Abnormal pregnancy

Question 1

Hypertension in pregnancy before __ weeks is not gestational but instead pre-existing hypertension.

Answer 1

20 weeks

Question 2

What is the first line management in gestational hypertension?

Answer 2

Labetalol

Question 3

What is first line gestation hypertension management in asthmatics?

Answer 3

Nifedipine

Question 4

Define hyperemesis gravidarum:

Answer 4

Persistent vomiting in pregnancy which leads to greater than 5% weight loss of pre-pregnancy weight and ketosis

Question 5

What anti-emetics are licensed for hyperemesis gravidarum

Answer 5

cyclizine
Metoclopramide
Promethazine

Question 6

What antiemetic is not licensed for hyperemesis gravidarum but is reserved for when all other options fail?

Answer 6

Ondansetron IV

Question 7

Aside from antiemetics what other medications can be given in hyperemesis gravidarum?

Answer 7

Steroids - prednisalone or hydrocortisone
Folic acid 5mg
Thiamine to prevent Wernicke’s encephalopathy
Thromboprophylaxis

Question 8

How is pre-eclampsia defined?

Answer 8

Gestational induced hypertension and proteinuria of great than 0.3g/24hours

Question 9

In gestational hypertension, at what point should you consider admitting to hospital?

Answer 9

If BP >160/110

Question 10

If a patient requires LMWH during their pregnancy at what point post partum can it be discontinued?

Answer 10

minimum 6 weeks

Question 11

If a patient undergoes a c-section do they require any anti-coagulation?

Answer 11

Yes. For 7 days postnatally the require anticoagulation with LMWH

Question 12

What investigation normally used for DVTs and PEs isn’t very appropriate in pregnancy?

Answer 12

D-Dimers

They tend to be raised anyway due to pregnancy physiological changes

Question 13

At what stage in the pregnancy is the foetus most at risk of damage is the mother is infected by rubella?

Answer 13

The first 16 weeks - risk is 80%

Afterwards it is <5%

Question 14

List some risk factors (at least 5) for developing pre-eclampsia:

Answer 14

Previous pre-eclampsia
Diabetes
Smoking >20 a day
BMI >35kg/m2
CKD
Autoimmune disease
FHx 
Age >40
Multiple pregnancy
Chronic` hypertension
Age gap between pregnancy >10years
First child

Question 15

What are some of the features of severe pre-eclampsia?

Answer 15

Headache
Papilloedema
Brisk reflexes
Peripheral oedema
BP >170 systolic
RUQ pain
HELLP sydrome

Question 16

What medication is given to help with seizures in eclampsia?

Answer 16

Magnesium sulphate

Question 17

How can you correct an overdose from magnesium sulphate?

Answer 17

Calcium gluconate

Question 18

What medication is given in patients with gestational hypertension to reduce their risk of preeclampsia (give dose), or to any woman with risk for preeclampsia?

Answer 18

Aspirin 75mg

Question 19

What is eclampsia?

Answer 19

Grand mal seizures occurring due to pre-eclampsia

Question 20

In patients with preeclampsia what medication is given to benefit the foetus?

Answer 20

Steroids (dexamethasone)

Question 21

What are the benefits of dexamethasone

Answer 21

Lung maturation
Reduced risk of neonatal death
Reduced risk of NEC
Reduced risk of intraventricular haemorrhage

Question 22

What are some of the complications for a neonate when a mother has pre-existing diabetes?

Answer 22

Congenital anomalies
Miscarriage
Intrauterine death

Question 23

How often should pregnant women with diabetes (any kind) monitor their blood sugars?

Answer 23

4x daily

Question 24

What is the target fasting blood glucose in women with diabetes during pregnancy?

Answer 24

3.5 - 5.5 mmol.mol

Question 25

What is the target blood glucose 1 hour post meal in pregnant women with diabetes?

Answer 25

<7.8mmol/mol

Question 26

What are some clinical signs of gestational diabetes?

Answer 26

Polyhydramnios | Glycosuria

Question 27

What are the clinical symptoms of gestational diabetes?

