Problems in pregnancy Flashcards
1
Q
which blood problems are increased in risk during pregnancy (2)
A
DVT
PTE
2
Q
where is MSK pain common during pregnancy
A
back
pelvic girdle - pubic symphysis and sacroiliac joints
3
Q
which MSK hand problem is common during pregnancy
A
carpal tunnel syndrome
4
Q
why is carpal tunnel more likely during pregnancy
A
increased fluid in pregnancy = more pressure in compartment = median nerve more likely to be compressed
5
Q
carpal tunnel presentation
A
paresthesia of palmar lateral 3 and a half fingers
paralysis of thenar eminence (and LOAF muscles of hand)
6
Q
treatment of carpal tunnel
A
splint
7
Q
is hypertension in 1st trimester caused by pregnancy
A
no- usually hypotensive in first trimester, so probs a problem from before
8
Q
whats the difference between pregnancy induced hypertension and pre-eclampsia
A
pre-eclampsia has symptoms, pregnancy induced hypertension is just hypertension
9
Q
is pre eclampsia common
A
yes in 10% of pregnancies
10
Q
pathophysiology of pre eclampsia
A
diffuse vascular endothelial dysfunction
11
Q
if pre eclampsia starts <34 weeks what is the cause
A
placental problem (rare)
12
Q
if pre eclampsia starts >34 weeks what is the cause
A
maternal problem (common)
13
Q
risk factors for pre eclampsia
A
PMH CKD autoimmune disease diabetes chronic hypertension >40yo BMI>30 Fx
14
Q
if someone has pre eclampsia risk factors, what do you give them
A
75mg aspirin OD form 12w to birth
15
Q
pre eclampsia triad
A
hypertension
proteinuria >0.3g/l
oedema
16
Q
why do pre eclampsia patients get oedema
A
kidney function decreases = salt and water retention
17
Q
investigations for pre eclampsia
A
urinalysis
bp
maternal uterine artery doppler (MUAD)
fetal surveillance
18
Q
pre eclampsia hypertension treatment first line
A
methyl dopa
labetalol
nifedipine
19
Q
methyl dopa contraindication for pre eclampsia
A
depression
20
Q
labetalol contraindication for pre eclampsia
A
asthma (bc its a beta blocker)
21
Q
what do you in pre eclampsia
A
deliver baby - only cure of pre eclampsia
treat hypertension
22
Q
when do you deliver baby in pre eclampsia
what if baby is younger than this
A
deliver if >28w
if <28w keep in for as long as possible
23
Q
in pre eclampsia if baby is pre term (<37 weeks) and you deliver, what do you want to give
A
beclomethasone (steroids) IM - to decrease RDS risk
24
Q
seizure in pregnancy
A
eclampsia!!
may also be new onset epilepsy but unlikely
25
complication of untreated pre eclampsia (if you don't take baby out)
ECLAMPSIA!
