Prescribing in Pregnancy

Question 1

Which anticoagulants are safe to use?

Answer 1

LMWH or unfractioned heparin- safe to use in pregnancy and breastfeeding- don’t cross placenta. Clot busters- little evidence.
Warfarin- only ever use in women with mechanical prosthetic valves who are at high risk of valve thrombosis.

Question 2

SEs of warfarin use?

Answer 2

Stillbirth, prematurity, haemorrhage, ocular defects, fetal warfarin syndrome (nasal hypoplasia, hypoplasia of the extremitites, developmental delay.)

Question 3

Primary PPH Rx

Answer 3

Syntocinon 5 units IV or infusion
Misoprostol- prostaglandin E1 800mg
Haemabate (carboprost) PGF2a 250mcg IM
Tranexamic acid- antifibrinolytic 1g STAT IV

Question 4

3rd stage management

Answer 4

Syntometrine (oxytocin 5 units + ergometrine 500mcg) IM bolus.

Question 5

Medical Mx of miscarriage

Answer 5

Misoprostol 800mcg s/c or p/v. Cervical softener.

Mifepristone.

Question 6

Which analgesics are safe to use in pregnancy?

Answer 6

Paracetamol
Entonox (50% nitrous oxide, 50% oxygen)
Opiates- cause respiratory depression but generally safe

Question 7

Which analgesics are not safe to use in pregnancy?

Answer 7

NSAIDS- miscarriage and malformation in 1st trimester, premature closing of the ductus arteriosus in 3rd trimester.

Question 8

Which Abx are unsafe to use in pregnancy?

Answer 8

NOT trimethoprim- anti-folate. Teratogenic in 1st trimester.
NOT nitrofurantoin- neonatal haemolysis in 3rd trimester.
NOT co-amoxiclav- neonatal enterocolitis
NOT tetracyclines- tooth discolouration
Cephalosporins and penicillins are ok

Question 9

What prophylactic Abx to use for PPROM?

Answer 9

Erythromycin 250mg QDS PO 10 days- prophylaxis for chorioamnionitis

Question 10

Medical Mx of TOP?

Answer 10

Mifepristone 200mg- induces TOP in 60% on its own

Question 11

Medical Mx of ectopic

Answer 11

Methotrexate

Question 12

Medical Mx of menorrhogia

Answer 12

Tranexamic acid (anti-fibrinolytic)
Mefenamic acid (NSAID)
Prostap /gonapeptyl (GnRH analogues)

Question 13

Rx for endometritis

Answer 13

Co-amoxiclav 1.2g IV TDS

Clindamycin and metronidazole if penicillin allergic

Question 14

Rx for chorioamnionitis

Answer 14

Cefuroxime 1.5g TDS and metronidazole 500mg TDS IV

Question 15

Rx for HTN

Answer 15

Labetolol- CI in asthma. 200mg BD-TDS
Nifedipine-10mg OD
Do not use ACE-i or ARBs in pregnancy due to fetal renal damage in 2nd and 3rd trimester. Possibly malformation in 1st trimester.

Question 16

1st line treatment in eclampsia?

Answer 16

MgSO4

Question 17

Rx if mother has epilepsy?

Answer 17

Lamotrigine and liviteracetam.
Avoid valproate if possible- associated with neural tube and other developmental problems.
High dose folic acid (reduces risk of neural tube defects)

Question 18

Most likely causative organism of endometritis?

Answer 18

Group A strep, gram +ve organisms (staph, enterococcus), gram -ves (E.coli), anaerobes (peptococcus)