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JL Reproduction and Sexual Health > Week 4 part 2 > Flashcards

Week 4 part 2 Flashcards

1
Q

What are the effects of diabetes on pregnancy?

A
  1. Miscarriage
  2. Fetal malformations cardiac, neural tube, caudal regression syndrome
  3. IUGR/macrosomia
  4. Unexplained IUD
  5. PET
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2
Q

mEDICATIONS for diabetse in pregnancy>

A

Diet, metformin, insulin

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3
Q

When should labour be induced with diabetes?

A

At 37-38 weeks

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4
Q

Diabetes causes fetal macrosomia - what risk does this have?

A

Shoulder dystocia

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5
Q

Diabetes causes polyuria, polyhydramnios - what risk does this have?

A

Preterm labout/malpesntation/cord prolase

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6
Q

Diabetes causes increased O2 demands and polycythaemia - what risk does this have?

A

Risk of unexplained term still birth

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7
Q

Diabetes causes neonatal hypoglycaemia - what risk does this have?

A

Risk of cerebral palsy

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8
Q

Is PCOS a risk factor for gestational diabetes mellitus?

A

Yes

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9
Q

In pregnancy with pre-existing DM when should labour be induced?

A

At 37-38 weeks

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10
Q

Major cause of obsetric litigation?

A

Macrosomia

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11
Q

What is LSCS recommended in DM where macrosomia and EFW greatr than 4000g?

A

Macrosomia

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12
Q

What fetal effect of DM causes fetal malpresentations and possible increased risk preterm labouir?

A

Polyhydramnios

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13
Q

What does hyperinsulinaema in fetus cause risk of?

A

CP

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14
Q

wHAT IS THE leading cause of maternal death?

A

VTE - venous thromboembolism

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15
Q

wHAT ARE medications for VTE in pregnancy?

A

LMWH

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16
Q

Is pregnancy pro-thrombotic?

A

Yes

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17
Q

Virchows triad in preganncy

A

Stasis - secondar to venous compression by pregnant uterus
Hypercoagulability - effects of pregnancy
Vascular damage - varicose veins

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18
Q

Evolutionary - why is pregnancy a pro-coaguable state?

A

To decrease risk of post partum haemorrhage

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19
Q

Pregnancy is a pro coaguable state - what factors are increased?

A

7,8,9,10,12 and fibrinogen, increased platelets

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20
Q

Pregnancy is a pro coguable state - what factors are decreased?

A

Factor 11 and antithrombin 3

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21
Q

Three risk factors for VTE (preexisting)?

A

Obesoty
greater than 35 years of age
Smoker

also parity >3, elective CS, FH, varicose veins, systemic infection, immoblity, PET, twins

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22
Q

In pregnancy, if four or more risk factors for VTE?

A

Prophylaxis in first trimester

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23
Q

3 risk factors for VTE in pregnancy?

A

Prophylaxis from 28 weeks

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24
Q

Postnatally, if any previous VTE, anyone requiring antenatal LMWH, high risk thrombophilia, low risk thrombophilia + FH - what is managed?

A

High riSK - at least 6 weeks [pstnatal prophylactic LMWH

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25
Q

With DVT - what investigation is NOT done in pregnancy?

A

D-dimer - do ultrasound instead and give therapeutic heparin - treat then see!

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26
Q

What is the therapeutic dose of LMWH in pregnancy?

A

1mg twice daily OR once daily - continue until 3 months after delibery ot 6 months after treatment

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27
Q

Why is heparin safe in pregnancy?

A

Doesnt cross placenta - no anticoagulation effect on fetus

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28
Q

Side effects of heparin in pregnancy?

A

Haemorrhage
Hypersensitiity
HIT - heparin induced thrombocytopenia
Osteopenia

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29
Q

In PE in pregnancy what do u give before investigating?

A

Heparin

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30
Q

What mght PE cause on CXR in pregnancy?1.

