Pregnancy

Question 1

what is pre eclampsia?

Answer 1

hypertensive syndrome developed after 20wks gestation

Question 2

what causes pre eclampsia?

Answer 2

failure of trophoblast invasion with causes arterial maladaptation

Question 3

what does the placenta produce in pre eclampsia? what does this cause?

Answer 3

pro inflam proteins
vasoconstriction
salt retention
high BP

Question 4

features of pre eclampsia?

Answer 4

headache
vision change
N + V
oedema 
urine output change
RUQ pain 
SOB

Question 5

Ix for pre eclampsia?

Answer 5

BP
urinalysis
CTG
umbilical artery doppler

Question 6

if at high risk, what pre eclampsia Tx is given? when?

Answer 6

aspirin from 12 wks

betamethasone at 34-36wks

Question 7

what are high risk factors for pre eclampsia?

Answer 7

first preg
extremes of age
preg interval of >10yrs
BMI high
FHx
multi preg

Question 8

Tx for pre eclampsia?

Answer 8

labetalol
nifedipine
hydralazine
methyldopa

Question 9

what emergency can occur in pre eclampsia?

Answer 9

pre eclamptic toxaemia

Question 10

what is eclampsia?

Answer 10

tonic clonic seizure and pre eclampsia

Question 11

Tx for eclampsia?

Answer 11

IV labetalol/hydralazine
IV magnesium sulphate
IV diazepam (if persistent seizures)

Question 12

what does rhesus negative mean?

Answer 12

D antigen not found on surface of RBC

Question 13

what causes sensitisation in a RhD -ve mother?

Answer 13

leak of babies (RhD +ve RBC) into circulation, causing anti D antibodies produced

Question 14

what causes haemolytic disease of newborn?

Answer 14

RhD -ve sensitised mother has damage, causing anti D to cross placenta and haemolyse RhD +ve babies RBC

Question 15

what happens to the baby in haemolytic disease of new born?

Answer 15

haemolysis
decreased oxygen delivery
-> haemolytic anaemia

Question 16

features of haemolytic disease of new born?

Answer 16

jaundice
CCF
hepatosplenomegaly

Question 17

what type of jaundice occurs in haemolytic disease of new born?

Answer 17

pre hepatic

Question 18

Ix for haemolytic disease of new born?

Answer 18

maternal blood type
maternal serum Rh antibody
coombs test

Question 19

Tx for haemolytic disease of new born?

Answer 19

anti D immunoglob
28 and 34 wks
or 72hrs after an incident

Question 20

what are dizygotic and monozygotic twins?

Answer 20

di - two sperm, two ova

mono - one sperm, one ova

Question 21

for twins, what sacs can they be in? what are they called?

Answer 21

dichorionic - separate
monochorionic diamniotic - same sac but separate
monochorionic monoamniotic - same sac

Question 22

what affect does hyperglycaemia have on the fetus?

Answer 22

macrosomia
hypoxic
metabolic reprogramming (obesity/diabetes)

Question 23

risk factors for gestational diabetes?

Answer 23

>40
FHx
obesity
previous big baby/still birth
PCOS

Question 24

when is gestational diabetes recognised as not T2DM?

Answer 24

diagnosed during pregnancy, not at booking

Question 25

Ix for gestational diabetes?

Answer 25

GTT at 28 weeks | fasting ≥ 5.1, 2hr ≥ 8.5

Question 26

tx for gestational diabetes?

Answer 26

diet and exercise | insulin therapy

Question 27

follow up for gestational diabetes?

Answer 27

fasting glucose 6wks PP

Question 28

complications of gestational diabetes?

Answer 28

``` pre eclampsia polyhydramnios macrosomia shoulder dystocia neonatal hypos ```

Question 29

if diabetic during pregnancy, what should you take?

Answer 29

5mg folic acid

Question 30

what are the two types of IUGR? what causes them?

Answer 30

symmetrical - affected in early preg | disproportional - insult in late preg

Question 31

when is 1st 2nd 3rd trimester from?

Answer 31

1 - 13 wks 2 - 28 wks 3 - 40wks

Question 32

when is a baby a neonate?

Answer 32

0-27 days

Question 33

what should be used for VTE prophylaxis in pregnant women?

Answer 33

LMWH

Question 34

what diabetes drug should be avoided in pregnancy?

Answer 34

SU (switch to insulin)

Question 35

when does 'baby blues' most commonly occur?

Answer 35

3-10 days after birth

Question 36

features of baby blues?

Answer 36

``` tearful irritable anxious poor sleep confused ```

Question 37

Tx of baby blues?

Answer 37

self limiting support reassure

Question 38

features of puerperal psychosis?

Answer 38

irrational ideas mania delusions hallucinations

Question 39

antidepressants safe in pregnancy and breast feeding?

Answer 39

sertraline fluoxetine paroxetine

Question 40

features of floppy baby syndrome? what causes it?

Answer 40

hypothermia hypotonia respiratory depression withdrawal benzos cause it

Question 41

can lithium be used in pregnancy/breastfeeding?

Answer 41

yes but monitor | NOT IN BREASTFEEDING

Question 42

when is usual onset of PND?

Answer 42

2-6wks

Question 43

features of PND?

Answer 43

``` irritable anxious lacks enjoyment poor sleep wt loss lasts for weeks ```

Question 44

if a pregnant women requires a smear, what advice is given?

Answer 44

rescheduled to 12 wks post delivery

Question 45

what is sheehan's syndrome? why does it happen?

Answer 45

post partum hypopituitarism | ischaemia due to blood loss in pregnancy

Question 46

what emergency can occur in pre eclampsia?

Answer 46

HELLP

Question 47

Ix for HELLP?

Answer 47

FBC U and Es LFTs

Question 48

what vitamin should be taken during pregnancy?

Answer 48

Vit D

Question 49

when is folic acid useful? why?

Answer 49

only up until 4 wks | neural tube closes

Question 50

Tx for HELLP?

Answer 50

magnesium sulphate IV dexamethasone blood product replacement DELIVERY OF FETUS