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Stage 3: EJR - Obstetrics > Maternal medicine > Flashcards

Flashcards in Maternal medicine Deck (45):
1

When should women with pre-existing diabetes go for diabetic retinopathy screening

16 and 28w

2

Diabetes: risks to mum

• Miscarriage
• Pre-eclampsia
• Diabetic retinopathy
• Preterm labour
• Nephropathy
• Hypoglycaemia
• UTI, endometrial infx after giving birth

3

Diabetes: risks to foetus

• Macrosomia
• NTDs, cardiac defects
• Birth injury (due to large size)
• Intrauterine death
• Increased perinatal mortality

4

Risk factors for developing gestational diabetes

• BMI >30
• Previous baby 4.5kg or more
• 1st degree relative with diabetes
• High risk ethnicity: South Asian, Caribbean, Middle East
• Previous stillbirth
• Polyhydramnios

5

Who needs a glucose tolerance test at booking

• BMI >40
• Previous GDM
• Asian
• Afro-Carribean

6

Who needs a glucose tolerance test at 24-28weeks

• BMI >30
• 1st degree relative with diabetes
• Previous baby >4.5kg
• Previous unexplained stillbirth
• Confirmed polyhydramnios
• Parity >4
• PCOS
• Glycosuria

7

Glucose levels to diagnose GDM

Fasting glucose >5.6mmol

2 hour >7.8mmol

8

When is neural tube defect scan for diabetic mothers done

14-16w

9

When are growth scans done for diabetic mothers

28, 32, 36 weeks
Then every 2 weeks

10

From what week onwards are CTGs done for diabetic mothers

From 34 weeks

11

Target blood glucose to maintain mother at during antenatal/intrapartum period

4-7mmols

12

Target blood pressure to maintain mother at during antenatal/intrapartum period

Systolic <150
Diastolic 80-100

13

First line drug for treatment of gestational hypertension

Labetalol

14

Labetalol cannot be given to asthmatic patients. Why?

Labetalol is an alpha and beta blocker.

Beta blockers cannot be given to asthmatic patients.

15

Alternative drug to labetalol (for asthmatic patients) to manage gestational hypertension.

What is it's MoA

Hydralazine

Direct-acting smooth muscle relaxant; vasodilator

16

Definition of gestational hypertension

Newly detected hypertension after 20w
without significant proteinuria

17

Definition of pre-eclampsia

Newly detected hypertension after 20w
+ significant proteinuria

18

Define early onset pre-eclampsia. Is this better or worse for the foetus (compared to late onset)?

Onset <34w

Worse as usually growth-restricts foetus.

19

What level of hypertension would lead to pre-eclampsia

ANY level. May be severely ill even with mild hypertension.

20

Signs and symptoms of pre-eclampsia

• Severe headache
• Visual disturbance
• Epigastric pain and/or vomiting
• Rapid onset oedema

21

What dose of aspirin should be given to the following

-1 high risk factor for pre-eclampsia

-2 moderate risk factors for pre-eclampsia

75mg for both

22

High risk factors for pre-eclampsia

-pre-eclampsia in previous pregnancy
-CKD
-T1DM, T2DM
-chronic hypertension
-autoimmune disease

23

Moderate risk factors for pre-eclampsia

-first pregnancy
-pregnancy interval >10years
-age >40
-BMI >35
-multiple pregnancy
-FHx of pre-eclampsia

24

Magnesium sulfate is given to women with severe pre-eclampsia.

What is it for?

What's the loading dose?

Prophylaxis against eclampsia

4g loading dose

25

How to monitor for magnesium toxicity

Blood tests.

Patellar reflex is first to go.

26

Drugs: Contraindicated anti-hypertensives in pregnancy

ACE inhibitors (-pril)
ARBs (-artan)

27

Drugs: Contraindicated anti coagulants in pregnancy

Warfarin
Aspirin
Dalterparin
Rivaroxiban

28

Features of HELLP syndrome

o Haemolysis
o Elevated liver enzymes (indicate liver damage)
o Low platelet count

29

What is disseminated intravascular coagulation. Why is it dangerous in pregnancy?

o Small blood clots develop throughout bloodstream

o Depletes platelets & clotting factors

o Causes excessive bleeding later

30

If a mother has had labetolol , what needs to be monitored in a baby shortly after birth

Blood glucose.

Labetolol can cause neonatal hypoglycaemia.

31

Define eclampsia

Tonic-clonic seizure secondary to pre-eclampsia

32

Demographic risk factors for VTE in pregnancy

• Age >36
• Parity 3 or more

33

Current pregnancy-related risk factors for VTE in pregnancy

• Multiple pregnancy
• Pre-eclampsia
• Preterm/ stillbirth
• Ovarian hyperstimulation syndrome in 1st trimester
• Hyperemesis

34

Interpartum risk factors for VTE in pregnancy

• C section
• Prolonged labour >24h
• Postpartum haemorrhage >1L

35

What drug to use as prophylaxis for DVT in at-risk pregnant women

Daltepartin (LMWH)

36

Who needs increased dose of folic acid throughout pregnancy

-epileptics
-diabetics
-BMI>30
-sickle cell, malabsorption diseases

37

Drugs: Which anti-epileptic should be avoided during pregnancy

sodium valproate

38

Drugs: Which anti-epileptics are safe for pregnancy

Carbamazepine
Lamotrigine

39

What is used to screen GDM mums for T2DM 6-13 weeks after pregnancy?

Fasting glucose

40

How should women who had GDM with a negative postnatal screening test be managed?

Annual HbA1c test

41

Postnatal drug management of T1DM mums

Resume insulin (regime as before pregnancy)

There is increased risk of hypoglycaemia postnatally so must monitor carefully

42

Postnatal drug management of T1DM mums

Stop VRIII (if it was needed)

Resume metformin

43

Postnatal drug management of GDM mums

Stop all treatment.

Postnatal screen for T2DM

44

Who should get VRIII (variable rate insulin infusion) during labour?

T1DM automatically gets it.

T2DM and GDM only get if required.

45

Target HbA1c to maintain mother at during antenatal/intrapartum period

<48mmol/L