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Women's health > Problems in pregnancy > Flashcards

Problems in pregnancy Flashcards

1
Q

Hyperemesis Gravidarum : Diagnosis

A
  1. 5% pre-pregnancy weight loss
  2. dehydration
  3. electrolyte imbalance
    Severity scale : PUQE score
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2
Q

Hyperemesis Gravidarum : Diagnosis

A
  1. 5% pre-pregnancy weight loss
  2. dehydration
  3. electrolyte imbalance
    Severity scale : PUQE score
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3
Q

Hyperemesis Gravidarum : Risk factors

A
  1. increased levels of beta-hCG
    *multiple pregnancies
    *trophoblastic disease
  2. nulliparity
  3. obesity
  4. family or personal history of NVP
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4
Q

Hyperemesis Gravidarum : Diagnosis

A
  1. 5% pre-pregnancy weight loss
  2. dehydration
  3. electrolyte imbalance
    Severity scale : PUQE score
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5
Q

Hyperemesis Gravidarum : Management : First line

A
  • Antihistamines: oral cyclizine or promethazine
  • Phenothiazines: oral prochlorperazine or chlorpromazine
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6
Q

Hyperemesis Gravidarum : Management : Second line

A
  • Oral Ondansetron
    Risk : First trimester is associated with a small increased risk of the baby having a cleft lip/palate
  • Oral Metoclopramide or Domperidone:
    Risk : metoclopramide may cause extrapyramidal side effects. I
    t should therefore not be used for more than 5 days
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7
Q

Epilepsy in pregnancy : Epileptic drugs risk (3)

A
  1. Sodium valproate : risk of neural tube defects
  2. Carbamazepine : teratogenic
  3. Phenytoin : cleft palate
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8
Q

Epilepsy in pregnancy : Epileptic drugs risk - Phenytoin

A
  1. Phenytoin : cleft palate
    -Vitamin K needs to be given in last month of the pregnancy to prevent clotting disorder in the new born
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9
Q

Epilepsy in pregnancy : Epileptic drugs risk - which anti-epileptic is the safest in pregnancy?

A

Lamotrogine
Although - doses may need to be increased

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10
Q

Epilepsy in pregnancy : Breastfeeding

A

Breast feeding is considered safe for mothers taking antiepileptics

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11
Q

Pre-existing diabetes in pregnancy : Management

A
  1. Tight glycemic control
    * Weight loss : for women with BMI of > 27 kg/m^2
    * Stop oral hypoglycaemic agents : apart from metformin, and commence insulin
  2. Higher risk of developing foetal neural tube defects
    * Folic acid 5 mg/day from pre-conception to 12 weeks gestation
  3. Higher risk of cardiomyopathy 2nd to hyperglycaemia
    * detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts
    * tight glycaemic control reduces complication rates
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12
Q

Gestational diabetes : Definition

A
  • Glucose intolerance during pregnancy -> maternal and foetal hyperglycaemia
  • Resolves after deliver } Placenta is delivered and Human placental lactogen is no longer produced
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13
Q

Gestational diabetes : Physiology in normal pregnancy

A
  1. Placenta secreted Human placental lactogen
  2. hPL binds to systemic insulin receptors and causes insulin resistance } more glucose available for foetus
  3. This in turn causes Pancreatic beta cell hyperplasia
  4. Gestational diabetes occurs when}
  5. Insulin resistance > Beta cell hyperplasia leading to hyperglycaemia
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14
Q

Gestational diabetes : Foetal complications

A
  1. Macrosomia } increased risk of shoulder dystocia
  2. Respiratory distress syndrome :
    Impaired lung surfactant development : High insulin levels reduce surfactant production, leading to impaired lung development
  3. Jaundice / Cardiomyopathy :
    Increased erythropoiesis }
    Polycycthaemia } less iron available to developing organs }
    3x increased risk of congenital malformations + excess red cell break down at birth
  4. Hypoglycaemia : Beta cell hyperplasia
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15
Q

