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Reproduction Year 3 > Problems in Pregnancy > Flashcards

Problems in Pregnancy Flashcards

1
Q

how does maternal hyperglycaemia affect the fetus

A

fetal hyperinsulinaemia

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2
Q

what does fetal hyperinsulinaemia lead to

A

Increased fetal growth

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3
Q

what are the effects of increased fetal growth

A

Increased oxygen demands
Neonatal hypoglycaemia
Polyhydramnios

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4
Q

what does hypoglycaemia put neonates at risk of

A

cerebral palsy

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5
Q

what does macrosomia put fetus at risk of

A

shoulder dystocia

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6
Q

when is labour induced in mother with pre-existing diabetes

A

37-38 weeks

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7
Q

which ethnicities are more at risk of gestational DM

A

South asian, middle eastern, African

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8
Q

what diabetes meds are safe in pregnancy

A

Metformin

Insulin

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9
Q

when is labour induced in mothers with gestational DM

A

38 weeks

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10
Q

Treatment of venous-thrombo embolism

A

LMWH

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11
Q

Why is pregnancy a pro-thrombotic state

A

Virchow’s triad:

stasis: secondary to venous compression by pregnant uterus

Hypercoagubility: effects of pregnancy

Vascular damage: varicose veins

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12
Q

what causes the hypercoagulability

A

Increased levels of factor 7,8,9,10,12
Increased fibrinogen
Increased platelets
Decreased levels of factor 11 and antithrombin 3

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13
Q

Investigation of DVT in pregnancy

A

Duplex USS

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14
Q

Is D-Dimer assessment safe in pregnancy?

A

NO

Do duplex ultrasound for suspected DVT

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15
Q

Treatment of DVT in pregnancy

A

Heparin

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16
Q

which leg is DVT more common in

A

Left

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17
Q

Rule of treating a DVT in pregnancy

A

Treat then see- therapeutic heparin before confirmation if diagnosis is suspected

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18
Q

prophylaxis for DVT

A

TED stockings

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19
Q

why is heparin good in pregnancy

A

does not cross the placenta

safe for fetus

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20
Q

side effects of heparin

A

Haemorrhage
Hypersensitivity
Heparin induced thrombocytopenia
Osteopenia

21
Q

Investigation for suspected PE

A

1st line: CTPA

2nd line: Xray

22
Q

Next step if CTPA for suspected PE is negative

A

bilateral compression duplex dopplers

23
Q

why should an Xray be performed in a suspected PE

A

PE may also cause effusion, pulmonary oedema ect

24
Q

Can heparin be continued in labour

A

no it should be stopped

25
Q

If a woman has a thrombotic event in pregnancy, how long should she remain on LMWH

A

Remainder of pregnancy
6 Weeks post natal
total 3 months at least

26
Q

why is warfarin avoided

A

teratogenic
avoided weeks 6-12
stopped 6 weeks before labour

27
Q

can you breastfeed on warfarin

A

YES

used after pregnancy

28
Q

management of pregnant lady with hypothyroidism

A

INCREASE levothroxine by 25-50mcg in first trimester

repeat thyroid function test every trimester

29
Q

management of pregnant lady with hyperthyroidism

A

PTU in 1st trimester
Carbimazole in 2nd/3rd trimester

Beta blockers (propanolol)

30
Q

effects of uncontrolled maternal hyperthyroidism on the fetus

A

IUGR
Pre-term labour
Thyroid storm (severe hyperthyroidism, resp + cardiac collapse, exaggerated reflexes)

31
Q

treatment of a thyroid storm

A

lugols iodine
steroids
beta-blockers (labetolol)
fluids

32
Q

effects of uncontrolled hypothyroidism on the fetus

A

Neurological underdevelopment
Prematurity

Pre-eclampsia, post partum haemorrhage

33
Q

respiratory changes seen in pregnancy

A 
Increased resp rate - causes respiratory alkalosis 
Increased oxygen demand 
Tidal volume increases
Residual volume decreases
expiratory reserve decreases
34
Q

what is unchanged in pregnancy with regards to respiration

A

FEV1

PEFR

35
Q

Management of asthma in pregnancy

A

optimise control

use of B2 agonist +/- inhaled corticosteroids

36
Q

What is the worry with epilepsy in pregnancy

A

major fetal malformations due to drug treatment: neural tube defects, heart defects

37
Q

why is there increased chance of seizures in first trimester

A

due to hyperemesis and haemodilution

38
Q

what needs to be given to women taking hepatic enzyme inducing anticonvulsants (carbamazepine, phenytoin)

A

vitamin K 10-20mg from 34-36 weeks

39
Q

when is risk of seizure highest

A

peripartum period

40
Q

why is there deterioration of epileptic control in pregnancy

A

Decreased drug levels due to nausea + vomiting, increased volume of distribution and drug clearance

lack of drug absorption during labour

Hyperventilation during labour

41
Q

which anti-epileptic drugs are most associated with neural tube defects

A

carbamazepine

valproate

42
Q

which anti-epileptic drug is most associated with orofacial defects

A

phenytoin

43
Q

which anti-epileptic drugs are most associated with cardiac defects

A

valproate

phenytoin

44
Q

malformations seen in fetal anticonvulsant syndrome

A

Dysmorphic features (V shaped eye brows, low-set ears, broad nasal bridge, irregular teeth)

Hypertelorism (wide apart set eyes)

Hypoplastic nails and distal digits

45
Q

what do epileptic women need to take pre-conceptually

A

5mg folic acid

46
Q

why should anti-epileptic drugs be continued in labour

A

increased risk of fits around time of delivery

47
Q

post-partum management of neonate with epileptic mother

A

1mg IM Vit K

48
Q

asian woman with jaundice + pruritis

A

obstetric cholestasis

49
Q

ursodeoxycholic acid

A

tx of itchy jaundice

Reproduction Year 3 (36 decks)

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