Medical Conditions In Pregnancy

Question 1

RA in pregnancy key counselling points

Answer 1

Maternal disease normally improves antenatally but high risk of PP flare
Cannot use DMARDs or NSAIDs
Risks of IUGR and PTB
Rarely Atlanta-axial subluxation at GA
If on steroids, screen for GDM, stress steroids in labour

Question 2

Key points about sulfasalazine

Answer 2

Safe to use in pregnancy
Monitor FBC and LFTs
5mg folic acus

Question 3

Effect of SLE on pregnancy

Answer 3

Miscarriage
IuD
IUGR
PTB
Neonatal lupus syndromes

PET
VTE

Question 4

APLS and pregnancy

Answer 4

Worsening thrombocytopenia
Increased risk of thromboses

Miscarriage
IUD
IUGR
PTB
Abruption

PET

Question 5

Effect of pregnancy on pre exisiting diabetes

Answer 5

Retinopathy progression
Nephropathy
Hypoglycaemic unawareness
DKA
Anaemia
Gastric paresis 
Increasing insulin requirements

Question 6

BSL targets in pregnancy

Answer 6

<5 fasting

<6 2 hours post prandial

Question 7

Management of hypoglycaemia in the semi conscious or unconscious patient

Answer 7

IM glucagon 1mg if no IV

300mls 10% glucose if IV

Question 8

PN management in women with GDM

Answer 8

Stop treatment
Support lactation
Lifestyle advice to reduce risk factors
50-70% recurrence in future pregnancy
HbA1c at 3/12 PP

Question 9

Effect of pregnancy on sickle cell anaemia

Answer 9

Increased sickling, painful crises and infections

Question 10

Effect of sickle cell anaemia on pregnancy

Answer 10

Miscarriage, IUD, IUGR, PTB

PET, abruption, VTE, increased mortality

Question 11

Key principles of AN management in women with VWD

Answer 11

MDT
Haematology
Determine type of VWD
Factor levels (8 and VWF) each trimester and prior to delivery
Genetic counselling as baby may be at risk

Treatment of low levels with desmopressin, recombinant factor 8 and TXA
Avoid fetal trauma

Question 12

Pre conception management for women who have had a splenectomy

Answer 12

Require vaccination for pneumococcus, h. Influenzae, meningococcal

Penicillin prophylaxis

Question 13

Management of low platelets

Answer 13

Avoid regional anaesthesia if <80

Treatment if <50 for birth, procedures and if patient is bleeding

Question 14

What is the platelet threshold for which clexane is safe

Answer 14

> 50

Question 15

Conditions for which NSAIDs should be avoided?

Answer 15

VWD
ITP and other platelet disorders
Haemophilia

Question 16

Pre conception hep A and B vaccines should be offered to?

Answer 16

Women with transfusion dependent alpha or beta thalassaemia

Type 2 VWD

Question 17

Consequences of beta thalassaemia in pregnancy

Answer 17

If major and maternal anaemia/inadequate transfusion then miscarriage, IUGR, PTB, hypoxia

Question 18

Key investigations pre conception in beta thalassaemia

Answer 18

DEXA
LFTS, liver ultrasound and MRI for iron overload
ECG, ECHO, cardiac MRI
Platelets
Hb
Blood group and Ab screen
HIV/Hepatitis serology
Partner carrier status for adequate counselling
Renal function 
Ferritin and folate 
Serum fructosamine
TFTs

Question 19

Options for acute BP lowering

Answer 19

Labetalol 20-80mg IV - repeat in 10 mins if required

Nifedipine 10-20mg po - repeat 45 mins

Hydralazine 10mg IV - repeat 20 mins

Question 20

Antihypertensive in pregnancy for stable patients

Answer 20

Labetalol up to 400mg po q6h
Methyldopa 750ng po tds
Nifedipine up to 60mg po bd

Question 21

Signs of magnesium toxicity and treatment

Answer 21

Blurred vision
Weakness
Loss of deep tendon reflexes
Respiratory or cardiac arrest

