Women's Health/O&G Flashcards
Hypertension in Pregnancy
Scenario of preeclampsia with bp 148/93 proteinuria on examination peripheral edema and two clonic twitches next management
A. Iv hydralazine
B. IV MGSO4
B. IV MgSO4
Magnesium Sulphate. This woman has already developed into eclampsia as evidenced by clonic twitches and BP level.
take care using ABCDE (left lateral position, prepare suction to help with secretions) - first management would be magnesium sulfphate (IV) but it takes time to prepare, so actually first may be: IV Diazepam/Clonazepam/Midazolam
Magnesium Sulphate should be continued at least 24 hours after seizure.
Refer to Hypertension in Pregnancy - Anis Systematic Notes on OneNote for Photo of Management!
Thyroid in Pregnancy
22 yr old female Hypothyroidism scenario with labs asking about treatment in 18 wk preg
A. Daily iodine
B. Daily thyroxine
B. Daily thyroxine.
If there is a diagnosis of hypothyroidism in pregnancy, thyroxine should be initiated urgently at 1 - 2 mcg/kg/day then TFTs repeated in 6 weeks. TPO antibodies should also be checked.
Be aware that normally, thyroid levels in pregnant women is usually slightly increased in first trimester, then decrease in second and third trimester.
Hepatic synthesis of TBG (thyroid binding globulin) is increased during pregnancy. Total T4 & T3 are also increased. Levels of free T4 are less affected by pregnancy, but there is a slight increase in the first trimester. The slight increase is also partly due to HCG (due to structurally similar to TSH).
T4 is essential for fetal neural development. The fetal thyroid gland does not function until 12 weeks of getation. Thus, adequate maternal T4 is vital, especially in 1st trimester.
To meet this, sufficient iodine intake (200mcg/day) during pregnancy and lactation is needed to increase thyroid hormone production and provide iodine to fetus and neonate.There is also increased excretion of iodine in urine during pregnancy, due to increased glomerular filtration rate.
Best dietary sources for idoine is dairy products and white fish - thus vegas are at increased risk, and should be recommended to take supplements.
Contraception
27 year uni female dont want to be pregnant before finishing college strong history of factor v leiden what to prescribe
A. Pop implant
B. Соср
C. Estrogen/progesterone implant
If has factors of thrombosis: factor V leiden, preferably get a non-hormonal contraception. The only one that doesn’t affect is transdermal oestrogen patch/condoms.
