Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction SB > Problems in Pregnancy > Flashcards

Problems in Pregnancy Flashcards

1
Q

what is defined as pre-term birth

A

Delivery between 24 and 36+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what can cause a pre-term birth

A

infection

over distention [Multiple, polyhydraminos]

vascular [placental abruption]

intercurrent illness [UTI/pyelonephritis, appendicitis, pneumonia]

cervical incompetence

idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

risk factors for pre-term birth

A 
previous pre term labour
multiple
uterine anomalies
age
parity (=0 or >5)
poor socio-economic status
smoking/drugs [esp cocaine]
low BMI [<20]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is definition of small for gestational age (SGA)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is another cause of the baby being less than 10th centile

A

IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is IUGR

A

Intra Uterine Growth Restriction

i.e. poor growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 3 factors that contribute to IUGR

A

maternal
fetal
placental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the maternal factors that can cause IUGR

A

Lifestyle: Smoking, Alcohol, Drugs

Height and weight

Age

Maternal disease e.g. HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the fetal factors that can cause IUGR

A

Infection e.g. rubella, CMV, toxoplasma

Congenital anomalies e.g. absent kidneys

Chromosomal abnormalities e.g. Down’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the placental factors that can cause IUGR

A

infarcts
abruption

often secondary to hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the two sub categories of IUGR

A

symmetrical

asymmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is symmetrical IUGR

A

small head

small abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is asymmetrical IUGR

A

normal head

small abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

consequences of IUGR in labour/antenatal

A

risk of hypoxia

risk of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

consequences of IUGR in post natal

A 
Hypoglycaemia
Effects of asphyxia
Hypothermia
Polycythaemia
Hyperbilirubinaemia
Abnormal neurodevelopment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the clinical features seen that are suggestive of IUGR

A

Predisposing factors
Fundal height less than expected
Reduced liquor/amniotic fluid
Reduced fetal movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what can be used to assess the fetal heartbeat

A

Cardiotocography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what can be seen on a cardiotocoaphy that indicates good reflex reactivity of the fetal circulation

A

Accelerations

- an increase in fetal HR at the start of a uterine contraction returning to baseline rate before next contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what can cause loss of baseline variability seen on Cardiotocography and why is this worrying

A

loss of baseline variability may be caused by sedative or analgesic drugs

in general, the less baseline variability present the greater the possibility of asphyxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what other reading on the Cardiotocography suggests fetal asphyxia

A

any deceleration whose lowest point is past the peak of contraction [i.e. decelerations with lag time]

associated with asphyxia = longer the lag time, more serious the fetal asphyxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the causes of large for dates pregnancy

A

wrong dates
multiple pregnancy
diabetes
polyhydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the definition of polyhydramnios

A

excess amniotic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are cause of polyhydramnios

A 
Monochorionic twin pregnancy
Fetal anomaly
Maternal diabetes
Hydrops fetalis 
Ideopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is Hydrops fetalis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are Sx of polyhydramnios

A

discomfort
labour
membrane rupture
cord prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Ix of polyhydramnios

A

ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

in relation to multiple pregancies, what does zygosity mean

A

refers to number of eggs fertilised to produce twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

in relation to multiple pregancies, what does chorionicity refer to

A

membrane pattern of the twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what type of twins are at a higher risk of pregnancy complications

A

monochorionic/monozygous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is meant by monovular zygosity

A

one ovum + one sperm fertilised

1 zygote splits into 2

think identical twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is meant by binovular zygosity

A

two ova + two sperm fertilised

2 zygotes

think non-identical twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what type of chorionicty will dizygotic twins always have

A

Dichorionic Diamniotic

i.e. no contact been amniotic fluid/sacs or membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what are the types of chorionicty monozygotic twins can have

A

Monochorionic Diamniotic

Monochorionic Monoamniotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is Monochorionic Diamniotic

A

One membrane but two separate amniotic sacs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is Monochorionic Monoamniotic

A

one membrane with one amniotic sac between the 2 fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

how can we tell the chrionicity before birth

A

ultrasound

  • shape and thickness of membrane
  • twin peak at 12 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

how are multiple pregnancies diagnosed

A

usually ultrasound @ 12 weeks

Also

  • exaggerated pregnancy Sx e.g. excessive sickness
  • high AFP
  • large for dates uterus
  • feeling more than 2 fetal poles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what can cause perinatal mortality in multiple pregnancies