IV calcium gluconate 1g over 10 mins

Question 22

Investigations for a seizure in pregnancy

Answer 22

PET screen
Glucose
Calcium/magnesium
CXR - hypoxia
EEG
Toxicology screen
MRI or CT head

Question 23

Mitral stenosis effects in pregnancy

Answer 23

MS on pregnancy - IUGR, PTB, iUD, fetal cardiac conditions of congenital HD in mum

Pregnancy on MS - pulmonary oedema, AF, left atrial thrombus formation

Question 24

Indications for assisted second stage

Answer 24

MS
Severe MR
Marfans syndrome and aortic root 40-45mm
Intracranial aneurysm
CF - patients prone to pneumothoraces

Question 25

Consequences of marfans syndrome in pregnancy

Answer 25

AD inheritance therefore offspring risk PTB, PPROM, PPH Dilatation of aortic root (may increase long term rate of growth) and risk of aortic dissection

Question 26

Key factors in management of Marfans syndrome in pregnancy

Answer 26

Frequent ECHO to look for progressive aortic root dilatation Beta blockers to minimise dilatation and dissection (labetalol or metoprolol) Aim SBP <130 Restrict activity to minimise haemodynamic stress Tertiary hospital with cardio thoracic services Vaginal delivery root <40mm Assisted del 40-45 C section >45

Question 27

IBD and pregnancy

Answer 27

Offspring more likely to have IBD APH, IUGR, PTB Higher rates of infertility if inflammation UC worsens, Crohns stable Avoid MTX as teratogen

Question 28

Effects of prolactinoma on pregnancy

Answer 28

Infertility Macroprolactinoma growth Pituitary apoplexy

Question 29

Prolactinoma treatment options

Answer 29

Cabergoline 0.25mg po twice/week Bromocriptine 1.25mg po niche for one week then increase to BD Transphenoidal surgery if elevates optic chiasm and doesn’t substantially shrink with the above

Question 30

Postnatal management in ICP

Answer 30

Confirm LFTs have normalised at 3-6 weeks Avoid oestrogen containing contraceptives as may exacerbate symptoms Recurrent 50-90% in subsequent pregnanxy

Question 31

Immediate management if HbsAg positive at booking

Answer 31

Counsel Check e antigen status. If positive perform HBV DNA and LFTs If e antigen negative just check LFTs Test and vaccine household contacts Full STI screen

Question 32

MTX exposure pre pregnancy within 3/12

Answer 32

MTX embryotoxic Offer continuation vs TOP 25% miscarriage, 9% congenital anomaly, 66% normal pregnancy FM referral Early/tertiary anatomy scan Nuchal scan for early identification of structural anomalies

Question 33

Medical treatment options for RA in pregnancy

Answer 33

Azaithoprine Hydroxychloroquine Sulfasalazine Prednisolone

Question 34

Extra articular manifestations of RA

Answer 34

``` Cardiac Amyloidosis Vasculitis Subcutaneous nodules Pulmonary ```

Question 35

Laboratory findings in hemolytic anaemic

Answer 35

High LDH Low haptoglobin Increased unconjugated bilirubin

Question 36

Umbilical vein varix

Answer 36

Dilatation of umbilical veiN Associated with structural anomalies and aneuploidy MFM, tertiary anatomy, amniocentesis Fortnightly growth from 32/40, and weekly LV and CTG IOl 39-40

Question 37

Gastroschisis observation in pregnancy

Answer 37

Serial growth scans until 32/40 then weekly until 37/40. | IOL 37-80

Question 38

Four features of Edward syndrome

Answer 38

T18 IUGR Choroid plexus cysts Microngathia Cardiac

Question 39

Four features of patau syndrome

Answer 39

T13 Cardiac Cleft lip or palate Midline defer face, eye, forebrain Omphalocele

Question 40

FAS four criteria generally

Answer 40

Maternal ETOH consumption Growth restriction/FTT Facial dysmorphism CNS abnormalities - intellectual impairment, behavioural