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J Repro > Problems in pregnancy > Flashcards

Problems in pregnancy Flashcards

1
Q

which blood problems are increased in risk during pregnancy (2)

A

DVT

PTE

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2
Q

where is MSK pain common during pregnancy

A

back

pelvic girdle - pubic symphysis and sacroiliac joints

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3
Q

which MSK hand problem is common during pregnancy

A

carpal tunnel syndrome

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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

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5
Q

carpal tunnel presentation

A

paresthesia of palmar lateral 3 and a half fingers

paralysis of thenar eminence (and LOAF muscles of hand)

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6
Q

treatment of carpal tunnel

A

splint

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7
Q

is hypertension in 1st trimester caused by pregnancy

A

no- usually hypotensive in first trimester, so probs a problem from before

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8
Q

whats the difference between pregnancy induced hypertension and pre-eclampsia

A

pre-eclampsia has symptoms, pregnancy induced hypertension is just hypertension

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9
Q

is pre eclampsia common

A

yes in 10% of pregnancies

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10
Q

pathophysiology of pre eclampsia

A

diffuse vascular endothelial dysfunction

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11
Q

if pre eclampsia starts <34 weeks what is the cause

A

placental problem (rare)

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12
Q

if pre eclampsia starts >34 weeks what is the cause

A

maternal problem (common)

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13
Q

risk factors for pre eclampsia

A 
PMH 
CKD 
autoimmune disease 
diabetes 
chronic hypertension 
>40yo 
BMI>30
Fx
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14
Q

if someone has pre eclampsia risk factors, what do you give them

A

75mg aspirin OD form 12w to birth

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15
Q

pre eclampsia triad

A

hypertension
proteinuria >0.3g/l
oedema

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16
Q

why do pre eclampsia patients get oedema

A

kidney function decreases = salt and water retention

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17
Q

investigations for pre eclampsia

A

urinalysis
bp
maternal uterine artery doppler (MUAD)
fetal surveillance

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18
Q

pre eclampsia hypertension treatment first line

A

methyl dopa
labetalol
nifedipine

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19
Q

methyl dopa contraindication for pre eclampsia

A

depression

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20
Q

labetalol contraindication for pre eclampsia

A

asthma (bc its a beta blocker)

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21
Q

what do you in pre eclampsia

A

deliver baby - only cure of pre eclampsia

treat hypertension

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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

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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

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24
Q

seizure in pregnancy

A

eclampsia!!

may also be new onset epilepsy but unlikely

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25
Q

complication of untreated pre eclampsia (if you don’t take baby out)

A

ECLAMPSIA!

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26
Q

how does eclampsia present

A

seizure

coma

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27
Q

management of eclampsia

A

IV labetalol to control bp
magnesium sulphate IV - to stop seizures
deliver baby

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28
Q

what can pre eclampsia do to the liver

A

liver rupture - RUQ pain

HELLP syndrome

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29
Q

what is HELLP syndrome

what is the mortality

A

Haemolysis
Elevated Liver enzymes
Low Platelets

= high mortality

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30
Q

re eclampsia haem complication

A

DIC

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31
Q

pre eclampsia cardio complication

A

pulmonary oedema

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32
Q

pre eclampsia placental complication

A

placental abruption

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33
Q

what is the difference between morning sickness and hyperemesis gravidarum

A

hyperemesis gravidarum = decreased QoL, v unwell (dehydration, ketosis, electrolyte imbalance, emotional instability)

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34
Q

management of hyperemesis gravidarum

A

IV fluids for rehydration
electrolyte replacement
steroids - if recurrent and severe

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35
Q

bleeding in early pregnancy differentials (6)

A

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

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36
Q

bleeding in late pregnancy (antepartum) differentials (4)

A

placenta praevia
placental abruption
vasa praevia
uterine rupture

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37
Q

miscarriage definition

A

loss of embryo <24weeks

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38
Q

what is the most common cause for miscarriage

A

chromosomal abnormality = not functional with life

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39
Q

environmental causes of miscarriage (4)

A

infection
severe emotional upset
iatrogenic (eg after CVB)
smoking/drugs/alcohol misuse

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40
Q

how does a miscarriage present

is it painful;

