Medical Problems in Pregnancy

Question 1

What are the booking bloods

Answer 1

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

Question 2

when is booking visit

Answer 2

8-12 weeks

Question 3

when is dating ultrasound

Answer 3

11/12weeks

Question 4

when are monthly visits until

Answer 4

28weeks

Question 5

when is anti d given

Answer 5

28 and 24 weeks

Question 6

when are fortnightly visits

Answer 6

28-36 weeks

Question 7

when are weekly visits

Answer 7

37 weeks to deliverly

Question 8

what is done at each antenatal visit

Answer 8

gestation
BP
urinalysis
FSH
fetal heart

Question 9

when can you diagnose pre existing hypertension in pregnancy

Answer 9

Htn at booking or before 20 weeks

Question 10

when is gestational hypertension diagnosed

Answer 10

new HTN more than 20 weeks without proteinuria

Question 11

Preeclampsia

Answer 11

new HTN after 20 weeks and significant proteinuria

Question 12

what do you give women with significant risk factors for preeclampsia

Answer 12

aspirin

Question 13

What anti hypertensive medications should be avoided in pregnancy

Answer 13

ACE and ARBs

Question 14

What antihypertensives are used in pregnancy

Answer 14

labetalol
methydopa
nifedipine - if monotherapy fails

Question 15

what are the target BP controls in pregnancy

Answer 15

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

reduce medication doses if BP less than 130/90

Question 16

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

Answer 16

IUGR

placental abruption

Question 17

when do you deliver in preeclampsia

Answer 17

37 weeks

Question 18

what are the risks to the fetus with diabetes in pregnancy

Answer 18

miscarriage
IUGR
neurol tube defects
macrosommia
polyhydramniois
neonatal hypoglycaemia

Question 19

what diabetic treatments can be used in pregnancy

Answer 19

diet
metformin
insulin

Question 20

when would you induced in diabetes

Answer 20

consider at 37-38 weeks in PRE EXISTING DIABETES

38 weeks in GDM on INSULIN, 41 weeks if just diet and everything else normal

Question 21

what is there an increased risk of in polyhydramnios

Answer 21

malpresentation
preterm labour
cord prolapse

Question 22

what does macrosomia increase the risk of

Answer 22

shoulder dystocia

Question 23

what is the aim HBA1c in pregnancy

Answer 23

less than 6 percent

Question 24

what extra scans are done in gestational diabete

Answer 24

28, 32 and 36 week growth scan

Question 25

what is there an increased risk of in polycythaemia

Answer 25

thrombotic events | jaundice

Question 26

what is the leading cause of maternal death in the uk

Answer 26

venous thromboembolism

Question 27

what medication is given to treat VTE in pregnancy

Answer 27

LMWH

Question 28

what coagulation changes occur in pregnancy

Answer 28

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

Question 29

when would you give anticoagulant prophylaxis in pregnancy

Answer 29

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

Question 30

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

Answer 30

6 weeks postnatal LMWH | give for 10 days in intermediate risk

Question 31

in which leg are DVTs more common in

Answer 31

left

Question 32

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

Answer 32

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

Question 33

name a low molecular weight heparin

Answer 33

daltaparin

Question 34

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

Answer 34

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

Question 35

what are the risk factors of heparin

Answer 35

haemorrhage heparin induced thrombocytopenia osteopenia

Question 36

how do you manage a potential PE in pregnancy

Answer 36

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

Question 37

how often is the chest x ray normal in pe

Answer 37

half the time

Question 38

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

Answer 38

etelectasis effusion oedema

Question 39

what is the worry with CTPA

Answer 39

increased risk of breast cancer

Question 40

should heparin be stopped in labour

Answer 40

yes

Question 41

how long before an epidural should anticoagulants be stopped

Answer 41

24 hours if therapeutic | 12 hours if prophylactic

Question 42

is warfarin safe in breastfeeding

Answer 42

yes

Question 43

how long should PE therapy be given for

Answer 43

at least 6 weeks post natal and 3 months in total

Question 44

is warfarin safe in pregnancy

Answer 44

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

Question 45

what should you do in women with hypothyroid in pregnancy

Answer 45

increase levothyroxine in first trimester do tft every trimester

Question 46

what is the effect of pregnancy on hyperthyroidism

Answer 46

worsens in first trimester due to hcg gets better in second and third trimester

Question 47

effects of hyperthyroid on fetus

Answer 47

IUGR preterm labour thyroid storm

Question 48

what should epileptic women be given in pregnancy

Answer 48

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

Question 49

when is the risk of seizures highest in pregnancy in epileptics

Answer 49

peripartum period

Question 50

which anticonvulsant should definterly be avoided in pregnnacy

Answer 50

phenobarbitone - due to risk of neonatal convulsions

Question 51

what additional scans do epileptic women get in pregnancy

Answer 51

anomaly scan detailes 18-20 weeks | cardiac scan 22 weeks

Question 52

what delivery should be done in pts with epilepsy

Answer 52

c section only is recurrent seizures in late pregnancy or labour

Question 53

should antiepileptics be continued in labour

Answer 53

yes

Question 54

what is the post partum management in epilepsy

Answer 54

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