A 
Congenital anomalies
Pre term labour
Growth restriction
Pre eclampsia
Antepartum haemorrhage
Twin to twin transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Mx of multiple pregnancies

A

More frequent antenatal visits

Detailed anomaly scan @ 18 weeks

Regular scans from 28 weeks for growth

Routine iron supplementation

Warning to mother risk and signs of pre term labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Delivery of multiple pregnancies

A

Triplets or more – Caesarean section

Twins if twin one cephalic aim for vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is the definition of gestational diabetes

A

carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what are the consequences of gestational diabetes

A

Overgrowth of insulin sensitive tissues and macrosomia

Hypoxaemic state in utero

Short term metabolic complications

Fetus has an increased long term risk of obesity, insulin resistance and diabetes

43
Q

what is seen in a fetus when the mother has GDM

A

hyperinsulinaemia

- decreased arterial O2 and increased EPO

44
Q

when is GDM screened for

A

at 28 week gestation

45
Q

what are the diagnostic values of GDM

A

Fasting >=5.1 mmol/l

2 hour >=8.5 mmol/l

46
Q

what are risk factors of GDM

A 
Family history of diabetes
Previous big baby
Previous unexplained still birth
Recurrent glycosuria
Maternal obesity
Previous gestational diabetes
47
Q

what complications of diabetes in pregnancy is specific to pre-existing DM

A

Congenital anomalies
Miscarriage
Intra uterine death

48
Q

what are the other complications of diabetes in pregnancy

A 
Pre eclampsia
Polyhydramnios
Macrosomia
Shoulder dystocia
Neonatal hypoglycaemia
49
Q

Mx of GDM

A

1st line = diet, weight control, exercise

2nd line = Metformin/Insulin

50
Q

at what week are women with large for dates babies offered to be delivered on

A

38 weeks gestation

51
Q

what should women with pre existing diabetes be offered during pregnancy

A

Fetal anomaly scan at 18 weeks

Regular eye checks for retinopathy

52
Q

what affects does hypertension have on the kidneys

A 
decreased GFR
proteinuria
increased serum uric acid
increased creatinine/potassium/urea
oliguria/anuria
acute renal failure
53
Q

what affects does hypertension have on the liver

A

RUQ pain
abnormal liver enzyme
hepatic capsule rupture
HELLP syndrome

54
Q

what is HELLP syndrome

A

HELLP syndrome is a subtype of severe pre-eclampsia characterised by haemolysis (H), elevated liver enzymes (EL), and low platelets (LP)

55
Q

how can HTN affect the placenta

A

IUGR
placental abruption
intrauterine death

56
Q

what cardio medication should be stopped in pregnancy

A

ACEi

ARBs

57
Q

what medication is used to Tx HTN in pregnancy

A

1st line = Labetalol
2nd line = Methyldopa
3rd line = Nifedipine [usually add if mono therapy fails]

58
Q

when should Tx be started in HTN in pregnancy

A

when BP is ≥150 mmHg systolic and/or ≥100 mmHg diastolic

59
Q

what is the target BP control

A

Aim for BP <150/80-100 mmHg

If target organ damage aim for BP <140/90 mmHg

< 140/90 consider reducing dose

< 130/90 Reduce dose

60
Q

if there is pre-eclampsia, when should the baby be aimed to be delivered

A

at 37 weeks

61
Q

gestational diabetes but the neonate are risk of hypoglycaemia - what does this put that at risk of