Gestational diabetes : Risk factors

A
  • BMI > 30
  • Previous gestational diabetes or Macrosomia in foetus
  • First degree relative with diabetes or Ethnic origin with high prevalence of diabetes
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16
Q

Gestational diabetes : Investigation

A

Oral glucose tolerance test : 24 - 28 weeks

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17
Q

Gestational diabetes : Diagnosis

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

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18
Q

Gestational diabetes : Management

A
  1. Glucose self monitoring initiated
    * Fasting plasma glucose < 7
    i) Diet and exercise : 1-2 weeks
    ii) + Metformin
    ii) + Insulin
  • Insulin should be started first line if;
    i) Fasting glucose > 7
    ii) Plasma glucose 6 - 6.9 and evidence of complications such as macrosomia
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19
Q

Hypertension in pregnancy : Normal Physiology of BP

A
  1. Blood pressure falls in the first trimester } especially diastolic
  2. Continues to fall until 20-24 weeks
  3. BP increases to pre-pregnancy levels
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20
Q

Hypertension in pregnancy : Pre existing hypertension

A

Definition : >140/90 before 20weeks
1. Switch to oral labetamol or nifedipine and hydralazine (if asthmatic)
1. Aspirin 75mg from 12 weeks

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21
Q

Hypertension in pregnancy : Gestational hypertension

A

Definition : >140/90 after 20 weeks without proteinuria
* Increases risk of pre-eclampsia
* Aspirin 75mg from 12 weeks

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22
Q
A
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23
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24
Q

Jaundice in pregnancy : Intrahepatic cholestasis of pregnancy : Features + Incidence

A

Incidence
* Third trimester
* Most common liver disease in pregnancy

Clinical features
* Pruritus in palms and soles
* Raised bilirubin

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25
Q

Jaundice in pregnancy : Intrahepatic cholestasis of pregnancy : Risk to foetus

A
  1. Risk of preterm labour
  2. Stillbirth
  3. Foetal distress
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26
Q

Jaundice in pregnancy : Intrahepatic cholestasis of pregnancy : Management

A
  1. Sx relief : Urseodeoxycholic acid
    * Weekly LFTS
    * Induced at 37 weeks
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27
Q

Jaundice in pregnancy : Acute fatty liver of pregnancy : Features + Incidence

A

Incidence
* Third trimester / immediate following delivery

Clinical features
* Abdominal pain, N`+V
* Jaundice
* Hypoglycaemia
* } ? Following HELLP syndrome in pre=eclampsia

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28
Q

Jaundice in pregnancy : Acute fatty liver of pregnancy : Ix and Mx

A
  • ALT > elevated
    Management
  • Supportive care - definitive mx is delivery
29
Q

PE in Pregnancy

A

Thromboembolism - leading cause of maternal death.
* LMWH used for mx

30
Q

Pyelonephritis in pregnancy

A
  1. Pyelonephritis - common in 20 weeks
  2. Risk with with asymptomatic bactaemaemia - treated with antibiotics as soon as it is confirmed
  3. Cefelexin - avoid trimethoprin
31
Q

Symphysis pubis dysfunction (SPD)

A
  1. condition that affectspregnantwomen, causing pain and discomfort in the pelvic region.
  2. It occurs due to the separation of the pubic symphysis, which is the joint that connects the two halves of the pelvis.
32
Q

Symphysis pubis dysfunction (SPD) - Clinical features and Mx

A

Symptoms of SPD
include pain in the pubic area, lower back, hips, and thighs, difficulty walking or standing, and a clicking or popping sensation in the pelvis.

