Revision - Obs 2 Flashcards
What drugs can increase the risk of peptic ulceration when given alongside NSAIDs? (2)
1) Corticosteroids
2) Aspirin
What drugs can increase the risk of GI bleeding when given alongside NSAIDs?
1) SSRIs
2) Venlafaxine
3) Anticoagulants
What drugs can increase the risk of renal impairment when given alongside NSAIDs?
1) ACEi
2) Diuretics
How do NSAIDs impact other antihypertensives ?
NSAIDs reduce therapeutic effects of other antihypertensives
In pregnancy, what are prostaglandins important for?
1) Maintaining ductus arteriosus
2) Softening cervix & stimulating uterine contractions at time of delivery
In what trimester are NSAIDs particularly avoided? Why?
3rd trimester:
1) can cause premature closure of the ductus arteriosus in the fetus.
2) can also delay labour
1st line management of HTN caused by pre-eclampsia?
Labetalol
3 adverse effects of beta blockers in pregnancy?
1) Fetal growth restriction
2) Hypoglycaemia in the neonate
3) Bradycardia in the neonate
How can medications that block the renin-angiotensin system (ACEi and ARBs) affect pregnancy?
1) Can cause hypocalvaria (incomplete formation of skull bones)
2) Can affect kidneys, and reduce the production of urine –> oligohydramnios
Can lithium be used in breastfeeding?
No - enters breast milk and is toxic to the infant, so should be avoided in breastfeeding.
What are some potential risks of SSRIs in pregnancy?
1st trimester:
- link with congenital heart defects
3rd trimester:
- risk of persistent pulmonary HTN of neonate
Which SSRI has the strongest link to congenital heart defects if taken in the 1st trimester?
Paroxetine
Impact of aminoglycosides during pregnancy?
Aminoglycoside Abx cross the placenta –> can cause ototoxicity e.g. irreversible bilateral congenital deafness.
What is an adverse effect of taking chloramphenicol in pregnancy?
‘Grey baby’ syndrome
Characterised by abdominal distention, hemodynamic collapse, and ashen-grey skin discoloration in neonates.
Give 2 effects of cocaine use during pregnancy
1) IUGR
2) Preterm labour
How can maternal diabetes affect amniotic fluid?
Can cause polyhydramnios
What are 2 effects of smoking during pregnancy?
1) Preterm
2) IUGR
What is the impact of tetracyclines in pregnancy?
Discoloured teeth
When is organ formation completed during development?
12 weeks (end of 1st trimester)
What is the only exception for use of warfarin in pregnancy?
In women with mechanical prosthetic heart valves who have a high risk of valve thromboses.
Warfarin is used in SOME of these women between 12-36 weeks.
What is the main cause of haemorrhage in pregnancy?
Uterine atony
Indications for syntocinon?
(2)
1) active mx of 3rd stage of labour
2) induce labour
Role of syntocinon in 3rd stage of labour?
Stimulates contraction of uterus (reduces risk of PPH)
Give 5 medications used in mx of PPH
1) IV oxytocin (IV)
2) ergometrine (IV)
3) carboprost (IM)
4) misoprostol (sublingual)
5) TXA
Role of ergometrine in 3rd stage of labour?
By constricting vascular smooth muscle of the uterus it can decrease blood loss.
Mechanism - stimulates alpha-adrenergic, dopaminergic and serotonergic receptors
Key adverse effect of ergometrine?
Coronary artery spasm
What is misoprostol?
Prostaglandin analogue
Indication for misoprostol?
1) Termination of pregnancy (TOP) following mifepristone
2) Miscarriage management
3) Induction of labour (cervical softener)
When is ergometrine NOT used?
HTN
What is a key adverse effect of mifepristone?
Menorrhagia
What is entonox?
Gas and air - 50% nitrous oxide and 50% oxygen
Abx management of UTIs in pregnancy?
