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Pathology by week > W27 - Obstetric haem > Flashcards

W27 - Obstetric haem Flashcards

1
Q

During normal pregnancy…

  1. Less iron is required
  2. There is an increase in haemoglobin concentration
  3. The platelet count falls
  4. The neutrophil coutn falls
A
  1. The platelet count falls
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2
Q

FBC in pregnancy - what happens to red cell mass, plasma volume, red cell size, neutrophil count, platelet count

A

FBC in pregnancy - what happens to red cell mass, plasma volume, red cell size, neutrophil count, platelet count

  1. Red cell mass rises (120-130%)
  2. Plasma volume rises (150%)

= net dilution so mild anaemia

  1. Macrocytosis (normal, or may be folate/b12 def)
  2. Neutrophilia
  3. Thrombocytopaenia (reduced count, size increased)
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3
Q

Iron requirments in pregnancy

  • foetus, maternal, total RDA
A

300 mg for foetus

500 mg for maternal increased red cell mass

RDA 30 mg

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4
Q

Daily iron absorption goes from ______ to ____ in pregnancy

A

Daily iron absorption goes from 1-2mg to 6mg in pregnancy

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5
Q

folate requirements in pregnancy

A

needed for additional growth and cell division

–Approx additional 200mcg/day required

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6
Q

Folic acid dose & duration for pregnancy

& why?

A

–Dose 400μg / day supplement before conception and for ≥ 12 weeks gestation

(5mg dose for those who are high risk)

to avoid neural tube defects

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7
Q

Anaemia in pregnancy - definition by trimester

A

–Hb < 110 g/l 1st trimester

–Hb < 105 g/l 2nd and 3rd trimester

–Hb < 100 g/l postpartum

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8
Q

Treatment of (mild) iron deficiency anaemia in pregnancy

A
  1. Trial of oral iron, continue at least 3 months beyond correction of Hb to replenish iron stores
  2. If not corrected, consider haemoglobinopathy screens
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9
Q

4 causes of thrombocytopaenia in pregnancy

A
  1. Gestational/incidental thrombocytopaenia
  2. Pre-eclampsia
  3. ITP
  4. Microangiopathic syndromes

other causes: BM failure, leukaemias, hypersplenism, DIC, etc.

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10
Q

nPhysiological decrease in platelet count during pregnancy is roughly… %

A

~ 10%

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11
Q

Platelet count sufficient for delivery is….

Platelet count sufficient for epidural is….

A

>50 x109/L sufficient for delivery

>70 x109/L sufficient for epidural

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12
Q

Mechanism of gestational thrombocytopaenia

A

Mechanism poorly understood, likely:

Dilution + increased platelet consumption

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13
Q

___% of women with pre-eclampsia develop thrombocytopaenia, and this is proportionate to _____

A

50% of women with pre-eclampsia develop thrombocytopaenia, and this is proportionate to severity

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14
Q

Immune thrombocytopaenia (ITP) in pregnancy:

  • % of thrombocytopaenia in pregnancy
  • treatment?
  • effect on baby?
A

Immune thrombocytopaenia (ITP) in pregnancy:

  • % of thrombocytopaenia in pregnancy = 5%
  • treatment = IVIG + steroids
  • effect on baby = unpredictable, but may affect baby as IgG abs can cross placenta. Tend to avoid ventous delibery and invasive foetal monitoring methods
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15
Q

Coagulation changes in pregnancy…

A) increse the likelihood of bleeding

B) Result in a hyperfibrinolytic state

C) Are mediated by BHCG hormone

D) Result in a leading cause of maternal mortality

A

D) Result in a leading cause of maternal mortality

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16
Q

Venous thromboembolism during pregnancy….

A) Has a higher incidence than during postnatal period

B) Is more common in women with high BMI

C) Is more likly to occur following vaginal delivery than elective C-section

D) Usually affects the right leg

A

B) Is more common in women with high BMI

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17
Q

VTE has more or less remained a leading cause of mortality in pregnancy, accounting for about 30% of all deaths - T or F?

A

True

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18
Q

Summarise coagulation changes (6) in pregnancy

A
  1. Factor VIII and vWF => x 3-5 fold
  2. Fibrinogen => x 2 fold
  3. Factor VII => x 0.5 fold

= hypercoagulable

  1. Protein S => falls to 1/2 basal
  2. PAI-1 => x5 fold
  3. PAI-2 priduced by placenta

= hypofibrinolytic

19
Q

What is the net effect of coagulation changes in pregnancy? and why is it like this?