Answer 27

Polyuria Polydipsia Dysuria

Question 28

What are some risk factors for developing GD

Answer 28

``` >BMI 30 Ethnicity (BAME more likely) Previous GD in pregnancy FHx Previous big baby ```

Question 29

Give some complications assoc. with any kind of diabetes in oregnancy?

Answer 29

``` Large baby - complicated delivery Shoulder dystocia Macrosomia Neonatal hypoglycaemia Pre eclampsia ```

Question 30

What are some of the main causes of PPROM?

Answer 30

``` Previous pre-term labour (20% risk after 1 previous episode, 40% risk after 2 episodes) Multiple pregnancy Smoking Uterine anomalies Parity (=0 or >5) Ethnicity Poor socio-economic status Drugs (especially cocaine) ```

Question 31

What % of pregnancies suffer from obstetric cholestasis?

Answer 31

0.7%

Question 32

What ethnic group is obstetric cholestasis most common in?

Answer 32

Asians

Question 33

What are the main symptoms of obstetric cholestasis?

Answer 33

Itching - pruritus mainly contained to hands and soles of feet Jaundice Raised bilirubin

Question 34

What medications can be given in obstetric cholestasis?

Answer 34

Ursodeoxycholic acid Vitamin K Antihistamines may ease pruritus Topical emollients to stop itching

Question 35

What investigations are appropriate for intrahepatic cholestasis of pregnancy? (Obstetric cholestasis)

Answer 35

Liver function tests USS of liver FBC Serum bile acids

Question 36

What are we trying to rule out when we USS liver and do a FBC and clotting screen in obstetric cholestasis?

Answer 36

HELLP syndrome In cholestasis of pregnancy, the LFTs will be mainly normal with deranged bilirubin, and the USS and clotting ties will be normal

Question 37

Why should mothers with cholestasis of pregnancy be induced at 37 weeks?

Answer 37

There is an increased risk of stillbirth

Question 38

What does HELLP syndrome stand for?

Answer 38

Haemolysis Elevated Liver enzymes Low Platelets

Question 39

What are some of the maternal consequences of pre-eclampsia?

Answer 39

``` Renal failure Pulmonary Oedema HELLP syndrome DIC Eclampsia Death ```

Question 40

Define premature preterm rupture of the membranes (PPROM)

Answer 40

This is when the amniotic sac breaks before the onset of labour, before 37 weeks

Question 41

What are some of the mechanisms that may lead to PPROM?

Answer 41

Infections weaken tensile strength of the foetal membranes Cervical incompetence Over distension of uterus Vascular causes incl. placental abruption

Question 42

For the neonate, what are some of the consequences of PPROM?

Answer 42

Infection Death Pulmonary hypoplasia

Question 43

What is the main risk for the mother in PPROM?

Answer 43

Chorioamnioitis

Question 44

On speculum examination, what would be seen in PPROM?

Answer 44

Vaginal pooling of blood in the vaginal posterior fornix

Question 45

What are the main principles of management in PPROM?

Answer 45

``` Antibiotic cover to prevent chorioamnionitis Monitor vital signs for infection Tocolytics Maternal steroids Mg Sulphate ```

Question 46

Why should co amoxiclav be avoided as antibiotic cover in PPROM?

Answer 46

It has an increased risk of causing NEC in neonates

Question 47

What antibiotic is given 1st line as cover in PPROM?

Answer 47

Erythromycin

Question 48

Before __ weeks foetal blood sampling cannot be carried out.

Answer 48

34 weeks

Question 49

What is hydrops fetalis?

Answer 49

This is when there is fluid accumulation in 2 compartments or more of the foetus e.g. ascites, pericardial effusion, oedema, pulmonary oedema

Question 50

If a mother has high levels of Rh d antibodies what is done with the foetus?

Answer 50

It is checked for anaemia by checking the middle cerebral artery

Question 51

What are the consequences of neonatal anemia?

Answer 51

Heart failure leading to Hydrops fetalis