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Flashcards in medical conditions in pregnancy Deck (91)
1

hypertentsion possible has a _______cause

placental, causing vasocinstriction

2

medications used in hypertension in pregnancy?

labetalol, methyl dopa, nifedipine

3

in severe hypertension in pregnancy?

hydralazine

4

ACE inhibitors and arbs?

not to be used in pregnancy

5

vasoconstriction in pregnancy, leads to decreased blood flow to ?

organs

6

htn in pregnancy, target blood pressure?

AIM FOR

7

if

reducing dose

8

if

reduce dose

9

what is chronic hypertension?

HTN at booking/less than 20 weeks

10

what is gestational hypertension?

new htn at 20 weeks WITHOUT significant proteinuria

11

pre eclampsia?

new hypertension after 20 weeks with significant proteinuria

12

hypertension can cause damage to?

brain, kidneys, liver, eyes, fetus, placenta

13

what causes decrease in GFR in pregnancy?

damage to blood vessels in the kidney, dropping flow rate

14

pathway of renal disease in pregnancy?

decreased grr, proteinuria, increased serum uric acid, increased creatinine, oliguria, acute renal failure

15

what causes RUQ pain in pregnancy?

abnormal liver enzymes, hepatic capsule rutpture

16

HELLP syndrome?

haemolysis, elevated liver enzymes, low platelets

17

risk factor for placental abruption?

HTN (high pressure)

18

risk factors for pre eclampsia?

1st pregnancy, over 40, obesity, history, hypertension, diabetes, kidney disease

19

if they have risk factors, prescribe?

aspirin

20

if pregnant woman has pre eclampsia, deliver?

deliver at 37 weeks

21

pre 123 ac7ampsia

37 weeks

22

effects of diabetes on pregnancy

miscarriage, fetal metabolic reprogramming, cardiac problems, neual tube defects, caudal regression synrome,

23

what is PET?

complication in late pregnancy HIGH BLOOD PRESSURE

24

PET can be a complication of GD

.

25

complications of GD?

IUGR, macrosomia, PET, dead, malformed, DELIVER 37 -38 WEEKS

26

management of GD?

diet, metformin, insulin

27

what is macrosomia due to?

hyperinsulinaemia, insulin acts as growth factor on insulin sensitive tissues

28

why do babies get shoulder dystocia?

macrosomia

29

what can polyhydramnios cause

pre term labour, cord prolapse, malpresentation

30

what is the risk factor for unexplained stillbirth

polycythaemia

31

what does neonatal hypoglycaemia predispose?

risk of cerebral palsy

32

risk factors for GDM?

poor obstetric history (especially death of previous macrocosmic baby), family history, polyhydramnios, significant glycosuria, PCOS. BMI >30

33

eyes - what do all pregnant women with diabetes get?

retina screening every trimester

34

delivery?

37-38 weeks in pre existing DM, 38 weeks GDM on insulin

35

GDM - after birth?

stop treatment, monitor BMs for 48 hours to ensure return to normal and no persistence of IGT

36

VTE and pregnancy, why is pregnancy pro thrombotic?

increased blood viscosity, increased plasma, decreased haemoglobin concentration. move less. venous compression by uterus.

37

what factors do you get an increase in?

7, 8, 10 and fibrinogen

38

decreased?(2)

factor II and ATIII

39

dont do d dimer in pregnancy, why?

it increases throughout gestation, not an accurate test

40

how would you diagnose DVT?

duplex ultrasound on lower limb

41

which anti coagulant is safe in pregnancy i.e. doesn't cross the placenta?

heparin

42

how do you manage a DVT in pregnancy

treat with heparin then see

43

side effects of heparin?

osteopaenia, haemorhage, hypersensitivity, heparin induced thromboctopaenia, allergy at injection site OHHHA

44

Investigations for PTE?

heparin, ABG, CXR

45

why can CXR be misleading?

normal in 50 % of PTE

46

what 4 things could be seen on a CXR in PTE?

effusion, focal opacities (white), atelectasis (partial collapse of lung), oligaemia (reduced vascularity)

47

term for partial collapse of lug?

atelectasis

48

reduced vascularity in lung?

oligaemia

49

CTPA - decreased chance of? but increased chance of?

child getting cancer than doing a VQ, but increased risk of breast cancer

50

when do you stop heparin? epidural anaesthetic?

before delivery, 24 hours before delivery

51

warfarin and LMWH when do you start them after birth?

