Pregnancy

Question 1

Most common cause of HTN in pregnancy

Answer 1

Pre-ecclampsia
Gestational
Chronic

Question 2

Summary of normal physiological changes in pregnancy:

Answer 2

Vascular resistance decreases
HR increases
Cardiac output increases (130%)
Blood pressure decreases in first semester and then begins to rise in third

Question 3

Risk factors for developing pre-eclampsia?

Answer 3

• presence of antiphospholipid syndrome with a relative risk of 9.7
• history of pre-eclampsia (RR 7.2)
• nulliparity
• obesity
• age>40

Question 4

Hep B and pregnancy

Answer 4

All woman should be tested for HBsAg in antenatal screen - if postive then test others

Woman with high viral load >200,000, should get tenofovir from week 28 to reduce the risk of transmission

Infant born to HBsAg positive woman should receive the HBIg and Hep B vaccine as soon after birth (optimum <4 hours). Then get the routine schedule hep B vax (2, 4, 6 mo)

and then get HBsAg and Anto-HBs to check for response to vax and exclude MTCT

DO NOT NEED TO CHANGE MODE OF DELIVERY
CAN BREAST FEED (it is NOT a risk of MTCT), even with tenofovir

Question 5

what happens to renin level in pregnancy?

Answer 5

increases

Question 6

Eclampsia:

Answer 6

There is a universal agreement that women with eclampsia require anticonvulsant therapy to prevent recurrent seizures and the possible complications of repeated seizure activity: neuronal death, rhabdomyolysis, metabolic acidosis, aspiration pneumonitis, neurogenic pulmonary oedema, and respiratory failure. Compared with phenytoin and diazepam, magnesium sulphate reduces the rate of recurrent seizures by one-half to two-thirds and reduces the rate of maternal death by one-third.

Question 7

RA

Answer 7

The majority of patients with rheumatoid arthritis will have reduced rheumatoid arthritis activity during pregnancy. 90% of patients will have a flare up of their disease during the postpartum period, usually within the first 3 months

Question 8

Maternal cardiovascular risk

Conditions in which pregnancy is contraindicated

Answer 8

Pulm. arterial hypertension of any cause
Severe ventricular dysfunction - EF <30% NYHA 3/4
Prev. peripartum CM with any residual impairment in LV function

Severe MS or symptomatic severe AS
Marfan sx with aorta dilated >45mm
Aortic dilatation >50mm with biscupid AV

Native severe coarctation