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Exam - M - Reproduction System (Megan and Rachel) > complications in pregnancy > Flashcards

complications in pregnancy Flashcards

1
Q

what is pre-eclampsia

A

hypertension + end-organ dysfunction +/- proteinuria in pregnancy

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2
Q

why does pre-eclampsia happen

A

spiral arteries of placenta form abnormally and the resistance in them increases

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3
Q

when can pre-eclampsia occur

A

20+ weeks gestation

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4
Q

what is chronic hypertension

A

hypertension that existed before 20 weeks gestation

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5
Q

what is gestational hypertension

A

hypertension occurring after 20wks gestation

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6
Q

what are lacunae

A

pools of blood
formed when spiral arteries break down and maternal blood flows into the pools of blood and out though uterine veins
form at about 20wks

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7
Q

what are risk factors for pre-eclampsia

A 
hypertension 
previous hypertension in pregnancy 
autoimmune conditions 
diabetes 
CKD
40+ 
BMI > 35 
over 10 years since last pregnancy 
multiple pregnancy 
first pregnancy 
FH
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8
Q

what is the prophylaxis for pre-eclampsia

A

aspirin from 12 weeks if the patient has a high risk factor or more than one moderate risk factor

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9
Q

how does pre-eclampsia present

A

triad of hypertension, proteinuria, oedema

headache 
visual disturbances 
nausea 
vomiting 
reduced urine output 
brisk reflexes
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10
Q

what investigations could you do in pre-eclampsia

A 
blood pressure 
urine dipstick - proteinuria 1+ 
LFTs - raised liver enzymes 
protein : creatinine >30mg/mmol 
albumin : creatinine >8mg/mmol 
FBC  low platelets, low Hb, raised bilirubin, raised urea, raised creatinine, raised urate 
coagulation tests 
CTG for fetus
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11
Q

how do you manage pre-eclampsia

A

routinelly monitor BP, symptoms, proteinuria
labetolol is first line
nifedipine is second line
methyldopa is third line
IV hydralazine if severe
IV magnesium sulphate in labour to prevent seizures
fluid restriction
give steroids if the baby needs to be delivered <36wks

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12
Q

how do you manage gestational hypertension

A

aim for 135/85
urine dipstick weekly
bloods weekly

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13
Q

what is HELLP syndrome

A

complication of severe pre-eclampsia/eclampsia

haemolysis
elevated liver enzymes
low platelets

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14
Q

what is eclampsia

A

onset of seizures (tonic clonic) in pregnancy or within 10 days of delivery

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15
Q

what are features of eclampsia

A

hypertension
proteinuria
thrombocytopenia
raised AST

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16
Q

how do you manage eclampsia

A

medical emergency

IV magnesium sulphate

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17
Q

what is gestational diabetes

A

carbohydrate intolerance that first comes on in pregnancy

reverts back to normal after delivery

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18
Q

what is a normal OGTT result

A

fasting < 5.6mmol/l

at 2 hours <7.8mmol/l

19
Q

what are risk factors for gestational diabetes

A 
history of GD
previous macrosomic baby >4.5kgs 
BMI>3
family history 
polyhydramnios
20
Q

what is the screening test for gestational diabetes and when would you do it

A

oral glucose tolerance test

for patients with risk factors

20
Q

what effect can diabetes have in each trimester, labour and in baby

A

1st - malformations
3rd - intrauterine death
labour - obstruction
neonatal - baby will be hypoglycaemic

22
Q

how do you manage gestational diabetes

A

28-36wks 4x US scans per week to monitor fetal growth
insulin +/- metformin
glibenclamide if insulin or metformin can’t be used

23
Q

if a patient has pre-existing diabetes and gets pregnant what should the management be

A

5mg folic acid daily from pre-conception to 12wks
retinal and renal assessment
induce labour at 38-40wks
maintain BG in labour with IV dextrose insulin infusion

24
Q

what are complications of diabetes in pregnancy

A

baby - hypoglycaemia, shoulder dystocia, respiratory distress, still birth, jaundice
patient - pre-eclampsia, worsening of nephropathy, retinopathy, hypoglycaemia, infections

25
Q

SROM

A

spontaneous rupture of membranes

26
Q

what changes happen in the blood during pregnancy (hypercoagulable state)

A

increase in fibrinogen, factors VIII, VW, platelets

decrease in antithrombin III and fibrinolysis

27
Q

what are risk factors for VTE in pregnancy

A 
older age 
increased BMI
IV drug use 
dehydration 
infections 
haemorrhage 
sickle cell disease 
operative delivery
28
Q

what is prophylactic care for VTE

A

TED stockings
advise increased mobility
hydration
if at increased risk - LMWH

29
Q

how can VTE present

A 
usually unilateral and in calf 
dilated superficial veins 
muscle tenderness 
increased girth of leg 
pain in calf 
redness 
PE: SOB, cough, hypoxia, pleuritic chest pain, tachycardia, haemodynamic instability, tachypnoea, fever
30
Q

what investigations could you do in VTE

A 
ECG
blood gas 
doppler 
V/Q scan 
lung scan 
CXR
CT pulmonary angiogram
31
Q

how do you manage VTE

A

LMWH started ASAP, stopped 6wks after delivery

can switch to warfarin after delivery

32
Q

ROM

A

rupture of membranes

amniotic sac has ruptured

33
Q

PROM

A

prelabour rupture of membranes

amniotic sac has ruptured before onset of labour

34
Q

P-PROM

A

preterm prelabour rupture of membranes

amniotic sac rupture before labour and before 37wks gestation

35
Q

what is premature birth

A

birth before 37wks gestation
baby is nonviable before 24wks
under 28wks is extreme preterm

36
Q

what are risk factors for preterm labour

A 
multiple pregnancy 
polyhydraminos 
APH
pre-eclampsia 
infection 
APH
37
Q

what are prophylaxis options for preterm labour

A

progesterone - given to patients with cervical length less than 25mm between 16-24wks
cervical cerclage - stitch in cervix, is cervical length <25mm between 16-24wks with previous premature birth or cervical trauma

38
Q

how can you confirm rupture of membranes (ROM)

A

speculum examination - pooling of amniotic fluid in vagina

IGFBP-1

39
Q

how do you treat ROM

A

erythromycin 250mg 4x daily for 10 days

induction of labour from 34wks

40
Q

what is preterm labour with intact membranes

A

preterm labour with intact membranes

painful contractions

41
Q

how do you diagnose preterm labour with intact membranes

A

speculum to assess cervical dilatation

42
Q

how do you manage preterm labour

A 
CTG or intermittent auscultation to monitor foetus 
tocolysis - nifedipine 
corticosteroids before 35wks 
IV magnesium sulphate 
delayed cord clamping
43
Q

what is antepartum haemorrhage

A

haemorrhage in genital tract after 24wks but before delivery

44
Q

what can cause antepartum haemorrhage

A

placenta praevia
placental abruption
lesions - cervical erosions of polyps
vasa praevia

Exam - M - Reproduction System (Megan and Rachel) (45 decks)

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