Problems in Pregnancy Flashcards
What may cause a large for dates pregnancy?
Wrong dates Foetal macrosomia Polyhydramnios Diabetes Multiple pregnancy Obesity
At which birth weight is c-section recommended if the baby is large for gestational age?
5kg
What is polyhydramnios?
An excessive amount of amniotic fluid.
What is the most common form of twinned pregnancy?
Dizygotic (70% of cases).
Arising from 2 separate eggs being fertilised by 2 separate sperm
What increases risk of all pregnancy complications?
Diabetes
What is the most common cause of iatrogenic prematurity?
Pre-eclampsia
What is pre-eclampsia?
A condition arising during pregnancy characterised by high BP, proteinuria and oedema.
Do all 3 classic symptoms of pre-eclampsia always appear?
No, this does not rule out diagnosis.
Can pre-existing hypertension be diagnosed during pregnancy?
No, needs to be diagnosed prior to pregnancy or 3 months after (if not returned to a normal level).
Pregnancy-induced hypertension occurs when?
The 2nd half of pregnancy.
What occurs in pre-eclampsia physiologically?
Diffuse vascular endothelial dysfunction alongside circulatory disturbance.
At which gestation is early pre-eclampsia diagnosed?
Before 34 weeks.
At which gestation is late pre-eclampsia diagnosed?
After 34 weeks.
What are the 2 stages of pre-eclampsia?
Abnormal placental perfusion
Maternal syndrome
What is seen in HELLP syndrome?
Haemolysis
Elevated liver enzymes
Low platelets
What can commonly be the first marker of pre-eclampsia?
Elevated serum urate.
How should pre-eclampsia be investigated?
U+Es LFTs FBC Coagulation screen Check BP
What can be given to reduce the risk of pre-eclampsia?
Low dose aspirin.
This is safe to take in pregnancy.
When should a patient with pre-eclampsia be admitted?
If BP > 170/110mmHg, or BP>140/90mmHg with ++ proteinuria
Abnormal biochemistry
If symptoms are significant
Upon initiation of antihypertensive treatment
If there are signs of foetal compromise
What does a MAP > 150mmHg indicate?
There is a significant risk of a cerebrovascular accident.
At which Bp should antihypertensive treatment be initiated in pregnancy?
> 150/100mmHg
If > 170/110mmHg, treat immediately.
What drugs are used to treat hypertension in pregnancy?
Methyldopa
Labetalol
Nifedipine
When is methyldopa contraindicated?
In patients with depression.
When is labetalol contraindicated?
in asthmatic patients.
Is it possible to cure pre-eclampsia?
yes, only achievable by delivering the baby.
Important to stabilise the mother first.
When is delivery of the baby indicated in pre-eclampsia?
At-term gestation (37 weeks)
Inability to control BP
Rapid deterioration of the mother
Progression to eclampsia
What is eclampsia?
A seizure in association with hypertension occurring during pregnancy.
What form of seizure is seen in eclampsia?
Tonic clonic seizure
How is eclampsia treated?
Magnesium sulfate infusion.
This can be given prophylactically.
Which age group most commonly suffers from eclampsia?
Teenagers
What is defined as small for gestational age?
An infant born with a birthweight below the 10th centile.
What is defined as a low birthweight?
Infant <2.5kg at birth.
Is small for gestational age, the same thing as a low birthweight?
No.
What is foetal growth restriction?
Failure of the foetus to achieve its genetic growth potential.
Suggestive of a pathological obstruction.
Is SGA always a sign of pathology?
No, around 70% are meant to be small.
Try not to overtreat.
Treatment for SGA is initiated if below which centile?
3rd centile.
Are SGA babies more likely to be stillborn?
Yes
At which gestation should the measurement of the symphysis-fundal height begin?
24 weeks.
If below the 10th centile, refer.
How is SGA diagnosed?
USS
Measurement of the abdominal circumference
Estimated foetal weight
What is uterine artery notching a risk factor for?
Foetal growth restriction
If SGA is detected, how often should measurements be taken?
Every 2 weeks.
How should pre-eclampsia/uterine artery notching treated prophylactically?
150mg of aspirin taken nightly from 12 weeks gestation.
What are the main tools used to measure foetal growth?
Umbilical artery doppler
Abdominal circumference
When should babies found to be between the 3rd and 10th centile be delivered?
39 weeks gestation
When should babies below the 3rd centile be delivered?
Between 37 and 37+6 weeks.
What should be given to reduce complications and promote foetal lung maturity in premature babies?
Steroids
How should labour be monitored in SGA babies?
Continuous CTG