- Trimethoprim (anti folate drug) DO NOT use in 1st trimester (teratogenic)
- Nitrofurantoin DO NOT USE in 3rd trimester (neonatal haemolysis)
What can co-amoxiclav in pregnancy cause?
Risk of NEC
What Abx is given in Preterm Prelabour Rupture of Membranes (PPROM)? Why?
Erythromycin 250mg qds to prevent chorioamnionitis
Abx management of chorioamnionitis?
Cefuroxime + metronidazole
Abx management of endometritis?
Co-amoxiclav
What is endometritis?
Infection of uterus after pregnancy
2 key antihypertensives used in pregnancy?
1) Labetalol
2) Nifedipine
1st line anticonvulsant in eclampsia?
Mg Sulphate IV
Is epilepsy an indication for high dose folic acid (5mg)?
Yes
When does infection occur in cogenital rubella syndrome?
Infection in frist 20 weeks of pregnancy
Risk highest <10w
If pregnant women are concerned about contracting cogenital rubella syndrome, what can be done?
Test for rubella immunity
If they do not have antibodies to rubella, they can be vaccinated with two doses of the MMR, three months apart.
Vaccination must happen AFTER the birth (as is a live vaccine).
Features of congenital rubella syndrome?
1) congenital deafness
2) congenital cataracts
3) learning disability
4) congenital heart disease (PDA & pulmonary stenosis)
What 2 congential heart defects can congeniaal rubella syndrome cause?
1) PDA
2) Pulmonary stenosis
What can VZV infection in pregnancy lead to?
1) More severe cases in the mother, such as varicella pneumonitis, hepatitis or encephalitis
2) Foetal varicella syndrome
3) Severe neonatal varicella infection (if infected around delivery)
Who is immune to VZV in pregnacy?
Mothers that have previously had chickenpox are immune and safe.
When in doubt, IgG levels for VZV can be tested.
What does a positive IgG for VZV indicate?
Immunity
When can women that are not immune to varicella be offered the varicella vaccine?
before or after pregnancy (not during pregnancy as it is a LIVE vaccine)
If a non-immune woman is exposed to chickenpox in pregnancy, what can be done?
If not immune, they can be treated with IV varicella immunoglobulins as prophylaxis against developing chickenpox.
This should be given within 10 days of exposure.
When should IV varicella immunoglobulins be given?
Within 10 days of exposure
When the chickenpox rash starts in pregnancy, what is given?
What is the criteria for this?
Oral aciclovir
a) must have presented with 24 hours
b) must be more than 20 weeks gestation
When does infection occur in congenital varicella syndrome?
In the first 28 weeks of gestation
Features of congenital varicella syndrome?
1) Foetal growth restriction
2) Microcephaly, hydrocephalus and learning disability
3) Scars and significant skin changes located in specific dermatomes
4) Limb hypoplasia (underdeveloped limbs)
5) Cataracts and inflammation in the eye (chorioretinitis)
Listeriosis in pregnant vs non-pregnant women?
Listeriosis is many times more likely in pregnant women compared with non-pregnant individuals.
Impact of listeriosis on the pregnancy?
high rate of miscarriage or fetal death
can also cause severe neonatal infection.
How is Toxoplasma gondii typically spread?
It is primarily spread by contamination with faeces from a CAT that is a host of the parasite.
When is the risk of congenital toxoplasmosis highest?
LATER in pregnancy
Triad of features in congenital toxoplasmosis?
1) intracranial calcification
2) hydrocephalus
3) chorioretinitis
What is Parvovirus B19 also known as?
1) fifth disease
2) slapped cheek syndrome
3) erythema infectiosum
When are children with parvovirus infection contagious?
Infection 7-10 days before rash appears
They are not infectious once the rash has appeared.
Complications of infections with parvovirus B19 in pregnancy?
1) Miscarriage or fetal death
2) Severe fetal anaemia
3) Hydrops fetalis (fetal heart failure)
4) Maternal pre-eclampsia-like syndrome
When are complications of infections with parvovirus B19 in pregnancy most serious?