A
  1. Atelectasis - collapse of lung
  2. Effusion
  3. Focal opacities
  4. Regional oligaemia
  5. Pulmonary oedema
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31
Q

In poregnancy, if PE CXR is abnormal and high clinical suspicion what is done?

A

CTPA

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32
Q

In pregnancy, if CXR for PE is negative what is done?

A

Bilateal compression duplex dopplers

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33
Q

What is a risk factor in pregnancy when fetting CTPA done for potential PE?

A

History of breast cancer

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34
Q

With VTE for pregnancy - when is heaprin stopped?

A

Whwen in labour

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35
Q

If using warfarin in pregnancy for VTE when is it stopped?

A

6 weeks before labour start D2/3 - avoid in pregnancy 6-12 weeks teratogenic, miscarriage, neurological problems, still borth

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36
Q

Is warfarin ok with breast feeding?

A

YES

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37
Q

How is the dose of levothyroxine changed in pregnnacy for hypothyroid women?

A

Increased by 25-50mcg in first trimester

TFT every trimester

38
Q

What are the effect of hyperthyroid on pregnancy?

A
  1. IUGR
    2, Preterm labour
  2. Thyroid storm
39
Q

What medications are used for hyperthyroid in pregnancy?

A

Carbimazole and propothyouracil

Beta-blockers (propanalol) - IUGR

40
Q

What is the commonest chronic medical illness to complicate pregnancy?

A

Asthma

41
Q

What does the increased resp rate in pregnancy cause?

A

Resp alkalosis

42
Q

Resp changes in pregnancy

A 
Inceased O2 emand
Tital volume increase
Inspiratory capacity increases
Residual volume decreases
Expiratory reserve decreases
Reduction in functional residual capacity (diaphragmatic elevation, increase in subcostal angle)
43
Q

What respiratory related things are unchanged in pregnancy?

A

FEV1 and PEFR

44
Q

What are the major malformations with epilepsy in pregnancy?

A
  1. NTD
  2. orofacial
  3. Heart defects
45
Q

Why is there an increaesd chance of seizure in first trimester
?

A

Hyperemesis and haemodilution

46
Q

When might yo take vitamin K in epilepsy in pregnanyc/

A

If taking hepatic enxyme inducing anticonvulsants

47
Q

In epilepsy in pregnanhcy - when are seizures highest risk?

A

In peripartum period

48
Q

Effects of epilepsy on pregnancy: status epilepticus?

A

Less than 1% pregnancies but dangerous for mother and baby - treat vigourously

49
Q

What epileptic drug has major malformation of fetus like orofacial clefts?

A

Phenytoin

50
Q

What two epileptic drugs cause cardiac defects in fetus?

A

Phenytoin and valproate

51
Q

In fetus: v-shaped eyebrows, lowset ears, broad nasal bridge, irregular teeth, hypertelorism, hypoplastic nails + distal digits

A

fetal anticonvulsant syndrome

52
Q

if taking phenytoin, valproate nd carbamazepine - what is risk to fetus?

A

50%

53
Q

are benzodiazepines teratogenic?

A

no

54
Q

with anticonvulsants what is the mechanism of teratogenesis thought to be?

A

folate deficiency

55
Q

Preconceptually - what is management of epilespy in pregnancy?

A

TRake folic acid 5mg a day for at least 12 weeks prior to conception

56
Q

What scans are done for management of epilepsy in pregnancy?

A

Detailed fetal scan at 18-20 weeks with detailed fetal cardiac scan at 22 weeks

57
Q

If on enzyme inducers in pregnancy what drug should be given orally from 34-36 weeks?

A

Vit K 10-20mg

58
Q

In epilepdy in pregnancy what should neonate have 1mg of postpartum?

A

IM vit K

59
Q

What percentage of women conceive?

A

80%

60
Q

Who is the patient referred to if in pregnanyc: psychosis, severe anxiety, depression, suicidal, self-neglect, symptoms interfering with AOLs, history of bipolar or schizophrenia, history of puerperl psychosis, psycotropic meds?

