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3 Reproduction and Sexual Health > Medical Problems in Pregnancy > Flashcards

Medical Problems in Pregnancy Flashcards

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1
Q

give examples of direct complications of pregnancy

A

haemorrhage
sepsis
hypertensive disease eg PET

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2
Q

what are the main causes of maternal mortality in the UK?

A

cardiac disease
thrombosis/thromboembolism
neurovascular

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3
Q

under/overweight women are at high risk of venous thromboembolism in pregnancy

A

overweight

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4
Q

what should be considered when assessing what impact a medical condition would have on a pregnancy (consider each trimester)?

A 
effects on mum and fetus
drugs
1st trimester - inc risk of miscarriage?
2nd trimester - inc risk of malformation?
3rd trimester- PET? FUGR?
parturition- delivery?
puerperium- problems after birth?
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5
Q

what physiological cardiac factor decreases in pregnancy

A

TPR

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6
Q

what is a normal heart rate for a woman at term?

A

90-100bpm

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7
Q

why is cardiac disease more common in pregnancy?

A

increasing age
increasing BMI
more women with congenital HD

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8
Q

what is the risk of death from an MI in pregnancy?

A

1 in 13

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9
Q

woman presents with sudden onset chest pain in pregnancy, what investigation should be done?

A

ECG

consider CT

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10
Q

a pregnant woman presents with orthopnoea, what should be considered?

A

peri-partum cardiomyopathy

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11
Q

what kind of hypertension is almost fatal in pregnancy?

A

pulmonary

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12
Q

what anticoagulant should be given to pregnant women?

A

LMWH (doesnt cross placenta)

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13
Q

describe “normal” palpitations in pregnancy

A

occur at rest and/or lying down

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14
Q

when would a woman’s cardiac symptoms contraindicate her to pregnancy?

A

if she has marked symptoms during daily activities and is asymptomatic only at rest

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15
Q

an aortic root >_mm would contraindicate someone to getting pregnant; why is this?

A

45

puts them at increased risk of aortic dissection

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16
Q

how do ectopic beats present? are these normal?

A

“thumping” heartbeat relieved by exercise

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17
Q

Ix for suspected benign palpitations

A

ECG (24hr ECG if worried)

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18
Q

other causes of sinus tachycardia in pregnancy

A

sepsis
PE
thyroid problems eg hyperthyroidism

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19
Q

Ix sinus tachycardia

A

ECG
24h ECG
TFT
ECHO

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20
Q

most common arrhythmia in pregnancy

A

paroxysmal SVT

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21
Q

Ix cardiomyopathy

A

ECHO

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22
Q

Ix SVT

A

ECG
24h ECG
TFT
ECHO

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23
Q

what tumour can cause palpitations and should be investigated in pregnant women with these symptoms?

Study These Flashcards
A

phaeochromocytoma (do 24hr urinary catecholamines)

24
Q

why do women get breathless in pregnancy?

Study These Flashcards
A

physiological hyperventilation

25
describe the classic presentation of physiological breathlessness in pregnancy
SoB at rest/talking that improves with exertion, common in 3rd trimester
26
describe the outcomes of women with asthma in pregnancy
1/3 improve, 1/3 stay the same, 1/3 deteriorate
27
who is a greatest risk of deterioration in pregnancy from asthma?
those who have been in ICU for asthma severe disease cessation of therapy for safety concerns those who didnt improve in last pregnancy
28
describe asthma treatment pathway in pregnancy
SAME AS NORMAL 1. SABA 2. add inhaled corticosteroid 3. add LABA (stop if desnt work) 4. try inc dose of inh steroid or add 4th drug eg leukotriene receptor antagonist
29
asthma patients should have what kind of delivery?
SVD
30
what should women get in labour if they've been on oral steroids for >2 weeks
IV hydrocortisone
31
where do DVTs occur in pregnancy
left leg
32
when is VTE risk highest in pregnancy? why?
puerperium | virchow's triad is most affected have vascular damage from labour, in hypercoaguable state and blood is in stasis
33
prophylactic VTE Tx for high risk pregnant women?
LMWH antenatally
34
what puts women at low risk of VTE?
less than 3 risk factors
35
what would make a woman at high risk of VTE?
any previous VTE not related to surgery
36
prophylactic VTE Tx for low risk mothers
mobilisation | hydration
37
why is warfarin not used as VTE prophylaxis?
teratogenicity
38
what LMWH is used in tayside? how is the dose worked ou?
dalteparin | done by mum's weight
39
how is DVT diagnosed in pregnancy?
compression duplex USS (examination is not always clear)
40
if compression duplex USS is normal but you suspect DVT, what should you do?
repeat in 1 week
41
pregnant woman presents with a whole swollen leg and back pain...
iliac vein thrombosis
42
d dimers are always up during pregnancy T or F
T
43
Ix iliac vein thrombosis
MRI venography
44
after how long should a woman previously on warfarin be given LMWH after getting pregnant?
6 weeks
45
when can women on LMWH during pregnancy be switched back on to warfarin?
can be started on 5th postnatal day
46
skin change in antiphospholipid syndrome?
livedo reticularis
47
what precedes the pregnancy loss seen in APS?
FGR
48
Ix APS in pregnancy?
pregnancy morbidity in PMH vascular thrombosis IgM, IgG aCL tests
49
Tx APS in pregnancy?
low dose aspirin and LMWH
50
how does seizure frequency change in pregnancy?
usually doesnt change
51
what risks does a seizure in pregnancy have on baby?
fetal hypoxia and acidosis | = preterm birth, congenital malformations, haemorrhagic disease of newborn
52
what extra investigation should women with epilepsy be given?
scan of fetal anatomy at 18-20 weeks
53
what prophylactic medication should women with epilepsy be given?
5mg/day folic acid until the end of 1T
54
what factors increase the risk of intra-partum seizures?
``` stress pain sleep deprivation overbreathing dehydration ```
55
Tx seizures in labour
benzodiazepines are mainstay | IV lorazepam/diazepam
56
how can you keep babies safe if mum has epilepsy?
safe feeding position do activities on the floor eg dressing, playing low high chairs avoid maternal fatigue
57
PET prophylaxis?
aspirin

3 Reproduction and Sexual Health (51 decks)

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