6 weeks

52

how long on them?

3 months

53

when do you avoid warfarin in pregnancy?

6 - 12 weeks

54

can you breast feed with warfarin?

yes

55

bad effects on fetes - warfarin?

teratogenic, muscarriage, still birth

56

hypothyroid...what do you increase levothyroxin by in first trimester?

25-50mcg

57

what do you repeat every trimester?

thyroid function tests

58

minimal effects of hypothyroid on pregnancy

.

59

why is hyperthyroid made worse in pregnancy (first trimester)?

HCG acts like thyroid hormones

60

what happens second and third trimester?

gets better

61

preferred treatment of hyperthyroid?

PTU

62

what is given to reduce blood pressure in hyperthyroid?

propranolol

63

asthma in pregnancy - what does an increased RR cause?

resp alkalosis

64

what happens to pH? pCO2? HCO3?

ph goes up, picot goes down, hco3 goes down

65

02 demand is increased by?

20%

66

2 main changes in breathing in pregnancy?

increased rr, increased tidal volume

67

what is tidal volume?

normal volume inhaled/exhailed with no added effort

68

in pregnancy, what happens to residual volume?

decreased

69

what happens to FEV1 and Peak Expiratory Flow rate?

they remain unchanged

70

asthma has minimal effect on pregnancy, however in severe disease, when is the greatest risk of complication?

3rd trimester

71

treatment of asthma in pregnancy?

no difference

72

risk of maternal death in epilepsy due to aspiration?

yes

73

why is there an increased risk of seizures in first trimester?

hyperemesis and haemodilution

74

what is risk of malformation of foetus in maternal epilepsy due to?

anti epileptics

75

what is given to stop this?

5mg folic acid/day

76

when is vitamin k given if taking hepatic enzyme inducing anti convulsants

36 weeks

77

poorly controlled epilepsy likely to deteriorate in pregnancy

.

78

when is risk of seizures highest?

peri part period (last month of gestation)

79

increased risk in first trimester due to hyperemeseis and haemodilution, highest risk in last month of pregnancy

.

80

reasons for deterioration of control?

poor complicane (fear of teratogenesis)
decreased drug level due to nausea and vomiting
decreased drug level due to increased volume of distribution and increased drug clearance, lack of sleep, lack of absorption of drugs during labour

81

if mother has a seizure, how does baby cope?qrelatively resistant to short term hypoxia

no increased risk of miscarriage or obstetric complications

82

major risk is drugs!

ALL ANTI CONVULSANTS ARE TERATOGENIC

83

what is the mechanism thought to be?

foalate deficiency

84

major malformations? (3)

NTD, cardiac defects, orofacial defects

85

are benzos teratogenic?

no

86

women should be on folic acid pre conceptually and thought pregnancy (5mg per day)

wean off/change phenylbarbitone due to risks of neonatal withdrawal symptoms

87

vitamin k should be given orally from _______weeks (6am) if on enzyme inducers (anti convulsants) due to risk of vitamin k deficiency and hemorrhagic disease of the newborn

.

88

what are the two things epileptic women should be given when pregnant?

continue anti convulsants. 5mg folic acid per day. vitamin k from 34-36 weeks

89

anti epileptic drugs in labour?

continue them

90

neonate should receive?

1mg IM vit k. (hemorrhagic disease of newborn)

91

SUDEP?

risk of SUDEP increased in pregnancy