A

BLEEDING

not painful, just like period cramps

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41
Q

definition of threatened miscarriage

A

cervical os is closed, fetus still in uterus
pregnancy may still be saved (not confirmed miscarriage, just hypothetical)
may be asymptomatic

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42
Q

definition of inevitable miscarriage

A

pregnancy cant be saved

cervical os open and foetus can be seen

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43
Q

definition of incomplete miscarriage

A

foetus has passed mostly into vagina, but still slightly in uterus

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44
Q

definition of complete miscarriage

A

foetus has passed fully into vagina

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45
Q

investigations for miscarriage

A

US scan

speculum examination

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46
Q

why is pregnancy test not useful for miscarriage

A

will stay positive for days after miscarriage

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47
Q

treatment of miscarriage once feotus is out

A

IV fluids if massive blood loss

send home with pads

48
Q

treatment of miscarriage if feotus still inside (2)

A

medical induction of TOP - mifepristone and misoprostol

surgical induction of TOP - vacuum aspiration

49
Q

why would you do surgical TOP instead of medical in miscarriage

A

if heavy bleeding

medical will increase bleeding

50
Q

what conditions cause recurrent miscarriages (4)

A

antiphospholipid syndrome
PCOS
bacterial vaginosis
uterine abnormality

51
Q

investigations for recurrent miscarriages (2)

A

lupus anti coagulant, phospholipid and anti cardiolipin antibodies
pelvis US for uterine abnormalities

52
Q

in a miscarriage, is bleeding or pain more significant

A

bleeding

53
Q

ectopic pregnancy definition

A

abnormal site of implantation of fertilized egg ie not in the ampulla of fallopian tubes (outside of uterus)

54
Q

possible locations of ectopic pregnancy

A

ovary
c section scar
peritoneum - bc fallopian tubes open up into peritoneal cavity

anywhere outside the uterus

55
Q

causes of ectopic pregnancy (3)

A

pelvic inflammatory disease
endometriosis
IUCD

56
Q

what STI commonly causes pelvic inflammatory disease = increased risk of ectopic pregnancy

how does this work

A

chlamydia

causes narrowing of fallopian tubes

57
Q

presentation of ectopic pregnancy

A

v painful

little bleeding

58
Q

in ectopic pregnancy, is bleeding or pain more significant (6)

A 
PAIN!!!!
little bleeding 
dizziness/collapse 
shoulder tip pain 
guarding/tenderness of abdo
vomiting/diarrhea
59
Q

in ectopic pregnancy, where can the pain radiated to

A

shoulder tip

60
Q

shoulder tip pain

A

ectopic pregnancy

61
Q

why can ectopic pregnancy present with GI symptoms eg diarrhea

A

can implant in the peritoneal cavity

62
Q

investigations for ectopic pregnancy

A

hCG - to confirm pregnancy
US - to see empty uterus
speculum

63
Q

what do you see on US in ecptopic pregnancy

A

empty uterus

64
Q

empty uterus on US but positive hCG

A

ectopic pregnancy

65
Q

treatment of ectopic pregnancy in stable patient, pregnancy in early stages

A

methotrexate

66
Q

treatment of ectopic pregnancy in stable patient but pregnancy far on (ie methotrexate wont work)

A

laparoscopy (key hole surgery)

67
Q

treatment of ectopic pregnancy in unstable patient (eg in septic shock)

A

laparotomy - surgery, do salpingectomy (remove tube and ectopic)

68
Q

another name for molar pregnancy

A

hydatidiform mole

69
Q

definition of molar pregnancy

A

placental overgrowth with no/abnormal fetus (hence cant receive stuff from placenta = placenta overgrowth)

70
Q

‘grape like clusters’ on pathology

A

molar pregnancy

71
Q

which type of mole has no feotus

A

complete mole

completely fuckoed

72
Q

which type of mole has an abnormal fetus

A

partial mole

at leas they tried to make a baby = only partially fuckoed

73
Q

which type of mole increases your risk of choriocarcinoma

A

complete mole

74
Q

how does molar pregnancy present (2)

A

hyperemesis (vomiting blood)

vaginal bleeding - potentially with grape like tissue

75
Q

investigations for molar pregnancy (2 - 1 main one)

