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Obs & Gynae > Problems in pregnancy > Flashcards

Problems in pregnancy Flashcards

1
Q

What is the definition of a preterm baby?

A

A baby delivered between 24 to 36+6 weeks

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2
Q

What are the survival rates for a baby born at 24 weeks?

A

20-30%

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3
Q

What are the survival rates for a baby delivered at 32 weeks?

A

> 95%

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4
Q

What are the survival rates for a baby born at 27 weeks?

A

80%

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5
Q

What are some of the causes of preterm birth?

A

-Infection
-‘Over distension’:
Multiple
Polyhydramnios
-Vascular:
Placental abruption
-Intercurrent illness:
Pyelonephritis / UTI
Appendicitis
Pneumonia
-Cervical incompetence
-Idiopathic

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6
Q

What is polyhydramnios?

A

Excess amniotic fluid surrounding the baby

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7
Q

What are the risk factors for having a preterm labour?

A 
Previous preterm labour
Uterine anomalies
Age (teenagers)
Parity (=0 or >5)
Ethnicity
Poor socio-economic status
Smoking 
Drugs (especially cocaine)
Low BMI (
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8
Q

What are the indications for cesarean delivery of preterm labour?

A

Severe pre-eclampsia, kidney disease or poor fetal development

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9
Q

What is the definition of ‘small for gestational age’?

A

Infant with a birthweight that is less than 10th centile for gestation corrected for maternal height, weight, fetal sex and birth order

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10
Q

What are the maternal risk factors for poor growth of fetus?

A 
- Lifestyle:
Smoking
Alcohol
Drugs
- Height and weight
- Age
- Maternal disease e.g. hypertension
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11
Q

What are fetal risk factors for poor growth?

A

Infection e.g. rubella, CMV, toxoplasma
Congenital anomalies e.g. absent kidneys
Chromosomal abnormalities e.g. Down’s syndrome

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12
Q

What placental factors can cause poor fetal growth?

A

Infarction

Abruption

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13
Q

What is infarction or abruption of placenta often secondary to?

A

Hypertension

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14
Q

What is a ‘symmetrical’ picture of intrauterine growth restriction?

A

Baby has small head and small abdomen

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15
Q

What is an ‘asymmetrical’ picture of intrauterine growth restriction?

A

Baby has normal head and small abdomen

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16
Q

What is the most common cause of iatrogenic prematurity?

A

Pre-eclampsia

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17
Q

What percentage of primagravid women are affected by pre-eclampsia?

A

10%

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18
Q

What happens to blood pressure in early pregnancy?

A

BP falls until 22-24 weeks

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19
Q

What happens to blood pressure in later pregnancy?

A

After 22-24 weeks, continues to rise

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20
Q

When does pregnancy induced hypertension usually begin?

A

Second half of pregnancy

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21
Q

When does pregnancy induced hypertension usually resolve itself?

A

6 weeks after delivery

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22
Q

How can pregnancy induced hypertension be distinguished from pre-eclampsia?

A

No proteinuria in PIH

Better outcomes than pre-eclampsia

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23
Q

What proportion of cases of pregnancy induced hypertension go on to develop pre-eclampsia?

A

15%

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24
Q

What are the three features of pre-eclampsia?

A

Hypertension
Proteinuria (≥0.3g/l or ≥0.3g/24h)
Oedema

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25
Q

What is the consequence of the first stage of pre-eclampsia?

A

Abnormal placental perfusion

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26
Q

What is the consequence of the second stage of pre-eclampsia?

A

Maternal syndrome, multi-system involvement

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27
Q

What systems are involved in pre-eclampsia?

A 
CNS
Renal
Hepatic
Haematological 
Pulmonary
Cardiovascular
Placental
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28
Q

What are the risks to the CNS in pre-eclampsia?

A 
Eclampsia
Hypertensive encephalopathy
Intracranial haemorrhage
Cerebral Oedema
Cortical Blindness
Cranial Nerve Palsy
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29
Q

What renal disease is associated with pre-eclampsia?

A 
Reduced GFR
Proteinuria
Increased serum uric acid (also placental ischaemia)
Increased creatinine / potassium / urea
Oliguria /anuria
Acute renal failure: 
- acute tubular necrosis
- renal cortical necrosis
30
Q

What is HELLP syndrome?

A

Haemolysis, Elevated Liver enzymes, Low Platelets

31
Q

What haematological disease is associated with pre-eclampsia?

A 
Reduced Plasma Volume
Haemo-concentration
Thrombocytopenia
Haemolysis
Disseminated Intravascular Coagulation
32
Q

What pulmonary disease is associated with pre-eclampsia?

A

PE

Pulmonary oedema

33
Q

What placental disease is associated with pre-eclampsia?

A

Intrauterine growth restriction (IUGR)
Placental Abruption
Intrauterine Death

34
Q

What are the symptoms of pre-eclampsia?

