Medical Complications

Question 1

What hypertensive disorders exist in pregnancy?

Answer 1

Chronic (essential ) hypertension
Gestational hypertension
Pre-eclampsia

Question 2

What is gestational hypertension?

Answer 2

New hypertension after 20weeks gestation

Question 3

What is pre-eclampsia?

Answer 3

New hypertension after 20 weeks and significant proteinuria

Question 4

What other systems does hypertension in preganancy affect?

Answer 4

Renal
Liver
Placenta

Question 5

Hypertensive Effects on renal disease?

Answer 5

Decrease GFR
Proteinuria
Increased serum Uric acid
Increased creatinine/ potassium/ urea
Oliguria
Acute renal failure -> acute tubular necrosis , renal cortical necrosis

Question 6

Hypertensive effects on liver disease?

Answer 6

Epigastric / RUQ pain
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome

Question 7

What is HELLP syndrome?

Answer 7

Haemolysis
Elevated liver enzymes
Low platelets

Question 8

Placental disease due to hypertension?

Answer 8

IUGR
Placental abruption
Intrauterine death

Question 9

Investigations for hypertension?

Answer 9

U&Es
Serum urate 
LFTs
FBC
Coagulation screen
CTG
USS

Question 10

Hypertensive management?

Answer 10

BP monitoring

Meds- labetolol, methyldopa, nifedipine

Question 11

What hypertensive medications are not ok in pregnancy?

Answer 11

ACEi

ARBs

Question 12

What is the target BP for pregnancy?

Answer 12

Aim for <150/80-100 mmHg

Question 13

What effects does pregnancy have on diabetes?

Answer 13

Poorer control
Deterioration of renal function
Deterioration of ophthalmic disease

Question 14

What’s effects does diabetes have on pregnancy?

Answer 14

Miscarriage 
Fetal malformations - cardiac, neural tube defects, caudal regressions syndrome 
IUGR/ macrosomnia 
Unexplained IUD
PET

Question 15

What is the aim HbA1c in diabetes in pregnancy?

Answer 15

<6.0%

Question 16

What is the leading cause of maternal death?

Answer 16

VTE in pregnancy

Question 17

What investigation for DVT?

Answer 17

Duplex ultrasound of proximal leg

Question 18

Is d dimmer useful in pregnancy?

Answer 18

No

Question 19

Management of DVT in pregnancy?

Answer 19

LMWH

TEDs

Question 20

Investigations of PE?

Answer 20

CTPA
ABGs
CXR
ECG
Duplex US of proximal leg
V/Q scan

Question 21

Can you continue heparin during labour?

Answer 21

No

Question 22

Is warfarin safe during pregnancy?

Answer 22

Yes but stop 6-12 weeks

Question 23

When do you stop warfarin before labour?

Answer 23

6 weeks before

Question 24

Is warfarin safe during breastfeeding?

Answer 24

Yes

Question 25

What is hypothyroidism associated with in pregnancy?

Answer 25

Increased rates of miscarriage Still birth PET IUGR

Question 26

Treatment for hypothyroidism?

Answer 26

Increase levothyroxine

Question 27

What is hyperthyroidism associated with in pregnancy?

Answer 27

IUGR | Preterm

Question 28

If hyperthyroid, labour delivery survey and anaesthesia can lead to what?

Answer 28

Thyroid storm

Question 29

Management of hyperthyroidism?

Answer 29

PTU/ carbimazole TFTs every trimester Propranolol Growth scans

Question 30

Does Epilepsy worsen in pregnancy?

Answer 30

Not really, unless already poorly controlled then will deteriorate

Question 31

When are risk of epileptic seizures highest?

Answer 31

In peripartum

Question 32

Teratogenic risks of anticonvulsants?

Answer 32

Neural tube defects Orofacial defects Heart defects fetal anticonvulsant syndrome

Question 33

What is involved in fetal anticonvulsant syndrome?

Answer 33

Dystrophic features - v shaped eyebrows, low-set ears, broad nasal bridge, irregular teeth Hypertelorism Hypo plastic nails and distal digits

Question 34

Are antiepileptic drugs safe during labour?

Answer 34

Yes

Question 35

What should neonate be given after birth if mum epileptic?

Answer 35

1mg IM Vit K

Question 36

Management of epilepsy in pregnancy?

Answer 36

Folic acid 5mg /day from 12 weeks prior to conception | Continue drugs if well controlled

Question 37

What antiepileptic drug is not ok during pregnancy?

Answer 37

Phenobarbitone