Medical problems in pregnancy

Question 1

list cardiac problems in pregnancy

Answer 1

pulmonary hypertension 
ischaemic heart disease 
valve disease 
arrhythmias 
peri-partum cardiomyopathy 
congenital heart disease

Question 2

pulmonary HTN is fatal in pregnancy, true or false

Answer 2

true

Question 3

list causes of palpitations

Answer 3

physiological 
sinus tachycardia 
SVT
Ectopic beats 
hyperthyroidism 
phaeochromocytoma

Question 4

there is an increase/decrease in residual lung capacity in pregnancy

Answer 4

decrease

Question 5

what is the commonest respiratory condition to complicate pregnancy

Answer 5

asthma

Question 6

is treatment of asthma in pregnancy any different to normal treatment of asthma

Answer 6

no, same treatment

Question 7

steroids are safe/unsafe in pregnancy

Answer 7

safe

Question 8

what should you look out for in pregnant women taking steroids

Answer 8

weight gain –> GDM

immunosuppression –> infections, vaccines

Question 9

what is the management of asthma

Answer 9

1. SABA
2. SABA + ICS
3. SABA + ICS + LABA
4. Increase ICS dose
5. add 4th drug
6. PO prednisolone

Question 10

which drugs should be avoided in pregnant asthamtics

Answer 10

NSAIDs and haemabate

Question 11

what happens to the risk of VTE in pregnancy

Answer 11

increases!

Question 12

where are VTEs most commonly found

Answer 12

ileofemoral region in left leg

Question 13

what is Virchows triad

Answer 13

hypercoaguability
venous stasis
vascular damage

Question 14

LMWH is/not safe to use in pregnancy and does/not cross the placenta

Answer 14

safe to use and does not cross the placenta

Question 15

which imaging technique is safer to investigate PE in pregnant women and why

Answer 15

V/Q scan

avoid high dose radiation

Question 16

warfarin does/not cross the placenta

Answer 16

DOES cross the placenta

therefore teratogenic

Question 17

when should you convert warfarin to LMWH in pregnancy

Answer 17

6 weeks

Question 18

which anticoagulants can be used post natally

Answer 18

heparin and warfarin (can be used in breast feeding)

Question 19

what are pregnancy complications of autoimmune disorders

Answer 19

miscarriage 
PET
abruption 
FGR
stillbirth 
prematurity

Question 20

what are treatment related consequences of connective tissue disorders

Answer 20

teratogenic medications
sepsis
DM
osteoporosis

Question 21

autoimmune conditions tend to get better/worse in pregnancy

Answer 21

better

Question 22

which CTD medications are safe to use in pregnancy

Answer 22

steroids 
azathioprine
sulfasalazine 
HCQ 
aspirin 
monoclonal antibodies

Question 23

which CTD medications are NOT safe to use in pregnancy

Answer 23

gold 
penicillamine 
methotrexate 
NSAIDs
MMF
leflunamide

Question 24

what is anti-phospholipid syndrome

Answer 24

acquired thrombophilia with aterial, venous and small vessel thrombosis

Question 25

clinical features of APLS

Answer 25

recurrent miscarriages, DVT/PE, stroke, MI | IUGR, PET

Question 26

antibodies of APLS and how do you test for these

Answer 26

anti-cardiolipin anti-B2glycoprotein lupus anticoagulant 2 tests, 3 months apart

Question 27

how do you diagnose APLS

Answer 27

>=3 miscarriages <10wk >=1 foetal loss >10wk >=1 preterm birth due to PET or placental insufficiency

Question 28

management of APLS

Answer 28

low dose aspirin stop warfarin LMWH

Question 29

risks of maternal seizures

Answer 29

``` maternal abdominal trauma eg haemorrhage Pre term premature rupture of membranes prematurity hypoxia/acidosis foetal abnormalities haemorrhagic disease of the newborn childhood epilepsy ```

Question 30

which AED is not teratogenic

Answer 30

lamotrigine

Question 31

which AED are teratogenic

Answer 31

Na valproate phenytoin carbamazepine

Question 32

what increases the risk of peri partum seizures

Answer 32

``` stress pain sleep deprivation hyperventilation dehydration ```

Question 33

management of intra partum seizures

Answer 33

long acting BZD AED through labour c-section if high risk of SE left lateral tile to avoid comrpession of aortocaval vessels

Question 34

consequences of obesity in pregnancy

Answer 34

``` subfertility miscarriage IOL, instrumental delivery PPH, infection, VTE foetal macrosomia, bith injury ```

Question 35

foetal abnormality common in mothers with DM

Answer 35

VSD

Question 36

if there is a high suspicion of DVT but the scan is clear what could you do

Answer 36

give LMWH - see doses on NICE or RCOG | time it with delivery to prevent haemorrhage

Question 37

is warfarin teratogenic

Answer 37

yes

Question 38

is warfarin teratogenic

Answer 38

yes and it can anticoagulate the baby and cause IVH