A

US - main one

hCG

76
Q

US appearance of molar pregnancy

A

snowstorm appearance

77
Q

hCG level in molar pregnancy

A

v v high (higher than normal pregnancy) bc of overproduction of chorioblasts

78
Q

treatment of molar pregnancy

A

surgical removal

79
Q

what is invasion of molar pregnancy into the uterus called

how is it treated

A

choriocarcinoma

hysterectomy :(

80
Q

after what week is the antepartum period classed as

A

> 24w

81
Q

antepartum minor haemorrhage criteria

A

<50ml blood

82
Q

antepartum major haemorrhage criteria

A

50-1000ml blood

83
Q

antepartum massive haemorrhage criteria

A

> 1000ml blood or signs of shock

84
Q

what investigation do you want to do if antepartum haemorrhage

why

A

kleihauer to check if mum got any of babies blood

might need to give anti-D

85
Q

placenta praveia definition

A

low lying placenta

when the placenta is totally/partially implanted in the lower uterus

86
Q

when is placenta praevia usually picked up

A

20 week US scan

87
Q

why is a low lying placenta (placenta praevia) bad

A

less contractile muscles in lower uterus = harder to get out during labour

88
Q

major placenta praevia

A

placenta lying over internal cervical os

89
Q

minor placenta praveia

A

placentation not covering the internal cervical os

90
Q

presentation of placenta praevia

A

painless bleeding

91
Q

in placenta praevia, is bleeding or pain more significant

A

bleeding! probs painless

92
Q

painless bleeding >24w

A

placenta praevia

93
Q

investigations for placenta praevia

A

US - to see if major (covering cervical os) or minor (not covering cervical os)

94
Q

what investigation MUST YOU NOT DO for placenta praevia

why

A

vaginal exam and speculum

bc could rupture placenta = massive haemorrhage

95
Q

vaginal bleeding >24w, what investigation do you do first

why

A

US first

to exclude/diagnosis placenta praevia
only then can you do a vaginal/speculum examination

96
Q

what will hCG be like in placenta praevia

A

normal for pregnancy (high but not too high)

bc normal pregnancy

97
Q

management of placenta praevia

A

resus mum - fluids, crossmatch blood

anti-D

98
Q

what is the likely delivery method of a baby previously diagnosed with placenta praevia

what is the exception

A

likely c section

unless placenta >2cm from cervical, then can do vaginal

99
Q

what is placental abruption

A

separation of placenta from uterus before the birth of baby (usually happens after birth)

100
Q

in placental abruption, what does the amniotic sac fill with

A

blood

101
Q

risk factors for placental abruption (5)

A 
pre-eclampsia
smoking 
cocaine 
antiphospholipid syndrome 
polyhydramnios (too much amniotic fluid)
102
Q

how does placental abruption present

A

severe abdo pain
bleeding
woody/tender abdo

103
Q

woody abdomen >24w
severe abdo pain
bleeding

A

placental abruption

104
Q

painful bleeding >24w

A

placental abruption

105
Q

which is painless bleeding, placental abruption or placenta praevia

A

placenta praevia

106
Q

which is painful bleeding, placental abruption or placenta praevia

A

placental abruption

107
Q

investigations for placental abruption (1)

A

CTG - make sure baby is okay

108
Q

what would hCG be in placental abruption

A

v v high (higher than normal pregnancy)

bc placenta has released its contents (hCG)

109
Q

management of placental abruption (2)

A

resus mum - with fluids, blood etc

urgent c section

110
Q

complications of placenta praveia for baby if not taken out in time (3)

A

intrauterine death
hypoxia
small for dates - premature birth

111
Q

vasa praevia definition

A

when placenta blood vessels cross near cervical os

112
Q

how does vasa praevia present

A

sudden bleeding

fetal tachycardia - most other conditions with bleeding, it doesn’t really affect the baby, but this directly does

113
Q

treatment of vasa praevia

A

urgent c section

114
Q

how does uterine rupture present

A

severe abdo pain
bleeding
shoulder tip pain (bc into peritoneum)

115
Q

treatment of uterine rupture

A

emergency c section

resus mum - fluids, crossmatch blood

J Repro (28 decks)

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