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JG Year 2 > 235 Pregnancy 2 > Flashcards

235 Pregnancy 2 Flashcards

1
Q

What are the 3 key elements of pre-eclampsia?

A

Increased BP
Proteinuria
Oedema

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2
Q

When does pre-eclampsia usually present?

A

3rd trimester - term/during labour/6 weeks post partum

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3
Q

Name 3 S&S of pre-eclampsia

6 listed

A 
HA
Visual disturbances
N&V
Epigastric pain (?HELLP)
Sudden weight gain 
Brisk reflexes
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4
Q

Name 3 R/F od pre-eclampsia

9 listed

A 
Primip
Multip but new partner
Previous Hx
Expecting multiples
35
Obesity
DM
Renal failure
Sister had it
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5
Q

What is HELLP syndrome?

A

Eclampsia with:
Haemolytic anaemia
Elevated Liver enzymes
Low Platelet count

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6
Q

What is the usual PCR (protein creatinine ratio - 24 hr urine) in an expectant mother with pre-eclampsia?

A

> 0.3g

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7
Q

What is the treatment for and prevention of pre-eclampsia?

A

Magnesium sulphate

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8
Q

What is the cure for pre-eclampsia?

A

Placental delivery usually by 37 weeks

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9
Q

Which drug can be given in 23-32 weeks gestation in a mother showing signs of pre-eclampsia?

A

Steroids

Anti-hypertensives

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10
Q

At how many weeks should delivery happen in a 32 week gestation mother with pre-eclampsia?

A

34 weeks

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11
Q

What is the term for twins who have separate placenta’s?

A

Dichorionic-diamniotic

DCDA

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12
Q

What is the term given for twins who share a placenta but have their own amniotic sacs?

A

Monochorionic-diamniotic

MCDA

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13
Q

What is the term given for twins who share a placenta and an amniotic sac?

A

Monochorionic-monoamniotic

MCMA

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14
Q

What chorionicity and amnionicity are dizygotic twins? (always)

A

DADC

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15
Q

Name 3 foetal complications of monochorionicity

7 listed

A 
Miscarriage
Congenital abnormalities
Preterm
IUGR
Perinatal loss
TTT (twin to twin transfusion)
Malpresentation
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16
Q

Name 3 maternal complications of monochorionicity

7 listed

A 
Hyperemesis gravidarum
Miscarriage
PIH/pre-eclampsia
GDM
Anaemia
APH and PPH
Placenta praevia
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17
Q

During which scan is chorionicity determined?

A

Dating scan i.e. 12 weeks

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18
Q

At how many weeks should an uncomplicated DCDA be delivered?

A

37-38 weeks

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19
Q

At how many weeks should a MCDA be delivered?

A

36-37 weeks

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20
Q

Name 2 complications which can happen during twins delivery
(4 listed)

A

Insufficient uterine contraction
Foetal distress
Cord prolapse when membranes ruptured
PPH

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21
Q

When do maternal cardiovascular changes happen during pregnancy?

A

6/40 weeks

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22
Q

What is the increase of maternal CO during pregnancy?

A

30-50%

i.e. 4.5L/min –> 6L/min

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23
Q

What is the % increase in maternal blood volume during pregnancy?

A

150%

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24
Q

What is the average increase in HR of a woman during pregnancy?

A

10bpm

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25
Q

Why is there a reduction in afterload during pregnancy?

A

Decline in systemic vascular resistence

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26
Q

What is the cardiac demand of the uterus?

A

~ 400ml/min

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27
Q

What is the % increase of CO immediately post partum?

A

80%

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28
Q

What effect does progesterone have on peripheral vascular resistance?

A

Decreases

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29
Q

What happens to systemic arterial BP during pregnancy?

A

Reduces in first 24 weeks and gradual rise to non-pregnant levels by term

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30
Q

What causes oedema during pregnancy?

A

Increased RAAS activity leading to retention of Na and H2O

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31
Q

Name 3 normal clinical features of the CVS O/E during pregnancy

A

Dyspnoea
Oedema
CXR - cardiac rotation/oedema
Axis deviation

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32
Q

What ECG changes may be present during pregancy?

3 listed

A

Sinus tachy
Left axis deviation
ST changes and T wave inversion of lead III and aVF

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33
Q

Why does Hct and Hb seem to decrease during pregnancy?

A

RBC mass increases ~30% so Hct and Hb reduce relative to this

34
Q

What happens to the levels of serum protein, albumin and gamma globulin during pregnancy?

A

Reduces 70g/L to 60g/L

35
Q

What causes the prothrombotic state during pregnancy?

A 
Increase in factors:
I (fibrinogen)
VII
VIII
IX
X
XII
36
Q

In which trimester is there in increase in factor VIII, platelet aggregation and coagulation?

A

3rd

37
Q

How much blood loss will a pregnant woman tolerate before decompensating?

A

1.5L

38
Q

What maternal respiratory changes happen during pregnancy?

A

Increased tidal volume (30-40%)
Decreased residual vol
(20%)

39
Q

What effect does progesterone have on the urinary tract?

A

Decreased peristalsis
Decreased contraction pressure
(Smooth muscle effect)

40
Q

On which side does hydronephrosis usually occur during pregnancy?