Management
Advice and reassurance - consider adjusting movements, pelvic exercises

33
Q

Pre eclampsia : Diagnosis

A

New onset hypertension >140/90 after 20 weeks of pregnancy
AND 1 or more of the following;
1. Proteinuria

  1. Other organ involvement such as;
    * Renal insufficiency
    * Liver dysfunction
    * Neurological deficit
34
Q

Pre eclampsia : Pathophysiology

A
  1. Uteroplacental arteries are fibroses —> narrow
  2. Hypoperfused placenta —> Proinflammatory marker released into mother’s circulation
  3. Systemic vasoconstriction of vessels } Increases blood pressure
  4. Leads to end organ dysfunction and damage
35
Q

Pre eclampsia : Clinical features

A

Systemic vasoconstriction, reduces blood flow to end organs resulting in;

  1. Kidney impairment } Proteinuria - loss of proteins } Oedema
  2. Retinal impairment } flashing lights, blurred vision and Papilloedema
  3. Liver injury and inflammation : Abdominal pain and deranged LFTSs
  4. Vessel damage / Endothelial injury : Uses up a lot of platelets leading to microthrombi
    -Thrombi result in damage to RBCS } Haemolysis
36
Q

Pre eclampsia : Clinical signs

A
  1. Hyper - reflexia
  2. RUQ/Epigastric pain
37
Q

Pre eclampsia : High risk factors

A
  1. Hypertensive disease in a previous pregnancy
  2. Chronic kidney disease
  3. Autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
  4. Type 1 or type 2 diabetes
  5. Chronic hypertension
38
Q

Pre eclampsia : Moderate risk factors

A
  1. First pregnancy
  2. Age 40 years or older
  3. Pregnancy interval of more than 10 years
  4. Body mass index (BMI) of 35 kg/m² or more at first visit
  5. Family history of pre-eclampsia
  6. Multiple pregnancy
39
Q

Pre-eclampsia : Complications

A
  1. Eclampsia (Seizures)
    Assoc with : Cerebral oedema } Severe headache, altered mental state, myoclonus, RUQ pain

Extreme blood pressure rise;
1. Haemorrhagic stroke
2. Placental abruption

Foetal compromise
1. Intrauterine growth retardation
2. Prematurity

40
Q

Pre eclampsia : Mx of risk in pregnancy

A
  • ≥ 1 high risk factors
    Or
  • ≥ 2 moderate factors

Mx : Aspirin 75-150mg daily from 12 weeks gestation until the birth

41
Q

Pre eclampsia : Referral for Pre-eclampsia

A
  • BP >30/20
  • BP>160/100
  • Or 149/90> with protein urea or symptomatic IUGR
42
Q

Pre eclampsia : Acute management

A

Indic : BP > 160/110 } need admission and observation
1. Oral labetalol (Nifedipine if asthmatic)
2. Deliver baby } definitive management

43
Q

Eclampsia : Definition

A

Development of seizures in association with Pre-eclampsia

44
Q

Eclampsia : Management

A
  1. First line : Magnesium sulphate
    * Indication : Prevent seizures in severe pre eclampsia and treat them once they start
    * Administeration : 4mg IV bolus then 1g/hr } continue for 24 hours after seizure or delivery
    * Adverse effect : MgSO4 induced respiratory depression
    Tx : Calcium Gluconate
45
Q

Pre-eclampsia : HELLP syndrome

A

Complication of severe pre-eclampsia
* H- haemolytic
* Elevated liver enzymes
* Low platelets

46
Q

Anaemia in Pregnancy : Screening

A
  1. Booking visit 8-10 weeks
    Risk : Higher is twin and triplet pregnancies
    FBC - 20-24 weeks
    FBC repeated - 28 weekend
47
Q

Anaemia in Pregnancy : Investigation

A
  1. First trimester : < 110 g/L
  2. Second / Third trimester : < 105 g/L
  3. Postpartum : < 100 g/L
48
Q

Anaemia in Pregnancy : Management

A

Oral ferrous sulfate or Ferrous fumarate : Continue for 3 months after deficiency is corrected

49
Q

Obesity in Pregnancy : Definition

A

BMI > 30

50
Q

Obesity in Pregnancy : Risks :
Maternal

A

Maternal :
1. Early pregnancy :Miscarriage
2. During pregnancy : Increased risk of Gestational diabetes and Pre eclampsia
3. Delivery : Difficult labour and miscarriage

51
Q

Obesity in Pregnancy : Management

A

Obesity in Pregnancy : Management
1. Weight and diet modification
2. 5mg folic acid
3. >35/>40 } consultant led obstetric unit and antenatal consultation with anaesthetist