A

cerebral palsy

62
Q

when is a labour induced in pre-existing DM

A

37-38 weeks

63
Q

when is a labour induced in GDM on insulin

A

may be at 41 weeks if normal BMs and fetal growth

64
Q

what does macrosomia put the foetus at risk of

A

shoulder dystocia

65
Q

Tx of VTE

A

LMWH

66
Q

why is pregnancy thought to be pro-thrombotic

A

think Virchow’s triad

Stasis
- Secondary to venous compression by pregnant uterus

Hypercoagulability

Vascular damage
- Varicose veins

67
Q

what causes hyper coagulability state in pregnancy

A

↑ levels factor 7,8,9,10,12 and Fibrinogen
↑ numbers of platelets

↓ levels factor 11 and antithrombin 3

68
Q

in a suspected DVT, what investigation is not done in pregnancy

A

D-Dimer

69
Q

Ix of DVT in pregnancy

A

Duplex ultrasound

70
Q

Tx of DVT in pregnancy

A

Heparin

71
Q

what is the rule about Tx of a suspected DVT in pregnancy

A

Treat then see

72
Q

what can be prophylaxis for DVT

A

TED stockings

73
Q

why is heparin good in pregnancy

A

doesn’t cross the placenta so safe for the foetus

74
Q

side effects of heparin

A

haemorrhage
Heparin induced thrombocytopenia
osteopenia

75
Q

how does Heparin induced thrombocytopenia present

A

early in 5 days usually mild

76
Q

Ix for suspected PE

A

1st line = CTPA
2nd line = X-ray

If CTPA -ve = bilateral compression Duplex Dopplers

77
Q

why should an x-ray also be done in a suspected PE

A

as PE may also cause effusion, pulmonary oedema etc

78
Q

should heparin be continued when in labour?

A

no should be stopped

79
Q

if a women had a thrombotic episode during her pregnancy, how long should she remain on LMWH

A

Remainder of Pregnancy,
6 weeks postnatal,
total 3 months at least.

80
Q

why is warfarin not used at certain points in pregnancy

A

Avoided in pregnancy 6-12 weeks

Teratogenic 5 %, miscarriage, neurological problems, still birth

Stopped 6 weeks before labour

81
Q

why is warfarin used after pregnancy

A

is OK with breast feeding

82
Q

if a women has hypothyroid and becomes pregnant, what is the management

A

increase Levothroxine by 25-50mcg in first trimester

Repeat TFTs every trimester

83
Q

if a women has hyperthyroid and becomes pregnant, what is the management

A 
Carbimazole / PTU
Beta Blockers (propranolol)

TFT every trimester
Growth scans

84
Q

what are the effects on the pregnancy of hyperthyroid in the mother

A

IUGR, preterm labour Thyroid storm

85
Q

how does the pregnancy effect the mother’s hyperthyroid

A

Gets worse due to HCG in first trimester

Improves second and third trimesters

86
Q

what are resp changes seen in pregnancy

A

Increased resp rate-
Causes resp alkalosis

increased oxygen demand

tidal volume increases

residual volume decreases

expiratory reserve decreases

87
Q

what is unchanged in pregnancy in regards to respiration

A

FEV1

PEFR [peak flow]

88
Q

Mx of asthmatics in pregnancy

A

optimise control

use of B2 agonist +/- inhaled corticosteroids

89
Q

what is the concern of epilepsy in pregnancy on the effect it will have on the foetus

A

major malformations due to the drug treatment

- neural tube defects, orofacial and heart defect

90
Q

why is there an increased chance of seizures in the 1st trimester

A

due to hyperemesis and haemodilution

91
Q

what needs to be given to mothers taking hepatic enzyme inducing anticonvulsants

A

Vitamin K at 36 weeks

92
Q

what is the effect of the pregnancy on the woman’s epilepsy

A

in 25% increase in seizure frequency

If seizure free unlikely to have seizures UNLESS stops medications

93
Q

when is risk of seizure highest

A

in peripartum period

94
Q

why is there deterioration of control of epilepsy in pregnancy

A

Decreased drug levels due to nausea and vomiting

Decreased drug levels due to ↑volume of distribution and ↑drug clearance

Lack of sleep towards term and during labour

Lack of absorption of drugs during labour

Hyperventilation during labour

95
Q

what anticonvulsant is most associated with neural tube defects

A

valproate and carbamazepine

96
Q

what anticonvulsant is most associated with orofacial clefts

A

phenytion

97
Q

what anticonvulsant is most associated with cardiac clefts

A

phenytion and valproate

98
Q

what minor malformations are seen in fetal anticonvulsant syndrome

A 
Dysmorphic features (V-shaped eyebrows, lowset ears, broad nasal
bridge, irregular teeth)

Hypertelorism [wide apart set eyes]

Hypoplastic nails and distal digits

99
Q

how does the teratogenic risk of anticonvulsants change

A

increases with number of drugs

phenytion + valproate + carbamazepine = 50% risk to fetus

100
Q

what do epileptic women need to take pre conceptually

A

5mg folic acid

101
Q

what do epileptic women need to take during the pregnancy

A

continue folic acid

Vit K 10-20mg orally from 34-36 weeks if on enzyme inducers due to reduce risks of fetal Vit K deficiency and Haemorrhagic Disease Newborn

102
Q

should anti epileptic drugs be continued in labour

A

yes

as increase in fits around time of delivery

103
Q

what is postpartum management in epileptic cases

A

Neonate should have 1mg IM Vit K

Reproduction SB (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions