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Flashcards in Medical disorders in pregnancy Deck (67):
1

what are the booking bloods

FBC and blood group and ABs
harm-globulins
infection screen - hep B, HIV, rubella, VDRL
RBG

2

when is the booking visit
dating USS
anomaly scan
monthly visits are till when
anti D (2)
fortnightly visits when
weekly visits till when

8-12 weeks
11-12 weeks
20 weeks
till 28 weeks
28 and 34 weeks
28-36 weeks
37 weeks - delivery

3

what should be checked/asked at every antenatal visit

document gestation
BP
urinalysis
SFH (FSH)
fetal kicks/heart

4

incidence of hypertension in pregnancy
PET
severe PET
eclampsia

10-15%
3-5%
5/1000
5/10000

5

what is chronic (essential) ht
what is gestational ht
what is pre eclampsia

HTN present at booking or <20 weeks

new HTN> 20 weeks with proteinuria

new htn >20 weeks and significant proteinuria

6

what can lead to an increased risk inPET

chronic hypertension in mothers
or gestational hypertension

7

hypertension has what effects on the kidneys during pregnancy

increased GFR
proteinuria
serum uric acid
cr/k/urea
oliguria/anuria
acute renal failure

8

hypertension has what effect on liver

epigastric/RUQ pain
abnormal liver enxymes
hepatic capsule rupture
HELP

9

what is HELP synd

type of pre eclampsia - haemolytic, elevated liver enzymes, low platelets

10

placental and hypertension

IUGR
placental abruption
intra uterine death

11

investigations for htn

u&es
serum urate
LFTs
FBC
coag screen
CTG
US

12

management at booking

if there are risk factors for pre eclampsia -> put on aspirin

13

management of htn

labetalol
methyldopa
nifedipine (if the other two fail)

14

what should be stopped in preg

ACE and ARBs

15

what should be used in severe hypertension

labetalol PO/IV
hydralzaine IV
nifedipine PO

16

target BP

<150/80-100
organ damage <140-90
if <140/90 consider reducing dose
if <130/90 reduce dose

17

effects of hypertension on pregnancy and management of that

gestational htn
PET
eclampsia

monster BP, bloods, protein

18

planning of delivery in htn

vaginal
deliver at 37 weeks if PET

19

effects of pregnancy on DM

poorer control
deterioration of renal function
deterioration of ophthalmic disease
gestational DM

20

effects of medical condition on pregnancy

miscarriage
fetal malformations cardiac/NTD/caudal regression syndrome
IUGR/macrosomia
unexplained IUD
PET

21

medications in DM

diet
metaformin
insulin

22

planning of delivery in DM

vaginal
induce labour at 37-38 weeks

23

what does having diabetes lead to in the baby

fetal hyperinsulinaemia which leads to increased fetal growth

24

what 4 things does increased fetal growth lead to and whats a risk for each one

fetal macrosomia - risk of birth injury/shoulder dystonia

polyuria/polyhydramnios - risk of preterm labour/malpresentation/cord prolapse

increased oxygen demands/polycytheamia - risk of unexplained term stillbirth

neonatal hypoglycaemia - risk of cerebral palsy

25

risk factors for gestations DM

previous GDM
FH - one first degree relative or two second degree relatives
poor obstetric history
significant glycosuria
polyhydramnios
macrocosmic infant in this pregnancy
PCOS
weight>100kn or BMI >30
south asian, muddle eastern or african origin

26

BM target
HBA1C target
retinal screening when

4-6
<5%
every trimester

27

growth scans in DM
monitoring for what
elective delivery

serial growth scans at 28, 32, 36 weeks

PET

37-38 weeks in pre existing DM
38 weeks in GDM on insulin, may be 41 weeks if GDM on diet with normal Bfs and fetal growth

28

neonatal in DM

surveillance at delivery monitor BMs to ensure no neonatal hypoglycaemia

29

post natal management for mum in DM

return to pre pregnancy insulin/oral HG regime
GDM: stop treatment and monitor BM for 48 hours to ensure return to normal and no persistence

30

macrosmonia can lead to what

increased risk of birth injury/shoulder dystocia
obstetric litigation major cause
LSCS recommended in DM where macrosomia and EFW>4000g

