Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

REPRODUCTION & GYNAECOLOGY > Medical Problems in Pregnancy > Flashcards

Medical Problems in Pregnancy Flashcards

1
Q

Maternal mortality is highest in what geographical region?

A

Central Africa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the most common causes of maternal death in the UK?

A
  • Cardiac causes

- VTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What factors increase the risk of maternal mortality in pregnancy?

A
  • multiple health problems
  • vulnerabilities (children in social services, drug/alcohol abuse)
  • Ethnicity
  • Age
  • Medication
  • Overweight / obese
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the most common medical problems (Both direct and indirect) in pregnancy?

A
  • Diabetes
  • Hypertension
  • Cardiac disease
  • Respiratory disease - Asthma
  • VTE
  • Connective tissue disease - APS/Lupus
  • Epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is heart disease a common complication of pregnancy?

A

Heart works around 40% harder during pregnancy

- increased CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If patients have a previously known congenital cardiac condition, how should they be managed in pregnancy?

A
  • Pre-pregnancy counselling (especially on medication)

- Maximise scans (regular ECHO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why do acquired heart conditions obviously start in pregnancy?

A

Heart is asked to work a lot harder

=> disease traits may start to show

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is peri-partum cardiomyopathy usually diagnosed?

A

At time of birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What symptoms are common with peri-partum cardiomyopathy?

A

Orthopnoea

=> breathlessness lying down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HOw is continuity of care across different specialities managed in pregnant women with underlying conditions?

A

Hand held/ One track records

=> these can be accessed by any clinician the pregnant patient sees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

BY how much does pregnancy increase the risk of MI, and how is this prevented?

A 
3-4 x increased risk
check ECG (+CT) if required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The presence of what cardiac features would predict poor outcomes in pregnancy?

A
  • Pulmonary hypertension
  • Cyanosis
  • TIA
  • Arrhythmia
  • Heart failure
  • Left heart obstruction
  • Aortic dissection
  • MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If patients have valvular heart disease or arrhythmias increasing risk of stroke, how should they be anticoagulated in pregnancy?

A
  • LMWH used as it doesnt cross placenta (Warfarin teratogenic)
  • Stop before delivery due to haemorrhage risk
  • Warfarin can be recommenced 5 days post natal and is safe in breastfeeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What palpitations can occur in pregnancy?

A
  • Physiological (at rest/lying down)
  • Ectopic beats (relieved by exercise)
  • Sinus Tachycardia (normal in pregnancy)
  • SVT (usually predates pregnancy)
  • Hyperthyroidism
  • Phaeochromocytoma - RARE assoc. headache, sweating, HT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the main respiratory changes that occur during pregnancy?

A
  • less residual capacity
  • increased O2 capacity to take in enough O2 for mother and foetus
  • SOB common in 3rd trimester
  • SOB often improves with exertion (walking along corridor)
  • Asthma = common in pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is asthma normally treated in pregnancy?

A
  • treated as if patient is not pregnant
  • steroids safe for use in pregnancy
  • minimise asthma attacks as this can affect mother, placenta and => foetal development
17
Q

Acute asthma during labour is unlikely. TRUE/FALSE?

A

TRUE

due to endogenous steroids

18
Q

What vascular factors cause increased risk of VTE in pregnancy?

A

VIRCHOW’S TRIAD:

  • hypercoagulability
  • venous stasis
  • vascular damage
19
Q

How should VTE be screened for?

A

DVT - look for symptoms/signs (swollen, hot, red limb)
PE - pleuritic pain, SOB etc

If suspicious of DVT

  • Whole leg doppler (inc. groin)
  • if negative, repeat in 1 week
20
Q

HOw is a suspected DVT managed?

A

LMWH (Weight based)
Taken twice daily
- Enoxaparin/Dalteparin

21
Q

What investigations can be used to investigate a PE, and which of these may be avoided in pregnant women?

