Complications in Pregnancy/Post Partum Flashcards Preview

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

31

Should CXR be performed in all women with suspected PE?

Yes

32

What findings can CXR detect in PE?

Atelectasis
Effusion
Focal opacities
Regional oligaemia
Pulmonary oedema

33

What should be carried out if a CXR is -ve in PE?

Bilateral compression Duplex dopplers should be performed

34

Which has a lower risk of childhood cancer, CTPA or VQ scan?

CTPA

35

Should heparin be stopped in labour?

Yes

36

When should therapeutic and prophylactic heparin stopped pre-epidural?

24 and 12 hours before respectively

37

When should warfarin be stopped?

6 weeks before labour

38

Is warfarin okay in breast feeding?

Yes

39

How should levothyroxine be adjusted in pregnancy?

Increase by 25-50mcg in first trimester-repeat TFTs every trimester

40

How does hyperthyroidism change in pregnancy?

Gets worse due to HCG in first trimester
Improves 2nd and 3rd
Can cause IUGR, preterm labour, thyroid storm

41

What is the commonest chronic medical illness that complicates pregnancy?

Asthma

42

What is the asthma deterioration in the 3rd trimester usually due to?

Reduction or cessation of medications due to (unfounded) safety fears

43

What are some adverse effects in pregnancy due to asthma>

Hypoxaemia
PIH/PET
PTL/birth
LBW
IUGR
Neonatal morbidity e.g. TTN, hypoglycaemia, seizures, NNU admission

44

Does asthma treatment change in pregnancy?

No

45

What should be taken for epilepsy during pregnancy

5mg folic acid from 12 weeks prior to conception
Vit K from 34-36 weeks if taking hepatic enzyme inducing anticonvulsants

46

What are the maternal effects of epilepsy on pregnancy?

25-30% increased seizure frequency
54% no change
Poorly controlled (>1/month) likely to deteriorate in pregnancy
Risk of seizures highest in peripartum period

47

What are some reasons for deterioration of control in epilepsy?

Pregnancy
Poor compliance (fears of teratogenesis)
Decreased drug levels due to nausea and vomiting
Decreased drug levels due to increased volume of distribution and drug clearance
Lack of sleep
Lack of drug absorption
Hyperventilation during labour

48

What are the fetal effects of epilepsy in pregnancy?

Fetus is relatively resistant to short term hypoxia during seizures
Status epilepticus <1% pregnancies but dangerous
Major risk of teratogenicity

49

Are all anticonvulsants teratogenic?

Yes- but never drugs are safe but now shown to have risks associated with use

50

What are the major malformations associated with anticonvulsants?

Neural tube defects
Orofacial clefts
Cardiac defects

51

What are the minor malformations associated with anticonvulsants?

Fetal anticonvulsant syndrome
Dysmorphic features
Hypertelorism
Hypoplastic nails and distal digits