31

polycythaemia effects on baby

thrombotic effects
jaundice

32

effects of pregnancy on VTE/PE
medications

increased risk of it
LMWH

33

what is the main cause of maternal death

VTE

34

pregnancy is a what state in terms of coagulability

pro coagulable

35

what are there increased levels of and decreased levels of in terms of clotting factors

increased factor 7,8,9,10,12 and increase in fibrinogen and number of platelets

decrease in factors 11 and antithrombin 3

36

what are the risk factors for VTE and what should be done if there are < or 3 or 4 present

obesity
age >35
parity 3
smoker
gross varicose veins
current PET
immobility
FH of unprovoked or oestrogen provoked VTE in first degree relative
low risk thrombophillia
multiple preg

<3 - mobilisation and avoidance of dehydration
3 - prophylaxis from 28 weeks
4 or more - prophylaxis from first trimester

37

any previous VTE is managed how

antenatal prophylaxiss with LMWH

38

how many DVTs are asymp
which leg more common

50%
L>R

39

ix of DVT

D dimer not done in preg
duplex US
therapeutic heparin

40

management of DVT

FBC, clotting factos, Uns, LFTs
antixa levels
platelet levels
thrombophilia screen - not routine and controversial

TEDs

41

LMWH in DVT preg

once daily
outside preg 1.5mg/kg
therapeutic dose 1mg/kg twice or once daily
continue till 3 months after delivery or 6 months after treatment

42

SE of heparin

haemorrhage
hypersensitivity
allergy at injection site
HIT - heparin induced thrombocytopenia
osteopenia - osteoperosis on prolonged use

43

HIT

1-30%
early in 5 days, usually mild
late >5 days
with unfractionated heparin

44

PE ix

ABGs
CXR
ECG
duplex US
ventilation/perfusion scans
CTPA

45

CXR - who should it be done on
of negative what should be done

all women
bilateral compression duplex dopplers

46

duplex of lower limbs - useful or no

indirect way
limits further tests
if negative - doesn't help much

47

CTPA

less childhood cancer risk compared to VQ
increased breast cancer risk

48

labour and delivery in VTE/PE

stop heparin in labour in vaginal delivery

stop therapeutic anaesthesia 24 hours before planned surgery
stop prophylactic 12 hours before

49

what should be given post natally in VTE/PE

6 weeks or for a total of 3 months warfarin or LMWH

50

what should warfarin be avoided in

avoided in pregnancy 6-12 weeks - teratogenic, miscarriage, neurological problems, stillbirth
stop 6 weeks before labour

51

effects of pregnancy on hypothyroid women

increase levy by 25-5-mcg in first trimester and repeat TFTs every trimester

52

effects of pregnancy on hyperthyroid women

gets worse due to HCG in first trimester
improves in second and third trimester

53

effects of hyperthyroid on pregnancy

IUGR
preterm labour
thyroid storm

54

medications in hyperthyroid

carbimazole/PTU
propanolol for IUGR
growth scans

55

respiratory changes in pregnancy

increase resp rate which can cause respiratory alkalosis
changes in PFTs

56

what happens to the tidal volume
the inspiratory capacity
FEV1 and PEFR
residual volume
expiratory reserve
functional residual capacity

increases
increases
stay the same
decreases
decreases
reduction in it

57

effects of pregnancy on asthma

can improve, deteriorate or stay the same

58

management of asthma

same

59

how many women of child bearing age have epilepsy

0.5%

60

what seizure types may be affected by pregnancy

all

61

what is epilepsy associated with

risks for maternal death due to aspiration

62

epilepsy in preg management

5mg folic acid
vit k from 36 weeks if taking hepatic enzyme inducing anti convulsants

63

effects of pregnancy on epilepsy

increase seizure frequency in some

64

effects of epilepsy on pregnancy

fetus resistant to short term hypoxia during seizures
no increased risk of miscarriage or obstetric cx
teratogenicity of drugs

65

pre conceptually in seizures

take folic acid 5mg/day at least 12 weeks prior to conception

66

epilepsy during pregnancy

continue folic acid
continue current drugs if well controlled - unless phenobarbitone
detailed fetal scan at 18-20 weeks with fetal cardiac scan at 22 weeks
vit k 10-20 mg orally from 34-36 weeks

67

post partum management in epilepsy

neonate should have 1mg IM vit K