A

CTPA
- Not used often in preg. due to increased breast tissue and vasculature that can take up radiation => risk of breast cancer

V/Q Scan

22
Q

What teratogenic effects can warfarin cause?

A
  • midface hypoplasia
  • stippled chondral calcification
  • short proximal limbs
  • short phalanges
  • scoliosis
23
Q

For how long should anticoagulation be continued after pregnancy?

A

until at least 6 weeks post-natal

AND until at least 3 months post-partum

24
Q

Connective tissue diseases such as antiphospholipid and lupus can cause what complications to the actual pregnancy?

A
  • Miscarriage
  • Pre eclampsia
  • Abruption
  • growth restriction (due to small vessel disease also affecting placenta => supply baby less)
  • Still OR Preterm birth
25
Q

What complications can connective tissue disease drug treatments cause?

A 
Teratogenic
Fetotoxic
Sepsis
Diabetes
Osteoporosis
26
Q

What drugs that may be used in connective tissue disease are NOT safe in pregnancy?

A
  • NSAIDs
  • Cyclophosphamide
  • Methotrexate
  • Penicillamine
27
Q

How are patients normally diagnosed with Antiphospholipid syndrome?

A
  • Antiphospholipid autoantibodies - positive on 2 tests >6 weeks apart
  • clinical disease picture (i.e. recurrent miscarriage/ clotting, severe pre-eclampsia etc)
28
Q

What pregnancy outcomes are common for patients with antiphospholipid?

A
  • Early Pregnancy Loss
  • T2 / T3 IUD
  • Preterm Birth (<34 weeks
  • Foetal Growth Restriction
29
Q

How are patients with antiphospholipid normally managed in pregnancy?

A
  • if no previous complications = foetal and maternal surveillance
  • Others = low dose aspirin and LMWH during preg.

Consider prophylaxis also

30
Q

What is the most important risk factor for determining seizure deterioration in pregnancy?

A

Seizure free period

no seizure in 9 months prior to pregnancy, up to 92% of mothers will remain seizure free

31
Q

What obstetric complications can occur as a result of a woman having epilepsy during pregnancy?

A 
Miscarriage
antepartum haemorrhage
Pre-eclampsia
IOL/C-section
PPH
32
Q

What are the largest risks to the foetus if a mother has a seizure during pregnancy?

A
  • Maternal abdominal trauma - Foetal-maternal haemorrhage
  • Preterm birth
  • Hypoxia/acidosis
33
Q

By how much do AEDs increase the risk of teratogenicity in a foetus and how can this be minimised?

A

2-3X increased risk for any single AED

  • reduce Polytherapy as this increases risk
  • use lowest effective dose where possible
  • avoid valproate in women of reproductive age
  • counsel epileptic patients on contraception
34
Q

Give examples of foetal malformations from AEDs which can be visualised on a 20 week anomaly scan?

A 
Spina Bifida
Heart defects (e.g. septal)
Lip defects (cleft-lip palate)
35
Q

Seizure risk is higher during labour. TRUE/FALSE?

A

TRUE

Stress, pain, sleep deprivation, over-breathing and dehydration increase the risk of intra-partum seizures

36
Q

If status epilepticus occurs during labour, what procedure is carried out?

A

Left lateral tilt

takes pressure of uterus off of aortic/caval vessels

37
Q

What “baby-safety” measures have been put in place for mothers with epilepsy?

A
  • Avoid excessive fatigue
  • Safe feeding position
  • Lowest setting for high chairs
  • Dress baby on the floor
  • Use padded sling / carrycot
38
Q

What perinatal outcomes are common in pregnant mothers who are obese?

A

congenital abnormalities
macrosomia
shoulder dystocia
stillbirth

39
Q

How should pregnant mothers who are obese be managed during pregnancy?

A 
Check BMI at bookin appt.
PET prophylaxis - Aspirin
Thromboprophylaxis
OGTT at 26-28 weeks
Anaesthetic Review @ 34 weeks
MDT plan for labour &amp; birth

REPRODUCTION & GYNAECOLOGY (58 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions