Complications in Pregnancy/Post Partum Flashcards Preview

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Flashcards in Complications in Pregnancy/Post Partum Deck (51)
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1

What are booking bloods?

FBC and Blood Group & Antibodies
Haemaglobinopathies
Infection screen
-Hepatitis B
-HIV
-Rubella
-VDRL
Random Blood Glucose

2

When are monthly/fortnightly/weekly antenatal visits carried out?

Monthly till 28 wks
Fortnightly till 36 weeks
Weekly till delivery

3

When is Anti D administered?

28 and 34weeks

4

What is checked at each antenatal visit?

Accurately document gestation
BP
Urinalysis
SFH (FSH)
Fetal Heart/Kicks

5

What is the incidence of hypertensive disorders in pregnancy?

HTN 10-15%
PET 3-5%
Severe PET 5/1000
Eclampsia 5/10000

6

What is gestational hypertension?

New HT >20wks without significant proteinuria

7

What renal disease can occur in pregnancy?

Decreased GFR
Proteinuria
Increased serum uric acid (also placental ischaemia)
Increased creatinine/K+/urea
Oliguria/anuria
Acute renal failure- ATN, renal cortical necrosis

8

What liver disease can occur in pregnancy?

Epigastric/RUQ pain
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome (haemolysis, elevated liver enzyme, low platelets)

9

What placental disease can occur in pregnancy?

IUGR
Placental abruption
Intrauterine death

10

How should risk factors for preeclampsia be managed?

Aspirin
Surveillance

11

What anti-hypertensive medications are used in pregnancy?

Labetalol
Methyldopa
Nifedipine (usually if monotherapy fails-top up)
Stop ACE & ARBS

12

What can be used for severe hypertension e.g. 165/110?

Labetalol (oral or IV)
Hydralazine (IV)
Nifedipine (oral)

13

What BP should be aimed for in pregnancy?

<150/80-100
If target organ damage, aim for <140/90 (if this consider reducing dose, if <130/90 reduce)

14

What management should be carried out in diabetes-related pregnancies?

Screening
Detailed USS including extended cardiac views
Dietetic support
Diet, Metformin, Insulin
BM 4-6
HbA1C <6.0%
Retinal screening every trimester

15

When should delivery be carried out in diabetes-related pregnancies?

37-38wks in pre-existing DM
38 wks in GDM on insulin
41 weeks if GDM on diet with normal BMs and fetal growth

16

How should diabetes be managed in the post-natal mother?

Pre-existing: return to pregnancy regime
GDM: stop treatment and monitor BMs for 48 hrs to ensure normal and no persistence of IGT

17

What is the incidence of VTE in pregnancy?

1/1000

18

What is the main cause of maternal death?

VTE

19

What is pregnancy in terms of coagulability?

A pro-coagulable state

20

Why is pregnancy pro-coagulable?

To decrease risk of PPH

21

What clotting cascade changes occur in pregnancy?

Increased levels factor 7,8,9,10,12 and Fibrinogen and numbers of platelets
Decreased levels factor 11 and antithrombin 3

22

What percentage of early DVTs are asymptomatic?

50%

23

What is the ratio of DVT starting in the left compared to the right leg?

Left > Right 8:1

24

What investigations are used in DVT?

D-dimer (not in pregnancy)
Duplex US on lower limb

25

What medication is given in DVT?

Heparin- treat then see

26

What overall haematology investigations occur in DVT?

Baseline investigations
–FBC, clotting, Us & Es, LFTs
AntiXa levels- Not routine.
Platelet levels- Not routine
Thrombophilia screen:
Not routine
Controversial
Affected in pregnancy
No influence to immediate management
Interpretation usually by haematologists.

27

How are TEDs used in DVT?

Acute phase-2 years
Decrease thrombotic syndrome by 50%

28

Describe LMWH use in DVT?

Dalta-parin etc
Longer duration of action so used 1x/daily
Outside pregnancy 1.5mg/kg
Therapeutic dose 1mg/kg/twice daily (or once)
Continue 3 months post delivery, or 6 months after treatment onset
Doesn't cross placenta-safe for fetus

29

What are the S/Es of heparin?

Haemorrhage
Hypersensitivity
Allergy at injection site
Heparin induced thrombocytopenia- early in 5 days usually mild, late >5 days
Osteopenia-osteoporosis on prolonged usage, less with unfractionated

30

What Ix is carried out in PE?

ABGs
Chest x ray
ECG
Duplex ultrasound lower limbs
Ventilation/perfusions scans
CTPA