26
how does eclampsia present
seizure
| coma
27
management of eclampsia
IV labetalol to control bp
magnesium sulphate IV - to stop seizures
deliver baby
28
what can pre eclampsia do to the liver
liver rupture - RUQ pain
| HELLP syndrome
29
what is HELLP syndrome
| what is the mortality
Haemolysis
Elevated Liver enzymes
Low Platelets
= high mortality
30
re eclampsia haem complication
DIC
31
pre eclampsia cardio complication
pulmonary oedema
32
pre eclampsia placental complication
placental abruption
33
what is the difference between morning sickness and hyperemesis gravidarum
hyperemesis gravidarum = decreased QoL, v unwell (dehydration, ketosis, electrolyte imbalance, emotional instability)
34
management of hyperemesis gravidarum
IV fluids for rehydration
electrolyte replacement
steroids - if recurrent and severe
35
bleeding in early pregnancy differentials (6)
implantation bleeding (10 days after implantation)
vaginal infection
PR bleeding/haematuria - might not even be vaginal! people are v para
miscarriage
ectopic pregnancy (rarely)
molar pregnancy
36
bleeding in late pregnancy (antepartum) differentials (4)
placenta praevia
placental abruption
vasa praevia
uterine rupture
37
miscarriage definition
loss of embryo <24weeks
38
what is the most common cause for miscarriage
chromosomal abnormality = not functional with life
39
environmental causes of miscarriage (4)
infection
severe emotional upset
iatrogenic (eg after CVB)
smoking/drugs/alcohol misuse
40
how does a miscarriage present
is it painful;
BLEEDING
not painful, just like period cramps
41
definition of threatened miscarriage
cervical os is closed, fetus still in uterus
pregnancy may still be saved (not confirmed miscarriage, just hypothetical)
may be asymptomatic
42
definition of inevitable miscarriage
pregnancy cant be saved
| cervical os open and foetus can be seen
43
definition of incomplete miscarriage
foetus has passed mostly into vagina, but still slightly in uterus
44
definition of complete miscarriage
foetus has passed fully into vagina
45
investigations for miscarriage
US scan
| speculum examination
46
why is pregnancy test not useful for miscarriage
will stay positive for days after miscarriage
47
treatment of miscarriage once feotus is out
IV fluids if massive blood loss
| send home with pads
48
treatment of miscarriage if feotus still inside (2)
medical induction of TOP - mifepristone and misoprostol
| surgical induction of TOP - vacuum aspiration
49
why would you do surgical TOP instead of medical in miscarriage
if heavy bleeding
| medical will increase bleeding
50
what conditions cause recurrent miscarriages (4)
antiphospholipid syndrome
PCOS
bacterial vaginosis
uterine abnormality
51
investigations for recurrent miscarriages (2)
lupus anti coagulant, phospholipid and anti cardiolipin antibodies
pelvis US for uterine abnormalities
52
in a miscarriage, is bleeding or pain more significant
bleeding
53
ectopic pregnancy definition
abnormal site of implantation of fertilized egg ie not in the ampulla of fallopian tubes (outside of uterus)
54
possible locations of ectopic pregnancy
ovary
c section scar
peritoneum - bc fallopian tubes open up into peritoneal cavity
anywhere outside the uterus
55
causes of ectopic pregnancy (3)
pelvic inflammatory disease
endometriosis
IUCD
56
what STI commonly causes pelvic inflammatory disease = increased risk of ectopic pregnancy
how does this work
chlamydia
causes narrowing of fallopian tubes
57
presentation of ectopic pregnancy
v painful
| little bleeding
58
in ectopic pregnancy, is bleeding or pain more significant (6)
```
PAIN!!!!
little bleeding
dizziness/collapse
shoulder tip pain
guarding/tenderness of abdo
vomiting/diarrhea
```
59
in ectopic pregnancy, where can the pain radiated to
shoulder tip
60
shoulder tip pain
ectopic pregnancy
61
why can ectopic pregnancy present with GI symptoms eg diarrhea
can implant in the peritoneal cavity
62
investigations for ectopic pregnancy
hCG - to confirm pregnancy
US - to see empty uterus
speculum
63
what do you see on US in ecptopic pregnancy
empty uterus
64
empty uterus on US but positive hCG
ectopic pregnancy
65
treatment of ectopic pregnancy in stable patient, pregnancy in early stages
methotrexate
66
treatment of ectopic pregnancy in stable patient but pregnancy far on (ie methotrexate wont work)
laparoscopy (key hole surgery)
67
treatment of ectopic pregnancy in unstable patient (eg in septic shock)
laparotomy - surgery, do salpingectomy (remove tube and ectopic)
68