A

Psychiatry team for psychotherapy

61
Q

Pervasive or episodic fearfulness, avoidance and autonomic arousal
Often concurrent depression
Phobias, obsessive compulsive, post traumatic stress

A

Anxiety disorders

62
Q

What do anxiety disorders predict?

A

Post natal depression

63
Q

What drug should be avoided when treatint anxiety disorders in pregnancy and why?

A

Benzos - cleft and neonatal withdrawal

64
Q

What do 50% of bipolar women go on to develop postnatally if it isnt getting treatd?

A

Episode of bipolar and risk of suicide

Baby can be affected by bipolar 1 in 7

65
Q

Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of valproate?

A
  1. NTD
  2. craniofacial defects
  3. CV abnormality
  4. IUGR
  5. Reduced IQ
  6. Cleft
66
Q

Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of carbamazapine?

A

Facial dysmorphism
Cardiac abnormalities
Fingernail hypoplasia
NTD

67
Q

Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of lamotrigine?

A

Cleft

Steveen Johnson syndrome to baby if breastfed

68
Q

What mood stabiliser for bipolar in pregannncy can cause vit k deficiency and haemorrhagic disease of newborn?

A

Carbamazepine

69
Q

What anomalies can lithium cause to newborn?

A

Cardiac abnormalities, risk maternal toxicity, Ebsteins anomaly
Nenoatal hypotonia, hypothyroidism, hypoglycaemia

70
Q

Is lithium used for BPAD in pregnanyc allowed for breastfeeding?

A

NO it is contraindicated

71
Q

What is risk of schizophrenai to child?

A

10%

72
Q

For treating schizoprenia in pregnancy what can atypicals such as clozapine, olanzapine, risperidone and quetiapine cause?

A

Gestational diabetes

IUGR

73
Q

For treating schizoprenia in pregnancy: are tpyical antipsychotics safe?

A

Yes

74
Q

For treating schizoprenia in pregnancy: which atypical is contraindicated in breast feeding?

A

Clozapine

75
Q

What condition in pregnancy causes this: IUGR, prematurity, hypokalaemia, hyponatraemia, metabolic alkalosis, miscarriage, premature delivery

A

Eating disorders - bulimia nervosa, anoerxia

76
Q

Who is mikld-moderate depression in pregnancy treated by?

A

GP

77
Q

Who is severe depression in pregnancy treated by?

A

Psychiatry

78
Q

What two drugs are not used to treat depression in pregnancy and why?

A

Venlafaxine - hypertension

Paroxetitine - cardiac abnormalities

79
Q

What two antidepressants have high levels in breast mild?

A

Citalopram and fluoxetine SSRIs

80
Q

Which antidepressant SSRI is ok for breastfeeding?

A

Sertraline

81
Q

Are antidepressants amitriptyline and nortryptiline safe in pregancy and okay for breast feeding?

A

Yes

82
Q

What condition do 10% of women get after pregnancy and the onset is 2-6 weeks?

A

Postnatal depression

83
Q

What condition do 50% of women get after pregnancy?

A

Baby blues

84
Q

Brief period of emotional instability, tearful, irritable, anxiety and poor sleep?

A

Baby blues - 3-10 days self-loimiting

85
Q

Usually presents within 2 weeks of delivery
Early symptoms are sleep disturbance and confusion, irrational ideas
Mania, delusions, hallucinations, confusion

A

Puerperal psychosis

86
Q

Name some risk factors for puerperal psychosis? (0/1% of women)

A
  1. Bipolar 50%

2. 1st degree relative with history

87
Q

Management of puerperal psychosis?

A

An emergnency - admit toi specialist mother-baby unit, antidepressantsm antipsychotics, mood stabilisers and ECT

88
Q

facial deformities, lower IQ, neurodevelopmental delay, epilepsy, hearing, heart and kidney defects

A

Faetal alcohol sybdrome

89
Q

Are cocaine, amphetamine and ecstasy teratogenic?

A

Yes

90
Q

Should you be breastfeeding if alcohol greaster than 8, HIV or cocaine?

A

No

JL Reproduction and Sexual Health (18 decks)

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