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Obstetrics > Conditions in Pregnancy > Flashcards

Conditions in Pregnancy Flashcards

1
Q

What needs to happen to the dose of levothyroxine dueing pregnancy

A

Increased usually by around 30-50%

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2
Q

What can happen if hypothyroidism medication is not altered during pregnancy

A

Miscarriage, anaemia, small for gestation age, pre-eclampsia

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3
Q

Which hypertensive medications need to be stopped

A

ACEI, ARBs, thiazide and thiazide like diuretics

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4
Q

Which hypertensive medications are safe in pregnancy

A

Labetelol, calcium channel blockers and alpha blockers

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5
Q

What effects can pregnancy have on epilepsy

A

Worsen seizure control due to lack of sleep, stress, hormonal changes, altered medication regimes

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6
Q

Which drugs are safest in pregnancy for epilepsy

A

Levetiracetam, lamotrigine and carbamazepine

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7
Q

Which drugs are avoided in pregnancy

A

Sodium valproate and phenytoin

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8
Q

Which medications can be continued for rheumatoid arthritis during pregnancy

A

Hydroxychloroquine and sulfasalazine

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9
Q

What can happen to arthritis symptoms during pregnancy

A

Can improve due to release of increased amounts of steroids, then may flare up after delivery

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10
Q

Why is pregnancy considered a diabetogenic state

A

Due to the increased insulin resistance - insulin antagonists are produced by the placenta

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11
Q

What can happen in pregnancy of a patient who is a type 1 diabetic

A

Increased insulin requirements so tight control can lead to hypoglycaemia. Progression of diabetic neuropathy and diabetic ketoacidosis

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12
Q

Effects of diabetes on fetus and neonates

A

Congenital manformations, macrosomia, polyhydramnios, birth risks, risk of stillbirth and neonatal death, polycythaemia and jaundice, fetal hypoglycaemia

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13
Q

Effects of diabetes on pregnant mother

A

Miscarriage, pre-eclampsia, infection, caesarean, early induction of labour, poor progress in labour, macrosomia

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14
Q

When should pregnancy be advised against in T2DM

A

If HbA1c is above 86

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15
Q

What additional management is given to T2DM mothers

A

Aspirin 75mg from 12 weeks (pre-eclampsia), early dating and anomaly scan, regular BP and urinalysis, 4 weekly growth scans from 28 weeks

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16
Q

What is obstetric cholestasis associated with

A

Increased risk of stillbirth

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17
Q

Presentation of obstetric cholestasis

A

Pruritis, fatigue, dark urine, pale greasy stools, jaundice. Typically later in pregnancy - third trimester

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18
Q

Treatment of obstetric cholestasis

A

Ursodeoxycholic acid, water soluble Vit K if clotting is deranged

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19
Q

What happens in acute fatty liver of pregnancy

A

There is rapid accumulation of fat within the liver cells causing acute hepatitis. There is impaired processing of fatty acids in the placenta

20
Q

Presentation of acute fatty liver disease of pregnancy

A

General malaise and fatigue, nausea and vomiting, jaundice, abdominal pain, anorexia, ascites. Normally in 3rd trimester

21
Q

Investigation and results of acute fatty liver in preg

A

LFTs will show elevated ALT and AST, also may have raised bilirubin, WBC, derranged clotting and low platelets

22
Q

Treatment of acute fatty liver of pregnancy

A

Delivery of baby and treatment of acute liver failure. Can lead to liver failure and mortality so needs promt treatment

23
Q

What happens in rhesus incompatibility

A

Mothers anti-rhesus D antibodies cross the placenta into the fetus -> fetus then is rhesus D positive -> these autoantibodies attach themselves onto the RBCs of fetus and immune system attacks them -> haemolysis -> haemolytic disease of the newborn

24
Q

Ways to manage rhesus incompatibility

A

Prevention of sensitisation using IM anti-rhesus D injections

25
Q

When is anti-rhesus D antigen given

A

28 weeks gestation if babys blood group is found to be rhesus positive, in antepartum haemorrhage, amniocentesis procedures, abdominal trauma, and within 72 hours of sensitisation event

26
Q

What does the Kleinhauer test measure

A

How much fetal blood has passed in to the mothers blodo to determin whether further doses of anti-D are required

27
Q

Risk of UTIs during pregnancy

A

Preterm birth, low birth weight, pre-eclampsia

28
Q

Which is most common cause of UTI in pregnancy

A

E.coli

29
Q

Treatment of UTIs in 3rd trimester of pregnancy

A

Trimethroprim - in 1st trimester as it is a folate antagonist and causes congenital malformatoins

30
Q

Treatment of UTIs in 1st trimester of pregnancy

A

Nitrofurantoin - avoided in 3rd trimester as risk of neonatal haemolysis

31
Q

Management of anaemia in pregnancy

A

Iron replacement, supplementary iron, and if low B12 then IM hydroxocobalamin or oral cyanocobalamin

32
Q

Risk factors for VTE in pregnancy

A

Smoking
Parity >3
Age >35
BMI >30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
FHx of VTE
thrombophilia
IVF pregnancy

33
Q

Guidelines for starting VTE prophylaxis in pregnancy

A

From 28 weeks if there are 3 risk factors
First trimester if there are 4 or more risk factors

34
Q

Which medications are given for VTE prophylaxis

A

LMWH unless contraindicated - enoxaparin

35
Q

What circumstances is VTE prophylaxis stopped in pregnancy

A

Until 6 weeks postnatally
Temporarily stopped during labour
Not started if there is PPH, spinal anaesthesia or epidurals

36
Q

What is hyperemesis gravidarum

A

Severe form of nausea and vomiting in pregnancy with 5% weight loss compared with before pregnancy. Dehydration and electrolyte imbalance

37
Q

Score to assess severity of hyperemesis gravidarum

A

Pregnancy-unique quantification of emesis score (PUQE)

38
Q

Management of hyperemesis gravidarum

A

Antiemetics, PPIs, acupressure on wrist, ginger

39
Q

Anti emetics used in pregnancy

A

Prochlorperazine, cyclizine, ondansetron, metoclopramide

40
Q

Presentation of nausea and vomiting in pregnancy

A

Start in the first trimester peaking at 8-12 weeks, often resolving by 16-20 weeks. More severe in molar pregnancies, multiple pregnancies, first pregnancy or overweight

41
Q

Risks and complications of gestational diabetes

A

Macrosomia, birth trauma, shoulder distocia, increased induction, increased LSCS, pre-eclampsia, neonatal hypoglycaemia, polycythaemia, increased perinatal mortality rate

42
Q

Risk factors for GDM

A

BMI >30, previous macrosomic baby, previous GDM, FHx of diabetes, ethnic origin of asian, middle eastern, southern europe, afro caribbean. Glycosuria

43
Q

What classifies as gestational diabetes

A

Carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition in pregnancy.

44
Q

How to test for gestational diabetes

A

2 oral 75g oral glucose tolerance test for women with risk factors at 26-28 weeks. If after 2 hours >7.8mmol/L or fasting >5.6mmol/L

45
Q

Management of gestational diabetes

A

Diet and exercise advice, metformin or insulin, 4 weekly growth scans from 24 weeks, delivery by 40 + 6 weeks

Obstetrics (8 decks)

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