1st & 2nd trimester
How can parvovirus infection in pregnancy lead to foetal anaemia?
1) parvovirus infection of the erythroid progenitor cells in the fetal bone marrow and liver
2) these cells produce RBCs –> the infection causes them to produce faulty red blood cells that have a shorter life span.
3) Less red blood cells results in anaemia.
4) This anaemia leads to heart failure, referred to as hydrops fetalis.
Result of foetal anaemia in parvovirus B19 infection?
Hydrops foetalis
Can cause known as mirror syndrome)
What triad is seen in maternal pre-eclampsia-like syndrome?
1) hydrops fetalis
2) placental oedema
3) oedema in the mother
It also features hypertension and proteinuria.
Women suspected of parvovirus infection need tests for…?
1) IgM to parvovirus, which tests for acute infection within the past four weeks
2) IgG to parvovirus, which tests for long term immunity to the virus after a previous infection
3) Rubella antibodies (as a differential diagnosis)
Management of parvovirus infection in pregnancy?
Supportive
Features of congenital zika syndrome?
1) microcephaly
2) foetal growth restriction
3) other intracranial abnormalities e.g. ventriculomegaly and cerebellar atrophy
Risk of UTIs in pregnancy?
Increases risk of preterm delivery
May increse risks of other adverse outcomes e.g. low birth weight, pre-eclampsia
When are pregnant women tested for asymptomatic bacteruria?
Booking scan (and routinely through pregnancy)
Risks of asymptomatic bacteriuria in pregnancy?
- Higher risk of developing lower urinary tract infections
- Pyelonephritis
- Subsequently at risk of preterm birth.
What are nitrites produced by?
Nitrites are produced by gram-negative bacteria (such as E. coli)
These bacteria break down nitrates into nitrites
How do urine dispticks assess for leukocytes in the urine?
Urine dipstick tests examine for leukocyte esterase, a product of leukocytes.
Management of UTIs in pregnancy?
Requires 7 days (extended) course of Abx.
Abx options:
1) nitrofurantoin (avoid in 3rd trimester)
2) Amoxicillin (only after sensitivities are known)
3) Cefalexin
What 3 Abx are safe in pregnancy?
1) nitrofurantoin
2) amoxicillin
3) cefalexin
What is the most common risk following TOP?
Infection
Who should suspected cases of rubella in pregnancy be discussed with?
The local Health Protection Unit
Mx of women at moderate or high risk of pre-eclampsia?
Aspirin 75-150mg daily from 12w gestation until birth
1st line mx of miscarriage?
Expectant i.e. waiting for a spontaneous miscarriage
Involves waiting for 7-14 days for the miscarriage to complete spontaneously
If unsuccessful then medical or surgical management may be offered
Give 3 situations where a miscarriage would be better managed medically or surgically
1) increased risk of haemorrhage
- late first trimester
- has coagulopathies or is unable to have a blood transfusion
2) evidence of infection
3) previous adverse and/or traumatic experience associated with pregnancy e.g. stillbirth
All pregnant women should take a daily supplement of vitamin D of what dose?
10micrograms
In a TOP, how long after mifepristone is misoprostol given?
48h later
When is a multilevel pregnancy test required after TOP?
2 weeks later
Cut off values for treatment of anaemia (Hb) in pregnancy:
a) 1st trimester
b) 2nd/3rd trimester
3) postpartum
a) Hb <110 g/l
b) <105 g/l
c) <100 g/l
When can ECV be offered if baby is breech?
36w
Is HbA1c used to diagnose gestational diabetes?
No
What can steroids cause in diabetics?
Hyperglycaemia –> close attention should be paid to the blood glucose measurements.
Define pueperal death
A maternal death within the puerperal period (first 6 weeks after birth).
1st line antiemetics for vomiting in pregnancy?
Antihistamines e.g. promethazine
