Pregnancy Flashcards
what is pre eclampsia?
hypertensive syndrome developed after 20wks gestation
what causes pre eclampsia?
failure of trophoblast invasion with causes arterial maladaptation
what does the placenta produce in pre eclampsia? what does this cause?
pro inflam proteins
vasoconstriction
salt retention
high BP
features of pre eclampsia?
headache vision change N + V oedema urine output change RUQ pain SOB
Ix for pre eclampsia?
BP
urinalysis
CTG
umbilical artery doppler
if at high risk, what pre eclampsia Tx is given? when?
aspirin from 12 wks
betamethasone at 34-36wks
what are high risk factors for pre eclampsia?
first preg extremes of age preg interval of >10yrs BMI high FHx multi preg
Tx for pre eclampsia?
labetalol
nifedipine
hydralazine
methyldopa
what emergency can occur in pre eclampsia?
pre eclamptic toxaemia
what is eclampsia?
tonic clonic seizure and pre eclampsia
Tx for eclampsia?
IV labetalol/hydralazine
IV magnesium sulphate
IV diazepam (if persistent seizures)
what does rhesus negative mean?
D antigen not found on surface of RBC
what causes sensitisation in a RhD -ve mother?
leak of babies (RhD +ve RBC) into circulation, causing anti D antibodies produced
what causes haemolytic disease of newborn?
RhD -ve sensitised mother has damage, causing anti D to cross placenta and haemolyse RhD +ve babies RBC
what happens to the baby in haemolytic disease of new born?
haemolysis
decreased oxygen delivery
-> haemolytic anaemia
features of haemolytic disease of new born?
jaundice
CCF
hepatosplenomegaly
what type of jaundice occurs in haemolytic disease of new born?
pre hepatic
Ix for haemolytic disease of new born?
maternal blood type
maternal serum Rh antibody
coombs test
Tx for haemolytic disease of new born?
anti D immunoglob
28 and 34 wks
or 72hrs after an incident
what are dizygotic and monozygotic twins?
di - two sperm, two ova
mono - one sperm, one ova
for twins, what sacs can they be in? what are they called?
dichorionic - separate
monochorionic diamniotic - same sac but separate
monochorionic monoamniotic - same sac
what affect does hyperglycaemia have on the fetus?
macrosomia
hypoxic
metabolic reprogramming (obesity/diabetes)
risk factors for gestational diabetes?
>40 FHx obesity previous big baby/still birth PCOS
when is gestational diabetes recognised as not T2DM?
diagnosed during pregnancy, not at booking
Ix for gestational diabetes?
GTT at 28 weeks
fasting ≥ 5.1, 2hr ≥ 8.5
tx for gestational diabetes?
diet and exercise
insulin therapy
follow up for gestational diabetes?
fasting glucose 6wks PP
complications of gestational diabetes?
pre eclampsia polyhydramnios macrosomia shoulder dystocia neonatal hypos
if diabetic during pregnancy, what should you take?
5mg folic acid
what are the two types of IUGR? what causes them?
symmetrical - affected in early preg
disproportional - insult in late preg
when is
1st
2nd
3rd trimester from?
1 - 13 wks
2 - 28 wks
3 - 40wks
when is a baby a neonate?
0-27 days
what should be used for VTE prophylaxis in pregnant women?
LMWH
what diabetes drug should be avoided in pregnancy?
SU (switch to insulin)
when does ‘baby blues’ most commonly occur?
3-10 days after birth
features of baby blues?
tearful irritable anxious poor sleep confused
Tx of baby blues?
self limiting
support
reassure
features of puerperal psychosis?
irrational ideas
mania
delusions
hallucinations
antidepressants safe in pregnancy and breast feeding?
sertraline
fluoxetine
paroxetine
features of floppy baby syndrome? what causes it?
hypothermia
hypotonia
respiratory depression
withdrawal
benzos cause it
can lithium be used in pregnancy/breastfeeding?
yes but monitor
NOT IN BREASTFEEDING
when is usual onset of PND?
2-6wks
features of PND?
irritable anxious lacks enjoyment poor sleep wt loss lasts for weeks
if a pregnant women requires a smear, what advice is given?
rescheduled to 12 wks post delivery
what is sheehan’s syndrome? why does it happen?
post partum hypopituitarism
ischaemia due to blood loss in pregnancy
what emergency can occur in pre eclampsia?
HELLP
Ix for HELLP?
FBC
U and Es
LFTs
what vitamin should be taken during pregnancy?
Vit D
when is folic acid useful? why?
only up until 4 wks
neural tube closes
Tx for HELLP?
magnesium sulphate
IV dexamethasone
blood product replacement
DELIVERY OF FETUS