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Flashcards in Medical Problems in Pregnancy Deck (54)
1

What are the booking bloods

FBC
Blood group
Haemaglobinopahies
Infection screen - hep B, HIV, rubella, VDRL
Random blood glucose

2

when is booking visit

8-12 weeks

3

when is dating ultrasound

11/12weeks

4

when are monthly visits until

28weeks

5

when is anti d given

28 and 24 weeks

6

when are fortnightly visits

28-36 weeks

7

when are weekly visits

37 weeks to deliverly

8

what is done at each antenatal visit

gestation
BP
urinalysis
FSH
fetal heart

9

when can you diagnose pre existing hypertension in pregnancy

Htn at booking or before 20 weeks

10

when is gestational hypertension diagnosed

new HTN more than 20 weeks without proteinuria

11

Preeclampsia

new HTN after 20 weeks and significant proteinuria

12

what do you give women with significant risk factors for preeclampsia

aspirin

13

What anti hypertensive medications should be avoided in pregnancy

ACE and ARBs

14

What antihypertensives are used in pregnancy

labetalol
methydopa
nifedipine - if monotherapy fails

15

what are the target BP controls in pregnancy

less than 150/80-100
less than 140/90 if organ damage

reduce medication doses if BP less than 130/90

16

what is there a greater risk of to the baby in hypertension in prgnancy

IUGR
placental abruption

17

when do you deliver in preeclampsia

37 weeks

18

what are the risks to the fetus with diabetes in pregnancy

miscarriage
IUGR
neurol tube defects
macrosommia
polyhydramniois
neonatal hypoglycaemia

19

what diabetic treatments can be used in pregnancy

diet
metformin
insulin

20

when would you induced in diabetes

consider at 37-38 weeks in PRE EXISTING DIABETES
38 weeks in GDM on INSULIN, 41 weeks if just diet and everything else normal

21

what is there an increased risk of in polyhydramnios

malpresentation
preterm labour
cord prolapse

22

what does macrosomia increase the risk of

shoulder dystocia

23

what is the aim HBA1c in pregnancy

less than 6 percent

24

what extra scans are done in gestational diabete

28, 32 and 36 week growth scan

25

what is there an increased risk of in polycythaemia

thrombotic events
jaundice

26

what is the leading cause of maternal death in the uk

venous thromboembolism

27

what medication is given to treat VTE in pregnancy

LMWH

28

what coagulation changes occur in pregnancy

factors seve, eight, ten and fibrinogen levels increased
antithrombin three levels decreased

29

when would you give anticoagulant prophylaxis in pregnancy

four or more risk factors - give straight away
three or more rsiks factors- give after 28 weeks

30

what do you give prophylactically in high risk for vte post natally

6 weeks postnatal LMWH
give for 10 days in intermediate risk

31

in which leg are DVTs more common in

left

32

how should investigations and management be done for a dvt in preganncy

not a d dimer
ultrasound
therapeutic heparin
TEDs for up to two yeards

33

name a low molecular weight heparin

daltaparin

34

how long should therapeutic doses of heparin be given after a dvt in pregnancy

for three months after delivery or 6 months after treatment whichever is longer

35

what are the risk factors of heparin

haemorrhage
heparin induced thrombocytopenia
osteopenia

36

how do you manage a potential PE in pregnancy

Give heparin!

first do chest x ray then CTPA if abnormal or high clinical suspicion

37

how often is the chest x ray normal in pe

half the time

38

what can you see on x ray f there is a pe

etelectasis
effusion
oedema

39

what is the worry with CTPA

increased risk of breast cancer

40

should heparin be stopped in labour

yes

41

how long before an epidural should anticoagulants be stopped

24 hours if therapeutic
12 hours if prophylactic

42

is warfarin safe in breastfeeding

yes

43

how long should PE therapy be given for

at least 6 weeks post natal and 3 months in total

44

is warfarin safe in pregnancy

no - particularly avoid in 6-12 weeks as tetatrogenic
if given stop six weeks before labour

45

what should you do in women with hypothyroid in pregnancy

increase levothyroxine in first trimester

do tft every trimester

46

what is the effect of pregnancy on hyperthyroidism

worsens in first trimester due to hcg

gets better in second and third trimester

47

effects of hyperthyroid on fetus

IUGR
preterm labour
thyroid storm

48

what should epileptic women be given in pregnancy

high dose folic acid 5mg
vit K from 36 weeks if taking hepatic enzyme inducing anticonvulsants due to risk of fetal vit k deficiency and haemorrhagic disease of the newborn

49

when is the risk of seizures highest in pregnancy in epileptics

peripartum period

50

which anticonvulsant should definterly be avoided in pregnnacy

phenobarbitone - due to risk of neonatal convulsions

51

what additional scans do epileptic women get in pregnancy

anomaly scan detailes 18-20 weeks
cardiac scan 22 weeks

52

what delivery should be done in pts with epilepsy

c section only is recurrent seizures in late pregnancy or labour

53

should antiepileptics be continued in labour

yes

54

what is the post partum management in epilepsy

neonate gets vit K
risk of sudep increased in pregnancy and post natal period