Medical problems & prescribing in pregnancy

Question 1

How does pregnancy affect maternal BP?

Answer 1

Vasodilation so BP falls in early pregnancy till 22-24 weeks then steady rise

Question 2

How is gestational hypertension defined?

Answer 2

Hypertension (>140/90) in the second half of pregnancy that resolves <6 weeks post birth
No proteinuria or oedema

Question 3

What is pre-eclampsia?

Answer 3

Hypertension + oedema + proteinuria (>0.3g/24hr)

Question 4

Symptoms of pre-eclampsia

Answer 4

Headache
Visual disturbance
Rapid progressive oedema 
Nausea/vomiting 
Epigastric/RUQ pain

Question 5

What is the prophylaxis for pre-eclampsia?

Answer 5

Low dose aspirin from 12 weeks if high risk

Question 6

What efect does pregnancy have on renal diseas?

Answer 6

Decreased GFR
Increased serum uric acid
Increased creatinine/potassium/urea

Question 7

What is HELLP syndrome?

Answer 7

Haemolysis Elevated Liver enzymes Low Platelets

Question 8

How is HELLP treated?

Answer 8

Steroids + delivery 
Seizure prevention (magnesium sulphate)

Question 9

What is the most common liver disease of pregnancy?

Answer 9

Intrahepatic cholestasis of pregnancy

Question 10

What are the clinical features of intrahepatic cholestasis of pregnancy?

Answer 10

Pruritis (hands & soles of feet)
No rash
Jaundice
Raised bilirubin

Question 11

How is intrahepatic cholestasis of pregnancy managed?

Answer 11

Urso for symptomatic relief

Typically induced at 37 weeks

Question 12

What are the clinical features of acute fatty liver of pregnancy?

Answer 12

Abdo pain 
Jaundice 
Nausea & vomiting
Headache
Hypoglycaemia
Elevated ALT

Question 13

What hypertensives are used to treat in pregnancy?

Answer 13

Labetalol

Methyldopa

Question 14

Which anti-hypertensives should be avoided in pregnancy?

Answer 14

Diuretics + ACE inhibitors

Question 15

What type of seizure presents in eclampsia?

Answer 15

Tonic-clonic seizure

Question 16

What is the main cause of death in eclampsia?

Answer 16

Pulmonary oedema

Question 17

Which diabetic medication is not safe in pregnancy and should be changed to insulin?

Answer 17

Sulphonylureas

Question 18

How does diabetics antenatal care differ from a regular person?

Answer 18

etinal screening every trimester

37-38 weeks delivery

Question 19

What blood glucose range should be aimed for with pregnant diabetics?

Answer 19

BM 4-6

HbA1c <6%

Question 20

How is a DVT diagnosed in pregnancy?

Answer 20

D-dimer NOT used

Duplex US of the lower limb

Question 21

How are women at high risk of VTE treated?

Answer 21

LMW Heparin prophylaxis (continue 3 months after delivery or 6 months after treatment)

Question 22

How long before delivery should warfarin therapy be stopped?

Answer 22

6 weeks

Question 23

Is warfarin ok in breast feeding?

Answer 23

Yes

Question 24

How is hypothyroidism managed in pregnancy?

Answer 24

Increase levothyroxine by 25-50mcg in 1st trimester

Question 25

What effect does pregnancy have on existing hyperthyroidism?

Answer 25

Worse in 1st trimester (due to HCG) | Improves 2nd & 3rd trimester

Question 26

Are carbimazole & PTU safe in pregnancy?

Answer 26

Yes

Question 27

What effect can the increased RR have on ABG's in pregnancy?

Answer 27

Resp alkalosis (increased pH, decreased pCO2, decreased bicarb)

Question 28

Which anti-epilapticscancause NTD?

Answer 28

Valproate | Carbmazepine

Question 29

Which anti-epileptic can cause orofacial defects?

Answer 29

Phenytoin

Question 30

Which anti-epileptics can cause heart defects?

Answer 30

Phenytoin | Valproate

Question 31

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

Answer 31

Hyperemesis & haemodilution

Question 32

What should be prescribed if a pregnan patient is taking hepatic enzyme inducing anti-epileptics?

Answer 32

Vit K from 36 weeks

Question 33

What should epileptics be prescribed in pregnancy to minimise foetal problems?

Answer 33

Folic acid - 12 weeks prior to conception & throughout pregnancy

Question 34

If either parent has epilepsy what is the chance of the kid having it?

Answer 34

5%

Question 35

If both parents have epilepsy what is the chance of the kid having it?

Answer 35

15-20%

Question 36

What should be avoided when treating anxiety in pregnancy?

Answer 36

Benzos (cleft, neonatal withdrawal)

Question 37

What problems can lamotrigine cause if taken whilst breast feeding?

Answer 37

Steven-Johnson syndrome (NEC)

Question 38

Is lithium contraindicated in breast feeding?

Answer 38

Yes

Question 39

Which anti-psychotic are safe to treat schizophrenia with in pregnancy?

Answer 39

Typical anti-psychotics

Question 40

Which depression drugs are contraindicated in pregnancy?

Answer 40

Venlafaxine | Paroxetine

Question 41

Why should cooked liver be avoided in pregnancy?

Answer 41

High levels of vitamin A

Question 42

What should be used to treat nausea & vomiting in pregnancy?

Answer 42

Cyclizine

Question 43

What should be used to treat UTI'sin pregnancy?

Answer 43

Nitrofuratoin (1st & 2nd trimester) | Trimethoprim (3rd trimester)

Question 44

What drug is safe for treatment of pain in pregnancy (e.g. headache)?

Answer 44

Paracetamol

Question 45

Which drug if taken when breastfeeding can cause neonatal hypoethyroidism?

Answer 45

Amiodarone

Question 46

Which drugs if taken while breastfeeding can cause the baby to be drowsy?

Answer 46

Benzos

Question 47

Which drug suppresses lactation if taken when breast feeding?

Answer 47

Bromocriptine

Question 48

What issues can methotrexate cause if taken in pregnancy?

Answer 48

Skeletal defects

Question 49

What problems can warfarin cause if taken in pregnancy?

Answer 49

Limb & facial defects

Question 50

What problems can ACE inhibitors/ARBs cause if taken in pregnancy?

Answer 50

Renal hypoplasia