases.

 Orthostatic proteinuria.

42
Q

DDx of PET

  • Causes of edema with Pregnancy
A

 Preeclampsia & eclampsia.

 Gestational edema.

 Local causes: Leading to unilateral edema as inflammations or DVT.

 Generalized edema: Cardiac, hepatic, renal, nutritional or angioneurotic edema.

 Orthostatic edema.

43
Q

Prevention of PET

44
Q

Plan of TTT of Mild PET

45
Q

Plan of TTT of Severe Preclampsia

46
Q

Plan of TTT of Imminent Eclampsia

A

Immediate control & TOP ein 6 hours.

47
Q

Lines of TTT of PET

A
  • Expectant treatment
  • Control of HTN
  • Prevention & control of convulsions
  • Termination of pregnancy
  • Postnatal care
  • Treatment of complications
48
Q

Expectant TTT of PET

49
Q

Expectant TTT of PET

  • Rest
A

Complete physical & mental rest.

50
Q

Expectant TTT of PET

  • Diet
A

High protein & CHO e low Na+ diet.

51
Q

Expectant TTT of PET

  • Sedation
A

Benzodiazepines or phenobarbitone.

52
Q

Expectant TTT of PET

  • Observation
53
Q

Control of HTN in PET

  • Indications
A

Severe cases (antihypertensives have doubtful value in mild cases)

54
Q

Control of HTN in PET

  • Rationale
A

Prevention of maternal complications & not fetal complications ( dec BP → dec placental perfusion → fetal distress & may be IUFD).

55
Q

Control of HTN in PET

  • Precautions
A

Dec BP should be gradual & DBP should be around 100 mmHg (below that → dec placental perfusion).

56
Q

Control of HTN in PET

  • Disadvantages
57
Q

Control of HTN in PET

  • Used Drugs
A

Parenteral drugs:

  • Hydralazine
  • Labetalol
  • Diazoxide

Oral Drugs:

  • Methyl DOPA
  • Nifidiopine
  • Adrenergic blockers (Atenolol)
  • Mono-Hydralazine
  • Prazosin
58
Q

Control of HTN in PET

  • Hydralazine
59
Q

Control of HTN in PET

  • Labetalol
A

A & non-selective B-adrenergic blocker → VD.

60
Q

Control of HTN in PET

  • Diazoxide
A

Used in severe resistant HTN as a last resort.

61
Q

Control of HTN in PET

  • Methyl DOPA
62
Q

Control of HTN in PET

  • Nifidipine
63
Q

Control of HTN in PET

  • Mono-hydralazine
A

Weak antihypertensive used in combination
é ß blockers to inc their efficacy & dec their side effects.

64
Q

Control of HTN in PET

  • Prazosin
A

Weak antihypertensive - used in combination é other drugs.

65
Q

TTT of PET

  • Prevention & control of convulsions
A
  • Magnesium sulfate (MgSo4): Drug of choice
  • Diazepam (valium)
  • Phenytoin (Epanutin)
66
Q

Prevention & control of convulsions in PET

  • Action of MgSO4
A
  1. Curare like action on motor end plate → paralysis of peripheral muscles.
  2. Weak CNS depressant.
  3. Mild VD & diuretic.
  4. inc PGI2 production & dec platelet aggregation.
67
Q

Prevention & control of convulsions in PET

  • Indications of MgSO4
A

Used to prevent convulsions in cases in which delivery is decided.

68
Q

Prevention & control of convulsions in PET

  • Routes of MgSO4
A

IV (preferred rout), IM (painful) or SC (not used now).

69
Q

Prevention & control of convulsions in PET

  • Doses of MgSO4
70
Q

Prevention & control of convulsions in PET

  • Duration of MgSO4
A

Maintenance therapy is continued for 24 h after delivery.

71
Q

Prevention & control of convulsions in PET

  • Monitoring of MgSO4
72
Q

Prevention & control of convulsions in PET

  • SE of MgSO4
73
Q

Maternal SE of MgSO4

74
Q

Maternal SE of MgSO4

  • Toxicity
75
Q

Maternal SE of MgSO4

  • Drug Interactions
A
  1. Enhances action of curare like drugs.
  2. Synergistic action if given é CCB.
76
Q

Fetal SE of MgSO4

A

dec beat to beat variability in FHR pattern

77
Q

Neonatal SE of MgSO4

A

Hypermagnesemia, hypotonia & poor suckling.

78
Q

Antidote of MgSO4

A

Ca++ gluconate.

79
Q

Stroganoff method

A

Use of MgSo4 + morphine.

80
Q

Indications of TOP in PET

81
Q

Methods of TOP in PET

A

Vaginal & CS

82
Q

Vaginal Delivery in PET

  • Prerequisities
83
Q

Vaginal Delivery in PET

  • Precautions
84
Q

Postnatal Care in PET

  • Observation
85
Q

Signs of Improvement in Postnatal Care in PET

86
Q

Def of Eclampsia

A

Occurrence of tonic-colonic convulsive seizures that can’t be attributed to other causes in woman e preeclampsia.

87
Q

RF for Eclampsia

A

As pre-eclampsia.

88
Q

Types of Eclampsia

  • Acc to time of occurence
89
Q

Types of Eclampsia

  • Acc to recurrence
90
Q

Complications of Eclampsia

91
Q

Dx of Eclampsia

92
Q

Criteria of severity of eclampsia (Eden’s criteria)

93
Q

DDx of Eclampsia

  • Causes of Convulsion with pregnancy
94
Q

DDx of Eclampsia

  • Causes of Coma with pregnancy
95
Q

TTT of Eclampsia

A
  • During Fit
  • In Between Fits
96
Q

TTT of Eclampsia

  • During Fit
97
Q

TTT of Eclampsia

  • In between Fits
A
  • General measures
  • Prevention of further attacks of convulsions
  • Control of HTN
  • Termination of pregnancy
  • Postnatal care
  • Treatment of complications
98
Q

General Measures of TTT of Eclampsia in between fits

  • Observation
99
Q

TTT of Eclampsia in between fits

  • TOP

Obstetrics I - OSCE (32 decks)

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