Maternal medicine - Medical disorders in pregnancy

Question 1

Approach to maternal medical disorders on pregnancy

Answer 1

Structured framework in approach to medical disorder in pregnancy
 effect of disease on pregnancy → maternal, fetal, post-natal
 effect of pregnancy on disease → disease itself, medication

Each can be divided into pre-pregnancy, antepartum, intrapartum, postpartum periods

FDA classification of safety of medications in pregnancy

Question 2

Contraception and sterilization in women with medical disease

Considerations

Answer 2

Considerations:
- Any increase risk due to pre-existing medical condition e.g. COCP increase risk of venous thromboembolism
- Future fertility wish? Completed family?
- Effectiveness of contraception: type, compliance, effect of medication on contraception…?
- Absolute contraindication to pregnancy e.g. Eisenmenger syndrome

Question 3

GDM

Pathophysiology

Answer 3

Question 4

GDM

High risk factors indicating early OGTT

Answer 4

Question 5

GDM

Recommended screening time

Answer 5

Question 6

Diagnosis of GDM

Answer 6

Question 7

GDM

Maternal and fetal complications

Answer 7

Question 8

GDM

Management plan at diagnosis

Answer 8

Question 9

GDM

Antenatal care plan

Answer 9

Question 10

GDM

Intrapartum and postnatal care plan

Answer 10

Question 11

Effect of pregnancy on DM

Answer 11

Question 12

Effect of DM on pregnancy

Answer 12

Question 13

Pre-existing DM

Pre-pregnancy management

Answer 13

Question 14

Pre-existing DM

Management at diagnosis

Answer 14

Question 15

Pre-existing DM

Antenatal management

Answer 15

Question 16

Pre-existing DM

Intrapartum management

Answer 16

Question 17

Pre-existing DM

Postpartum management

Answer 17

Question 18

Thyroid disorder

Physiological changes during pregnancy

Answer 18

Question 19

Hypothyroidism

Effect of pregnancy on disease
Effect of disease on pregnancy
Management

Answer 19

Question 20

Hyperthyroidism

Effect of pregnancy on disease
Effect of disease on pregnancy
Management

Answer 20

Question 21

Autoimmune diseases during pregnancy

Usual disorders

Answer 21

Question 22

Effect of pregnancy on autoimmune disorders

Answer 22

Question 23

Effect of autoimmune disorders on pregnancy

Answer 23

Question 24

Treatment of autoimmune disorders during pregnancy

Answer 24

Question 25

SLE Effect of pregnancy on SLE Effect of SLE on pregnancy Management

Answer 25

Question 26

Differentiate SLE from pre-eclampsia

Answer 26

Question 27

Cardiac disease in pregnancy Effect of pregnancy on cardiac disease

Answer 27

Question 28

Cardiac disease in pregnancy Cardiac condition effect on pregnancy

Answer 28

Question 29

Management of cardiac condition in pregnancy - Contraindicated treatments - Treatment considerations

Answer 29

Question 30

Pre-pregnancy assessment of maternal cardiac conditions

Answer 30

Question 31

Antenatal management of maternal cardiac condition

Answer 31

Question 32

Intrapartum management of maternal cardiac conditions

Answer 32

Question 33

Epilepsy Effect of pregnancy on epilepsy Effect of epilepsy on pregnancy

Answer 33

Question 34

Epilepsy during pregnancy Treatment considerations

Answer 34

Question 35

Epilepsy during pregnancy Pre-pregnancy management

Answer 35

Question 36

Epilepsy during pregnancy Antenatal, intrapartum and postpartum management

Answer 36

Question 37

Thrombophilia and pregnancy Effect of pregnancy on thrombophilia

Answer 37

Question 38

Thrombophilia and pregnancy Effect of thrombophilia on pregnancy

Answer 38

Question 39

Thrombophilia and pregnancy Treatment

Answer 39

Question 40

Thrombophilia in pregnancy Pre-pregnancy assessment

Answer 40

Question 41

Thrombophilia in pregnancy Management for low-risk patients

Answer 41

Question 42

Thrombophilia in pregnancy Management for high-risk patients

Answer 42

Question 43

Renal disease in pregnancy Effect of pregnancy on CKD Effect of CKD on pregnancy

Answer 43

Question 44

Renal disease in pregnancy Pre-pregnancy management

Answer 44

Question 45

Renal disease in pregnancy Antenatal management

Answer 45

Question 46

Renal disease in pregnancy Considerations for renal transplant

Answer 46

Question 47

Renal disease in pregnancy Renal transplant timing and drug choice

Answer 47

Question 48

Skin disease in pregnancy Effect of pregnancy on eczema, acne, psoriasis

Answer 48

Question 49

Pemphigoid gestationis Prevalence S/S Dx Mx Impact on pregnancy

Answer 49

Question 50

Polymorphic eruption of pregnancy (PEP) Prevalence S/S Mx Impact on pregnancy

Answer 50

Question 51

Prurigo of pregnancy Prevalence S/S Mx Impact on pregnancy

Answer 51

Question 52

Pruritic folliculitis of pregnancy Cause S/S Mx

Answer 52

Question 53

Substance abuse in pregnancy Prevalence Common drugs

Answer 53

Question 54

Substance abuse in pregnancy Obstetric and maternal complications

Answer 54

Question 55

Alcohol use in pregnancy Prevalence Safe level Associated disorders

Answer 55

FASD: - Alcohol-related neurodevelopmental disorder (ARND) - Alcohol-related birth defects (ARBD) - Fetal alcohol syndrome (FAS)

Question 56

Alcohol-related neurodevelopmental disorder (ARND) Clinical features

Answer 56

Question 57

Alcohol-related birth defects (ARBD) Clinical features

Answer 57

Question 58

Fetal alcohol syndrome (FAS) Prevalence Diagnostic criteria

Answer 58

Question 59

Fetal alcohol syndrome (FAS) Clinical features

Answer 59

Facial dysmorphism: short palpebral fissure, thin vermillion border, smooth philtrum Growth retardation: prenatal or postnatal, ≤10th percentile at any time Brain involvement: microcephaly, structural brain abnormalities, hard neurologic signs, recurrent seizure not due to postnatal insult or fever Neurobehavioral impairment: global cognitive/intellectual deficits, developmental delay, functional deficits, impaired self-regulation Other features: - Cardiac defect: ASD, VSD, aberrant great vessels, ToF - Skeletal defect: large joint flexion contracture, pectus excavatum or carinatum, scoliosis, shortened and clinodactyly of 5th finger - Renal defect: aplastic / hypoplastic kidney, horseshoe kidney, duplex kidney, hydronephrosis - Ocular defect - Auditory defect

Question 60

Cigarette smoking Antenatal and intrapartum complications

Answer 60

Question 61

Opioid abuse in pregnancy Antenatal, neonatal complications

Answer 61

Question 62

Ketamine and metamphetamine abuse Antenatal and neonatal complications

Answer 62

Question 63

Cocaine abuse Antenatal complications

Answer 63

Question 64

Substance abuse in pregnancy Management

Answer 64