Conditions in Pregnancy

Question 1

What needs to happen to the dose of levothyroxine dueing pregnancy

Answer 1

Increased usually by around 30-50%

Question 2

What can happen if hypothyroidism medication is not altered during pregnancy

Answer 2

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

Question 3

Which hypertensive medications need to be stopped

Answer 3

ACEI, ARBs, thiazide and thiazide like diuretics

Question 4

Which hypertensive medications are safe in pregnancy

Answer 4

Labetelol, calcium channel blockers and alpha blockers

Question 5

What effects can pregnancy have on epilepsy

Answer 5

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

Question 6

Which drugs are safest in pregnancy for epilepsy

Answer 6

Levetiracetam, lamotrigine and carbamazepine

Question 7

Which drugs are avoided in pregnancy

Answer 7

Sodium valproate and phenytoin

Question 8

Which medications can be continued for rheumatoid arthritis during pregnancy

Answer 8

Hydroxychloroquine and sulfasalazine

Question 9

What can happen to arthritis symptoms during pregnancy

Answer 9

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

Question 10

Why is pregnancy considered a diabetogenic state

Answer 10

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

Question 11

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

Answer 11

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

Question 12

Effects of diabetes on fetus and neonates

Answer 12

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

Question 13

Effects of diabetes on pregnant mother

Answer 13

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

Question 14

When should pregnancy be advised against in T2DM

Answer 14

If HbA1c is above 86

Question 15

What additional management is given to T2DM mothers

Answer 15

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

Question 16

What is obstetric cholestasis associated with

Answer 16

Increased risk of stillbirth

Question 17

Presentation of obstetric cholestasis

Answer 17

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

Question 18

Treatment of obstetric cholestasis

Answer 18

Ursodeoxycholic acid, water soluble Vit K if clotting is deranged

Question 19

What happens in acute fatty liver of pregnancy

Answer 19

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

Question 20

Presentation of acute fatty liver disease of pregnancy

Answer 20

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

Question 21

Investigation and results of acute fatty liver in preg

Answer 21

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

Question 22

Treatment of acute fatty liver of pregnancy

Answer 22

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

Question 23

What happens in rhesus incompatibility

Answer 23

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

Question 24

Ways to manage rhesus incompatibility

Answer 24

Prevention of sensitisation using IM anti-rhesus D injections

Question 25

When is anti-rhesus D antigen given

Answer 25

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

Question 26

What does the Kleinhauer test measure

Answer 26

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

Question 27

Risk of UTIs during pregnancy

Answer 27

Preterm birth, low birth weight, pre-eclampsia

Question 28

Which is most common cause of UTI in pregnancy

Answer 28

E.coli

Question 29

Treatment of UTIs in 3rd trimester of pregnancy

Answer 29

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

Question 30

Treatment of UTIs in 1st trimester of pregnancy

Answer 30

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

Question 31

Management of anaemia in pregnancy

Answer 31

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

Question 32

Risk factors for VTE in pregnancy

Answer 32

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

Question 33

Guidelines for starting VTE prophylaxis in pregnancy

Answer 33

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

Question 34

Which medications are given for VTE prophylaxis

Answer 34

LMWH unless contraindicated - enoxaparin

Question 35

What circumstances is VTE prophylaxis stopped in pregnancy

Answer 35

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

Question 36

What is hyperemesis gravidarum

Answer 36

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

Question 37

Score to assess severity of hyperemesis gravidarum

Answer 37

Pregnancy-unique quantification of emesis score (PUQE)

Question 38

Management of hyperemesis gravidarum

Answer 38

Antiemetics, PPIs, acupressure on wrist, ginger

Question 39

Anti emetics used in pregnancy

Answer 39

Prochlorperazine, cyclizine, ondansetron, metoclopramide

Question 40

Presentation of nausea and vomiting in pregnancy

Answer 40

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

Question 41

Risks and complications of gestational diabetes

Answer 41

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

Question 42

Risk factors for GDM

Answer 42

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

Question 43

What classifies as gestational diabetes

Answer 43

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

Question 44

How to test for gestational diabetes

Answer 44

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

Question 45

Management of gestational diabetes

Answer 45

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