52
Q

Rheumatoid A in Pregnancy : Management

A

Avoid :
* Methotrexate >6 months prior to conception
If required:
* Sulfasalazine and hydroxychloroquinine } safe
* NSAID upto 32 weeks } risk of early close of Ductus arteriorsis after this
* Low dose corticosteroids

53
Q

Rhesus - in pregnancy : Pathophysiology

A
  1. Rhesus antigens are found on RBCs
  2. Rh - ve mother delivers a Rh +ve child
  3. Immune system : Anti-D antibodies against Rh antigen of the foetal RBC
  4. Later pregnancies : Anti-D antibodies can travel across the placenta and attack fetal RBC } Haemolysis
54
Q

Rhesus - in pregnancy : Management

A

IM Anti-D injections
1. Attaches to the rhesus-D antigens on the fetal red blood cells in the mothers circulation
2. Destroys fetal RBC in the mother’s blood
3. Prevents the mother’s immune system recognising the antigen creating it’s own antibodies to the antigen.
4. It acts as a prevention for the mother becoming sensitised to the rhesus-D antigen.

Given at : 28 weeks gestation and birth

55
Q

HIV in Pregnancy : Management

A

Aim : Reduce indigence of vertical transmission
* ART : Anti-retroviral therapy given to all pregnant women
* Delivery :
< 50 } Vaginal delivery if load >50 } C-section
Foetus : Tripe ART given after therapy for 4-6 weeks

56
Q

HIV in Pregnancy : factors affecting risk of transmission

A
  • Prolonged rupture of membranes
  • Delivery before 34 weeks
  • application of foetal scalp electrode monitoring - all increase risk of hIV transmission

**Except for C-section **

57
Q

Infections in Pregnancy : Chicken pox : Mx of exposure

A
  1. Check for varicella antibodies
    If no antibodies found;
    * < 20 weeks } Varicella-zoster Immunoglobulin
    * >20 weeks } VZIG or acyclovir - given 7-14 days after exposure due to higher effectiveness
58
Q

Infections in Pregnancy : Chicken pox : Mx of infection

A

> 20 weeks } Acyclovir

59
Q

Infections in Pregnancy : Rubella : Following exposure

A
  1. Risk for foetus : Risk of congenital rubella syndrome highest 8 - 10 weeks } rare beyond this
  2. Ix : IgM antibodies raised
  3. Mx : If no immunity - MMR given postnatally - not during pregnancy
60
Q

Congenital rubella

A

Cataracts, cardiac lesions, cerebral palsy and splenomegaly

61
Q

Oligohydramnios : Definition

A

reduced amniotic fluid
less than 500ml at 32-36 weeks

62
Q

Oligohydramnios : Causes

A
  • premature rupture of membranes
  • Potter sequence
    • bilateral renal agenesis + pulmonary hypoplasia
  • intrauterine growth restriction
  • post-term gestation
  • pre-eclampsia
63
Q

Puerperal Pyrexia : Definition

A

temperature of > 38ºC in the first 14 days following delivery.

64
Q

Puerperal Pyrexia : Causes

A
  1. endometritis: most common cause
    * Infection of the endometrial lining following childbirth
  2. urinary tract infection
  3. wound infections (perineal tears + caesarean section)
65
Q

Puerperal Pyrexia : Management

A

If endometritis suspected - admit for IV antibiotics

66
Q

Chorioamnionitis : Definition

A

infection of the amniotic fluid and fetal membranes, usually caused by ascending bacterial infection from the vagina and cervix.

67
Q

Chorioamnionitis : Clinical presentation

A

The patient’s presentation with PPROM;

  • abdominal pain, uterine contractions
  • ‘flu-like symptoms’, fever, and foul-smelling discharge are all characteristic features of chorioamnionitis.
  • This diagnosis is further supported by her current gestational age (24 weeks), as chorioamnionitis is more common in preterm pregnancies.
68
Q

Chorioamnionitis : Management

A
  1. Prompt delivery - may need C section
  2. IV antibiotic

Women's health (12 decks)

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