A 
Headache 
Visual disturbance
Epigastric / RUQ pain
Nausea / vomiting
Rapidly progressive oedema
35
Q

What are the signs of pre-eclampsia??

A 
Hypertension
Proteinuria
Oedema
Abdominal tenderness
Disorientation
Small for gestational age
Hyper-reflexia / involuntary movements / clonus
36
Q

What are the risk factors for pre-eclampsia?

A 
Higher maternal age
Obesity/high BMI
Previous hypertension
Family history
Multiple pregnancy i.e. twins
Nulliparity
Previous PET
Molar pregnancy
37
Q

Who develops more severe pre-eclampsia: nulliparous or multiparous women?

A

Multiparous

38
Q

What are the medical risk factors for developing preeclampsia?

A 
Pre-existing renal disease
Pre-existing hypertension
Diabetes Mellitus
Connective Tissue Disease
Thrombophilias (congenital / acquired)
39
Q

What measurement indicates high risk of cerebral haemorrhage?

A

Mean arterial pressure >150mmHg

40
Q

Does control of blood pressure reduce the risk of developing pre-eclampsia?

A

No

41
Q

What blood pressure measurement in pregnancy requires immediate treatment?

A

170/110mmHg

42
Q

What antihypertensive agents should be avoided in pregnancy?

A

ACEi

Diuretics

43
Q

What four drugs can be used to treat hypertension in pregnancy?

A

Labetolol
Methyldopa
Nifedipine
Hydralazine

44
Q

What is methyl dopa?

A

Centrally acting alpha agonist

45
Q

What condition contraindicates the use of methyldopa?

A

Depression

46
Q

What is labetalol?

A

Alpha and beta blocker

47
Q

What condition contraindicates the use of labetalol?

A

Asthma

48
Q

What is nifedipine?

A

Ca channel antagonist

49
Q

What is hydralazine?

A

Vasodilator

50
Q

What is the only cure for pre-eclampsia?

A

Delivery

51
Q

What are the indications for delivery in pre-eclampsia?

A 
Term gestation
Inability to control BP
Rapidly deteriorating biochemistry / haematology
Eclampsia or other crisis
Fetal Compromise - REDF, abnormal CTG
52
Q

What are crises associated with pre-eclamspia that would indicate delivery?

A 
Eclampsia
HELLP syndrome
Pulmonary Oedema
Placental Abruption
Cerebral Haemorrhage
Cortical Blindness
DIC
Acute Renal Failure
Hepatic Rupture
53
Q

Why would steroids be given just before delivery?

A

Reduce the risk of neonatal respiratory distress syndrome by promoting production of lung surfactant

54
Q

What is eclampsia?

A

Tonic-clonic (grand mal) seizure occuring with features of pre-eclampsia

55
Q

What is the management of severe PE/eclampsia?

A

Control BP
Stop / Prevent Seizures
Fluid Balance
Delivery

56
Q

What antihypertensives can be administered in eclampsia?

A

IV labetolol

IV hydralazine

57
Q

What medication can be given in eclampsia for seizure prophylaxis and treatment?

A

Magnesium sulphate IV

58
Q

What is the main cause of death in eclampsia?

A

Pulmonary oedema

59
Q

What are the symptoms of polyhydramnios?

A

Discomfort
Distended abdomen
Stretched skin

60
Q

What are the complications associated with polyhydramnios?

A

Labour
Membrane rupture
Cord prolapse

61
Q

What are the signs of polyhydramnios?

A

Tense abdomen
Hard to feel fetal poles
Much larger abdomen for dates

62
Q

What is the most common cause of polyhydramnios?

A

Diabetes/gestational diabetes

63
Q

How is polyhydramnios diagnosed?

A

Clinical

Ultrasound

64
Q

What are some of the other causes of polyhydramnios?

A 
Fetal abnormality
Multiple gestation
AV fistula in placenta
Oesophageal atresia
Hydrops fetalis
65
Q

What is hydrops fetalis?

A

Abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin oedema

66
Q

What is chorionicity?

A

Refers to the membrane pattern of twins

67
Q

What are the complications of multiple pregnancy?

A 
Congenital anomalies
Pre term labour
Growth restriction
Pre eclampsia
Antepartum haemorrhage
Twin to twin transfusion
68
Q

What pregnancy complications are specific to pre-existing diabetes?

A

Congenital anomalies
Miscarriage
Intra uterine death

69
Q

What pregnancy complications are associated with both pre-existing and gestational diabetes?

A 
Pre eclampsia
Polyhydramnios
Macrosomia
Shoulder dystocia
Neonatal hypoglycaemia
70
Q

What is the initial approach to reducing hyperglycaemia in gestational diabetes?

A

Diet
Weight control
Exercise

71
Q

When should hypoglycaemic therapy be considered in gestational diabetes?

A

Diet and exercise fail to maintain targets

Macrosomia on ultrasound

Obs & Gynae (20 decks)

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