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Flashcards in Medical Problems in Pregnancy Deck (80):
1

What is done at the booking visit?

general pregnancy advice; identify if low/high risk; info on choices for place of birth; discuss screening; BMI; BP; arrange dating USS; arrange booking bloods

2

When is the booking visit done?

8-12 weeks

3

When is the dating USS done?

11-12 weeks

4

When is the anomaly scan done?

20 weeks

5

When are anti-D injections given?

28 weeks and 24 weeks

6

How often do women have visits with the midwife between 20-28 weeks?

monthly

7

How often do women have midwife visit between 28 and 26 weeks?

fortnightly

8

How often do women have a midwife visit after 37 weeks?

weekly

9

What is the commonest medical problem in pregnancy?

HT

10

What is chronic hypertension in pregnancy?

HT present at booking or <20 weeks

11

what is gestational hypertension?

new HT >20 weeks without signif proteinuria

12

What is pre-eclampsia?

new HT >20 weeks and significant proteinuria

13

What are the life-threatening complications of hypertension in pregnnacy?

HELLP syndrome and eclampsia

14

What is HELLP syndrome?

haemolysis; elevated liver enzymes and low platelets

15

What anti-hypertensives are used in pregnancy?

labetalol; methyldopa; nifedipine; hydralazine

16

what anti-hypertensives should be stoppped?

ACEi and ARBs

17

What is the target for BP in pregnnacy?

<150/80-100

18

What is the BP target in pregnnacy with end organ damage

<140/90

19

What is the pathophysiology of pre-eclampsia?

deficient trophoblastic invasion which prevents development of high flow; low impedence uteroplacental circulation----dysunfction of vascular endothelial cells--vasconstriction and no insensitivty to vasocontrictors

20

What are the effects o hypertensive disorders on the fetus?

IUGR; abruption; IUD

21

When should the baby be delivered in pre-eclampsia?

37 weeks

22

What is the effect of pregnnacy on diabetes?

poorer control; deterioration of renal function and retionopathy

23

What are the effects of diabetes on pregnnacy?

miscarriage; fetal malformations; IUGR; macrosomia; IUD; PET

24

What fetal malformations are diabetics more at risk of?

cardiac; neural tube defects; caudal regressions syndrome

25

When should labour be induced by in diabetics?

37-38 weeks

26

What does neonatal hypoglycaemia carry the risk of?

CP

27

Why is there fetal polycythaemia in DM?

due to hyperinsulinaemia; increased metabolism so tissue hypoxia which stimulates increased erythopoeitin and polychythaemia

28

How often should babies of diabetic mother have growth scnas?

28,32,36 weeks

29

When should babies be delivered with pre-existing DM?

37-38 weeks

30

How long after delivery should BMs be monitored with GDM?

48 hours

31

When is C/S recommended in macrosomia?

EFW >4000g

32

What is the effect of polycythaemia on the fetus?

thrombotic; jaundice

33

What is the risk of polyhydramnios?

fetal malpresentations and increased risk of preterm labour

34

What is the main direct cause of maternal death in UK?

VTE

35

What is thought to be the reason for increased clotting factors in pregnancy?

evolutionary to decrease risk of PPH

36

What factors are increased in pregnancy?

VII; VIII; X and fibrinogen

37

What are the VTE risk factors?

obesity; age >35; parity =>3; smoker; gross varicose veins; current pre-eclampsia; immobility; FHx; multiple pregnancy; IVF

38

How many risk factors means you should give prophylaxis in the 1st trimester?

4 or more

39

Who should get prophylaxis from 28 weeks?

3 risk factors

40

Which leg do pregnnat women tend to develop DVT in?

left >right 8:1

41

What is the difficulty with DVT in pregnancy?

50% early DVTs are asymptomatic

42

How is DVT diagnosed in pregnancy?

duplex US on lower limb - not d-dimer

43

What is the dose for heparin in pregnnacy?

1mg/kg twice daily

44

How long should LMWH be continued after DVT?

3 months after delivery or 6 months after treatment

45

What are the SE of heparin?

haemorrhage; hypersensitivity; allergy at injection site; heparin induced thrombocytopenia; oesopenia

46

What may PE cause that can be seen on CXR?

atelectasis; effusion; focal opacities; regional oligaemia or pulmonary oedema

47

What is the first line ix for PE in pregnnacy?

CXR and ABGs

48

What are the risks of CTPA?

less childhood cancer but increased breast cancer

49

Why should warfarin be avoided in pregnancy?

teratogenic- miscarriage; neuro problems; still birth

50

When should CTPA done in pregnancy?

if CXR is abnormal and high clinical suspicion of PE

51

When should warfarin be used after birth?

day 2 or 3

52

Is warfarin safe to use in breastfeeding?

yes

53

How is hypothyroidism affected by pregnance?

need higher levothyroxine dose- 25-50mcg more;

54

How often should TFTs be checked in hypothyroid pregnnacy?

every trimester

55

What happens in the pregnnacy with hyperthyroidism?

gets worse in first trimester due to hCG but improves second and thrid trimesters

56

What are the effects of being hyperthyroid on the pregnnacy?

IUGR; preterm labour and thyroid storm

57

What is the problem with beta blockers eg propanolol in pregnnacy?

IUGR

58

When is the greatest risk of deterioration for severe asthmatics?

thrid trimester

59

What is the most common for deterioration of asthma in pregnancy?

reduction or cessation of medications due to unfounded safety fears

60

What is the risk of maternal death with epilepsy?

aspiration

61

What dose of folic acid should pregnant epileptics be on?

5mg folic acid

62

Why is there an increased risk of seizures in epilepsy in the 1st trimester?

hyperemesis and haemodilution

63

When is the greatest risk of seizures in pregnnacy?

peripartum

64

Why is there a deterioration of control of epilepsy in pregnancy?

poor compliance-safety fears; decreased drug levels due to vomiting; decreased drug due to increased volume of distribution and drug clearance; lack of sleep towards term; lack of absorption of drugs during labour; hyperventialtion during labour

65

When is epilepsy a risk to the fetus?

status epilepticus- fetus is resistant to short-term hypoxia but not prolonged

66

What are the major malformations with anticonvulsants?

neural tube defects; orofacial celfts and cardiac defects

67

What anticonvulsants are implicated in NTDs?

valproate (1-2%) and caramazepine (0.5-1%)

68

What anticonvulsants are implicated in orofacial defects?

phenytoin especially

69

which anticonvulsants are implicated in cardiac defects?

phenytoin and valproate

70

What is fetal anticonvulsant syndrome?

dysmorphic features; hypertelorism; hypoplastic nails and distal digits

71

What is hypertelorism?

increased distnace between two organs or body parts eg between eyes

72

What are the dysmorphic features seen with fetal anticonvulsant syndrome?

V-shaped eyebrows; lowset ears; broad nasal bridge; irregular teeth

73

What is the teratogenic risk with any one anticonvulsant of a major malformation?

6-7%

74

What is though to be the mechanism of teratogenesis with anticonvulsants?

folate deficiency

75

What should epileptic women take if on an enzyme inducer?

vit K from 34-36 weeks

76

Why should women on enzyme inducer take vitamin K?

risk of fetal vit K defieicney and haemorrhagic disease of the newborn

77

When should LSCS be done in epileptics?

only if recurrent generalised seizures in late pregnancy/labour

78

What pain relief during labour should epileptics be given?

early peidural to reduce pain/anxiety

79

What is given to neonate of epileptic mother after birth?

1mg IM vit K

80

How does the risk of SUDEP change in pregnancy?

increases in pregnnacy and postnatal period