another name for molar pregnancy
hydatidiform mole
69
definition of molar pregnancy
placental overgrowth with no/abnormal fetus (hence cant receive stuff from placenta = placenta overgrowth)
70
'grape like clusters' on pathology
molar pregnancy
71
which type of mole has no feotus
complete mole
| completely fuckoed
72
which type of mole has an abnormal fetus
partial mole
| at leas they tried to make a baby = only partially fuckoed
73
which type of mole increases your risk of choriocarcinoma
complete mole
74
how does molar pregnancy present (2)
hyperemesis (vomiting blood)
| vaginal bleeding - potentially with grape like tissue
75
investigations for molar pregnancy (2 - 1 main one)
US - main one
| hCG
76
US appearance of molar pregnancy
snowstorm appearance
77
hCG level in molar pregnancy
v v high (higher than normal pregnancy) bc of overproduction of chorioblasts
78
treatment of molar pregnancy
surgical removal
79
what is invasion of molar pregnancy into the uterus called
how is it treated
choriocarcinoma
hysterectomy :(
80
after what week is the antepartum period classed as
>24w
81
antepartum minor haemorrhage criteria
<50ml blood
82
antepartum major haemorrhage criteria
50-1000ml blood
83
antepartum massive haemorrhage criteria
>1000ml blood or signs of shock
84
what investigation do you want to do if antepartum haemorrhage
why
kleihauer to check if mum got any of babies blood
might need to give anti-D
85
placenta praveia definition
low lying placenta
when the placenta is totally/partially implanted in the lower uterus
86
when is placenta praevia usually picked up
20 week US scan
87
why is a low lying placenta (placenta praevia) bad
less contractile muscles in lower uterus = harder to get out during labour
88
major placenta praevia
placenta lying over internal cervical os
89
minor placenta praveia
placentation not covering the internal cervical os
90
presentation of placenta praevia
painless bleeding
91
in placenta praevia, is bleeding or pain more significant
bleeding! probs painless
92
painless bleeding >24w
placenta praevia
93
investigations for placenta praevia
US - to see if major (covering cervical os) or minor (not covering cervical os)
94
what investigation MUST YOU NOT DO for placenta praevia
why
vaginal exam and speculum
bc could rupture placenta = massive haemorrhage
95
vaginal bleeding >24w, what investigation do you do first
why
US first
to exclude/diagnosis placenta praevia
only then can you do a vaginal/speculum examination
96
what will hCG be like in placenta praevia
normal for pregnancy (high but not too high)
| bc normal pregnancy
97
management of placenta praevia
resus mum - fluids, crossmatch blood
| anti-D
98
what is the likely delivery method of a baby previously diagnosed with placenta praevia
what is the exception
likely c section
unless placenta >2cm from cervical, then can do vaginal
99
what is placental abruption
separation of placenta from uterus before the birth of baby (usually happens after birth)
100
in placental abruption, what does the amniotic sac fill with
blood
101
risk factors for placental abruption (5)
```
pre-eclampsia
smoking
cocaine
antiphospholipid syndrome
polyhydramnios (too much amniotic fluid)
```
102
how does placental abruption present
severe abdo pain
bleeding
woody/tender abdo
103
woody abdomen >24w
severe abdo pain
bleeding
placental abruption
104
painful bleeding >24w
placental abruption
105
which is painless bleeding, placental abruption or placenta praevia
placenta praevia
106
which is painful bleeding, placental abruption or placenta praevia
placental abruption
107
investigations for placental abruption (1)
CTG - make sure baby is okay
108
what would hCG be in placental abruption
v v high (higher than normal pregnancy)
bc placenta has released its contents (hCG)
109
management of placental abruption (2)
resus mum - with fluids, blood etc
| urgent c section
110
complications of placenta praveia for baby if not taken out in time (3)
intrauterine death
hypoxia
small for dates - premature birth
111
vasa praevia definition
when placenta blood vessels cross near cervical os
112
how does vasa praevia present
sudden bleeding
| fetal tachycardia - most other conditions with bleeding, it doesn't really affect the baby, but this directly does
113
treatment of vasa praevia
urgent c section
114
how does uterine rupture present
severe abdo pain
bleeding
shoulder tip pain (bc into peritoneum)
115
treatment of uterine rupture
emergency c section
| resus mum - fluids, crossmatch blood