A

A procoagulant state (increased risk of thrombosis)

This is evolved so that the body can reduce the risk of bleeding at the time of placental separation and uterine contraction.

20
Q

At what time is VTE most common in pregnancy times?

A

Postpartum (about 1-6weeks post delivery)

21
Q

Most significant RF for VTE identified in maternal deaths due to PE?

A

High BMI

22
Q

Incidence of thrombosis in pregnancy?

A

1 per 1000 <35 years

2 per 1000 >35 years

23
Q

DVT in pregnancy - which side is more common?

A

Left DVT (85%) - much higher compression on left side

24
Q

Age and VTE correlation in pregnancy?

A

Increase together

25
Q

Which anticoagulation is used throughout pregnancy? which is not?

A

Patients can be given LMWH

CANNOT use DOACs in pregnancy or breastfeeding

26
Q

Typical prophylactic anticoagulation regimen (4) in pregnancy

A
  1. Prophylactic dose LMWH
  2. TED stockings
  3. Mobilising
  4. Maintain hyrdration
27
Q

Guidance around LMWH/heparins and epidural in pregnancy?

A

Stop LMWH for labour or planned delivery, esp. for epidural

Epidural: wait 24 hours after treatment dose, 12 hours after prophylactic dose

28
Q

Warfarin use in pregnancy?

A

Warfarin is teratogenic, especially in 1st trimester - must avoid!

29
Q

Antiphospholipid syndrome (APLS) - how does it usually manifest?

A

Recurrent miscarriage (usually before 10w)

+ persistent lupus antigoagulant (LA) and/or antiphospholipid abs

30
Q

What do we give women with antiphospholipid syndrome during pregnancy?

A

aspirin and LMWH

31
Q

Deaths due to haemorrhage/fatal bleeding in pregnancy usually have to do with what?

A

with how the placenta is embedded (placenta praevia, placenta accreta)

32
Q

Define PPH

A

>500 ml blood loss within the 1st 24 hour of delivery

33
Q

causes of PPH (4)

A

1. Tone - uterine atony (most common)

2. Trauma - lacerations/rupture

  1. Tissue - retained POC
  2. Thrombin - coagulopathies
34
Q

What pregnancy related complications (5) could lead to DIC?

A

–Amniotic fluid embolism

–Placental abruption

–Retained dead fetus

–Preeclampsia (severe)

–Sepsis

35
Q

Haemoglinopathy screening aims (3)

A

To avoid birth of children with:

1) a° thalassaemia (Hb Bart’s, g4) => Death in utero, hydrops fetalis
2) b° thalassemia =>Transfusion dependent
3) HbSS (sickle cell disease) => counsel patient, life expectancy 43 yrs
4) Other compound HbS syndromes => Symptomatic, stroke etc.

& Some compound thalassaemias => Transfusion dependent, iron overload

36
Q

Alpha Hb - how many genes?

  • typical west African alpha thal?
  • typical Asian alpha thal?
A

4 genes

  • typical west African alpha thal => +/-, +/-
  • typical Asian alpha thal? => +/+, -/-
37
Q

Distinguishing iron deficiency anaemia from thalassaemia trait in microcytic disease

A

Red cell count INCREASED in thalassaemia trait

Red cell count LOW OR NORMAL in iron deficiency

38
Q

Haemolytic disease of the newborn is due to

A

rhesus disease

39
Q

Which of the following statements is correct?

A) In gestational thrombocytopaenia the baby’s platelet count is uusally affected

B) Thrombocytopaenia is rarely found in association with pre-eclampsia

C) Thrombotic thrombocytopenic purpura (TTP) remits spontaneously following delivery

D) The platelet count may fall following delivery in baby’s born to mothers with ITP

A

D) The platelet count may fall following delivery in baby’s born to mothers with ITP

40
Q

A reduction in pregnancy-associated thrombosis mortality rate can be attributed to:

A) Lower obesity rates

B) Improved targeted thromboprophylaxis

C) Rising maternal age

D) Increase in prevalence of gestational thrombocytopaenia

A

B) Improved targeted thromboprophylaxis

41
Q

Which of the following is correct?

A) 1 L blood loss can be considered normal following vaginal delivery

B) Uterine atony is a common cause of PPH

C) PPH is often caused by the changes in cogulation factors in pregnany

A

B) Uterine atony is a common cause of PPH

42
Q

Diagnosis?

A

HELLP - you see schistocytes

43
Q

Diagnosis?

A

Pencil cells

Hypochromatic cells

This is iron deficiency anaemia (B)

Pathology by week (70 decks)

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