A

Right (90%) due to dextrorotation of uterus by sigmoid colon

41
Q

What happens to the maternal GFR during pregnancy?

A

Increases by 150%

42
Q

What effect does progesterone have on the GIT?

4 listed

A
  1. Causes relaxation of the LOS causing reflux
  2. Reduction in GIT motility (improve absorption)
  3. Constipation
  4. Gall bladder dilatation and poor tone –> gallstones
43
Q

What is Mendelson’s syndrome?

A

Peptic aspiration pneumonia during pregnancy

44
Q

What is the drug management for reflux during pregnancy?

A

Alginates –> H2 agonists –> PPI

45
Q

Why would there be indication for operative vaginal delivery in a mother with CVD/Cardiac disease?

A

Would want to avoid valsalva

46
Q

After how many hours would you consider operative vaginal delivery in a primip with regional anaesthesia?

A

3 hours

47
Q

After how many hours would you consider an operative vaginal delivery in a multip with regional anaesthesia?

A

2 hours

48
Q

What are the requirements for instrumental delivery? (ABC)

A 
Adequate analgesia
Bladder empty
Cervix fully dilated
\+ head below level of ischial spines 
\+ facilities available for Caesarean
49
Q

What are Kiellands forceps?

A

Rotational forceps

50
Q

When should operative vaginal delivery be abandoned?

A

No evidence of progression descent with each pull

Delivery not imminent after 3 pulls by experienced operator

51
Q

What is the name of the incision made to the skin in a caesarian section?

A

Phanensteil

52
Q

Where is the incision made in the uterus during a caesarian section?

A

Lower segment

53
Q

What is the name of a vertical incision into the uterus?

A

Classical

54
Q

Name 3 absolute indications for caesarian section

5 listed

A 
Placenta praevia 
Severe antenatal foetal compromise
Uncorrectable abnormal lie
Previous classical caesarian section
Pelvic deformity
55
Q

When should a foetus be delivered before 34 weeks?

A

Severe pre-eclampsia

Severe IUGR

56
Q

Name the 2 causes of bleeding in early pregnancy

A

Ectopic

Miscarriage

57
Q

Name the 3 causes of bleeding during late pregnancy and labour

A

Abruption
Placenta praevia
Ruptured uterus

58
Q

Name 2 causes of bleeding postpartum

4 listed

A

Uterine atony
Trauma
Retained placenta/products

59
Q

In an incomplete miscarriage, what percentage has complete evacutaion after 3 days?

A

79%

60
Q

In a missed miscarriage, what percentage has complete evacutaion after 7 days?

A

37%

61
Q

What is the medical management of miscarriage?

A

Mifeprestone + prostaglandin

62
Q

What are the risks associated with surgical removal of retained products of conception?
(4 listed)

A

Cervical injury
Uterine perforation
Infection
Excessive bleeding

63
Q

When should Anti-D prophylaxis be administered to rhesus negative mothers?

A
64
Q

How many international units of prophylactic Anti-D should be given to a rhesus negative mothers before 20 weeks?

A

250IU

65
Q

How many international units of prophylactic Anti-D should be given to a rhesus negative mothers after 20 weeks?

A

500IU

66
Q

What is the medical management of ectopic pregnancy?

A

Methotrexate

67
Q

What is the incidence of molar pregnancy?

A

1-3:1000

68
Q

How much blood loss is in a minor antepartum haemorrhage?

A
69
Q

How much blood loss is in a major antepartum haemorrhage?

A

50-1000ml

70
Q

What is a concealed placental abruption?

A

Blood collecting behind the placenta with no evidence of vaginal bleeding

71
Q

Name 3 clinical features of placental abruption

6 listed

A 
Vaginal bleeding
Abdo pain
Irritable 'woody hard' uterus
Disproportionate shock
Foetal distress
72
Q

What is placenta accreta?

A

Firmly adherent placenta

73
Q

What is placenta increta?

A

Placenta invading the myometrium

74
Q

What is placenta percreta?

A

Placenta invading through the serosa and beyond

75
Q

What is vasa praevia?

A

Placental vessels overlying the cervix

76
Q

This is the 3rd highest direct cause of maternal death in the UK

A

PPH

77
Q

What is classed as primary PPH?

A

PPH

78
Q

What is classed as secondary PPH?

A

PPH >24 hours to 6 weeks postpartum

79
Q

What are the 4 ‘T’s which cause PPH?

A

Thrombin
Tissue
Tone
Trauma

80
Q

Which drugs can be given to stop bleeding where there is placenta praevia?

A

Oxytocics

81
Q

What is the Dx?

  • Hypertension ++
  • Proteinuria ++
  • Elevated liver enzymes +
  • Hypoglycaemia +
  • Hyperuricaemia +
  • Thrombocytopaeina (-DIC) ++
  • DIC +
A

HELLP syndrome

82
Q

What is the Dx?

  • Hypertension +
  • Proteinuria +
  • Elevated liver enzymes ++
  • Hypoglycaemia ++
  • Hyperuricaemia ++
  • Thrombocytopaeina (-DIC) +
  • DIC ++
A

Acute fatty liver of pregnancy (AFLP)

JG Year 2 (28 decks)

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