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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
What is the consequence of the first stage of pre-eclampsia?
Abnormal placental perfusion
26
What is the consequence of the second stage of pre-eclampsia?
Maternal syndrome, multi-system involvement
27
What systems are involved in pre-eclampsia?
``` CNS Renal Hepatic Haematological Pulmonary Cardiovascular Placental ```
28
What are the risks to the CNS in pre-eclampsia?
``` Eclampsia Hypertensive encephalopathy Intracranial haemorrhage Cerebral Oedema Cortical Blindness Cranial Nerve Palsy ```
29
What renal disease is associated with pre-eclampsia?
``` 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
What is HELLP syndrome?
Haemolysis, Elevated Liver enzymes, Low Platelets
31
What haematological disease is associated with pre-eclampsia?
``` Reduced Plasma Volume Haemo-concentration Thrombocytopenia Haemolysis Disseminated Intravascular Coagulation ```
32
What pulmonary disease is associated with pre-eclampsia?
PE | Pulmonary oedema
33
What placental disease is associated with pre-eclampsia?
Intrauterine growth restriction (IUGR) Placental Abruption Intrauterine Death
34
What are the symptoms of pre-eclampsia?
``` Headache Visual disturbance Epigastric / RUQ pain Nausea / vomiting Rapidly progressive oedema ```
35
What are the signs of pre-eclampsia??
``` Hypertension Proteinuria Oedema Abdominal tenderness Disorientation Small for gestational age Hyper-reflexia / involuntary movements / clonus ```
36
What are the risk factors for pre-eclampsia?
``` Higher maternal age Obesity/high BMI Previous hypertension Family history Multiple pregnancy i.e. twins Nulliparity Previous PET Molar pregnancy ```
37
Who develops more severe pre-eclampsia: nulliparous or multiparous women?
Multiparous
38
What are the medical risk factors for developing preeclampsia?
``` Pre-existing renal disease Pre-existing hypertension Diabetes Mellitus Connective Tissue Disease Thrombophilias (congenital / acquired) ```
39
What measurement indicates high risk of cerebral haemorrhage?
Mean arterial pressure >150mmHg
40
Does control of blood pressure reduce the risk of developing pre-eclampsia?
No
41
What blood pressure measurement in pregnancy requires immediate treatment?
170/110mmHg
42
What antihypertensive agents should be avoided in pregnancy?
ACEi | Diuretics
43
What four drugs can be used to treat hypertension in pregnancy?
Labetolol Methyldopa Nifedipine Hydralazine
44
What is methyl dopa?
Centrally acting alpha agonist
45
What condition contraindicates the use of methyldopa?
Depression
46
What is labetalol?
Alpha and beta blocker
47
What condition contraindicates the use of labetalol?
Asthma
48
What is nifedipine?
Ca channel antagonist
49
What is hydralazine?
Vasodilator
50
What is the only cure for pre-eclampsia?
Delivery
51
What are the indications for delivery in pre-eclampsia?
``` Term gestation Inability to control BP Rapidly deteriorating biochemistry / haematology Eclampsia or other crisis Fetal Compromise - REDF, abnormal CTG ```
52
What are crises associated with pre-eclamspia that would indicate delivery?
``` Eclampsia HELLP syndrome Pulmonary Oedema Placental Abruption Cerebral Haemorrhage Cortical Blindness DIC Acute Renal Failure Hepatic Rupture ```
53
Why would steroids be given just before delivery?
Reduce the risk of neonatal respiratory distress syndrome by promoting production of lung surfactant
54
What is eclampsia?
Tonic-clonic (grand mal) seizure occuring with features of pre-eclampsia
55
What is the management of severe PE/eclampsia?
Control BP Stop / Prevent Seizures Fluid Balance Delivery
56
What antihypertensives can be administered in eclampsia?
IV labetolol | IV hydralazine
57
What medication can be given in eclampsia for seizure prophylaxis and treatment?
Magnesium sulphate IV
58
What is the main cause of death in eclampsia?
Pulmonary oedema
59
What are the symptoms of polyhydramnios?
Discomfort Distended abdomen Stretched skin
60
What are the complications associated with polyhydramnios?
Labour Membrane rupture Cord prolapse
61
What are the signs of polyhydramnios?
Tense abdomen Hard to feel fetal poles Much larger abdomen for dates
62
What is the most common cause of polyhydramnios?
Diabetes/gestational diabetes
63
How is polyhydramnios diagnosed?
Clinical | Ultrasound
64
What are some of the other causes of polyhydramnios?
``` Fetal abnormality Multiple gestation AV fistula in placenta Oesophageal atresia Hydrops fetalis ```
65
What is hydrops fetalis?
Abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin oedema
66
What is chorionicity?
Refers to the membrane pattern of twins
67
What are the complications of multiple pregnancy?
``` Congenital anomalies Pre term labour Growth restriction Pre eclampsia Antepartum haemorrhage Twin to twin transfusion ```
68
What pregnancy complications are specific to pre-existing diabetes?
Congenital anomalies Miscarriage Intra uterine death
69
What pregnancy complications are associated with both pre-existing and gestational diabetes?
``` Pre eclampsia Polyhydramnios Macrosomia Shoulder dystocia Neonatal hypoglycaemia ```
70
What is the initial approach to reducing hyperglycaemia in gestational diabetes?
Diet Weight control Exercise
71
When should hypoglycaemic therapy be considered in gestational diabetes?
Diet and exercise fail to maintain targets | Macrosomia on ultrasound

Obs & Gynae (20 decks)

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