Conditions in Pregnancy

Question 1

Why is epilepsy affected in pregnancy

Answer 1

Enhanced metabolism of drugs
Increased volume of distribution
Increased protein so drugs bound
Decreased compliance with meds 
Hormone changes = more seizure
N+V

Question 2

Why are AED teratogenic

Answer 2

Anti-folate

Question 3

AED and contraception

Answer 3

Induce p450 so will affect OCP / POP

Question 4

What do you do pre-conception

Answer 4

Change drugs
Best control on lowest dose
Aim monotherapy
Folic acid 5mg

Question 5

What drugs safest

Answer 5

Lamotrigine

Carbamazepine

Question 6

What do you not give

Answer 6

No sodium valproate

Phenytoin

Question 7

What do you do antenatal

Answer 7

Consultant clinic
May need to increase doe
Vit K as risk of clotting issues in newborn

Question 8

What do you do intrapartum

Answer 8

Aim vaginal
CS if status
Continue AED
Treat seizure

Question 9

What do you do post partum

Answer 9

Vitamin K to baby
Reduce AED to pre-preg dose
Contraception

Question 10

What are complications

Answer 10

Infant epilepsy
IUGR
Microcephaly
Perinatal mortality 
Congenital malformation

Question 11

What are the DDx

Answer 11

Eclampsia = much more common 
Migraine
Panic attack
Phaeochromocytoma
HYpoglycaemia
Hyponatraemia
Intracranial mass 
Stroke

Question 12

What is major cause of hyperthyroid

Answer 12

Graves

Question 13

What is the relevance of thyroid and pregnancy

Answer 13

T4/T3/TBG increased to maintain free T4
TSH falls in 1st
HCG increases as mimics
bHCG similar action as TSH so if bHCG increases so does TSH
TSH = hyperemesis
Iodine deficiency as given to foetus and increased excretion in urine

Question 14

What are the symptoms of hyperthyroid

Answer 14

Tremor 
Weight loss
Irritable
Exophthalmos
Tachycardia
Restless

Question 15

Why does normal pregnancy mimc hyperthyroid

Answer 15

Tachy
Warm moist skin
Goitre
Anxiety

Question 16

What is show on bloods

Answer 16

Raised T3/4
Suppressed tSH
Growth scans
Look for Ab as fatal

Question 17

How do you treat

Answer 17

PTU
Carbimazole
BB for Sx

Question 18

What do you do for pre-pregnancy

Answer 18

Anti-thyroid

Surgery for goitre / dysphagia / stridor

Question 19

What are the complications

Answer 19

Miscarriage
IUGR
Pre-mature
Fertility reduced

Question 20

What should you beware of

Answer 20

TSH receptor stimulating Ab
Can cause fatal thyrotoxicosis if cross placenta
Test in newborn

Question 21

What is CI in preg

Answer 21

Radioactive iodine

Question 22

What is post-partum thyroiditis

Answer 22

Hyperthyroid
Followed by hypothyroid
Normal thyroid

Question 23

How do you Dx post partum

Answer 23

Clinica Sx
TFT
Monitor for hypo

Question 24

What do majority have

Answer 24

Thyroid peroxidase Ab

Question 25

How do you treat

Answer 25

Hyperthyroid = self-liming BB Treat hypothyroid Withdraw Rx after 6-12 months to see if need long term

Question 26

Why does anti-thyroid not work

Answer 26

Doesn't work due to gland destruction

Question 27

What causes hypothyroid

Answer 27

Primary due to underactive Thyroiditis Removal of thyroid due to hyperthyroid Thyroid peroxidase Ab in Graves cross placenta

Question 28

What are symptoms of hypothyroid

Answer 28

Tiredness Heat intolerance Hair loss Dry skin

Question 29

How do you treat

Answer 29

Increase thyroxin | Optimise t4 pre-conception

Question 30

What are risks of hypothyroid

Answer 30

``` Miscariage IUGR Infertility Oligomenorrhoea Menorrhagia Fertility Post partum depression ```

Question 31

Thrombocytopenia

Answer 31

Physiological OR | ITP

Question 32

How do you treat

Answer 32

Steroid if very severe | Transfusion in newborn

Question 33

What caues thrombocytopenia in newborn

Answer 33

Polycythaemia | ITP Ab cross placenta

Question 34

What are the symptoms of obstetric cholestasis

Answer 34

``` Intense pruritus - due to build up No rash Jaundice Raised bilirubin Cholestatic picture on LFT ```

Question 35

When is cholestasis / fatty liver common

Answer 35

3rd trimester

Question 36

How do you treat

Answer 36

UDCA for itch and improve outcome Vit K as deficient due to cholestasis Anti-histamine / topical emollient for Sx Chlorophenamine - sleep and itch Close monitoring of LFT Exclude other causes - gall stone, acute fatty liver, hepatitis

Question 37

What do you do with reagards to delivery and why

Answer 37

IOL at 37 to reduce risk of still birth / PPH and premature Baby's liver immature an can't deal with bile salts Also bile salts can constrict veins = hypoxia Follow up to make sure LFT back to normal

Question 38

What are the symptoms of acute fatty liver (rapid accumulation of fat leading to hepatitis)

Answer 38

``` Abdo pain N+V Headache Jaundice HYpoglycaemia PET if severe ```

Question 39

How do you Dx acute fatty liver and how do you Rx

Answer 39

ALT elevated Raised WBC Coagulopathy Stenosis on USS Rx = prompt delivery of baby as high risk of liver failure and mortality

Question 40

What do you do when treating RA but want to get pregnant

Answer 40

Defer conception until stable

Question 41

What is not safe

Answer 41

Methotrexate | Stop 6 months prior (men and women)

Question 42

What is safe

Answer 42

Sulfalasine Hydroxychloroquine Low dose steroid NSAID until 32 weeks

Question 43

What is risk of RA during delivery

Answer 43

Atalntoaxial subluxation

Question 44

What causes amniotic fluid embolism

Answer 44

Amniotic fluid passes into mothers blood which contains fatal cells leading to immune reaction

Question 45

What are main RF

Answer 45

Maternal age | Induction of labour

Question 46

How does it present

Answer 46

``` Usually around time of labour / delivery but can occur post partum SOB Cough Resp failure Tachy Hypotension Fever Haemorrhage ```

Question 47

How do you Rx

Answer 47

Supportive | Critical care