obgyn

Question 1

Define pre-eclampsia

Answer 1

New hypertension and proteinuria after 20 weeks gestation

Question 2

Which onset of pre-eclampsia can lead to IUGR?

Answer 2

Early onset pre-eclampsia (<34 weeks) can lead to intrauterine growth restriction. Late onset is not typically associated with IUGR, but fetal damage/death can occur

Question 3

Describe the mechanism of pre-eclampsia

Answer 3

1. Poor placental perfusion leading to oxidative stress.
2. Placenta oversecretes proteins that regulate angiogenic balance (decreased PLGF in maternal blood)
3. Widespread endothelial cell damage - vasoconstriction, increased vascular permeability, clotting dysfunction

Question 4

What are the risk factors for pre-eclampsia?

Answer 4

• HTN in any previous pregnancy
• CKD
• AI disease (SLE/APL)
• Type 1/2 diabetes
• Chronic HTN
• Nulliparous
• Age >40
• Pregnancy interval of more than 10 years
• BMI >35 at booking
• Family history of pre-eclampsia
• Multiple pregnancy

Question 5

What is HELLP syndrome?

Answer 5

Haemolysis
Elevated Liver proteins
Low Platelets

Question 6

What are the symptoms of haemolysis?

Answer 6

• dark urine
• raised lactic dehydrogenase
• anaemia

Question 7

What are the symptoms of elevated liver proteins?

Answer 7

• epigastric pain
• liver failure
• abnormal clotting

Question 8

What are the symptoms of pre-eclampsia (in a history)?

Answer 8

• usually asymptomatic, but
• headache
• visual disturbances
• nausea/vomiting
• epigastric pain

Question 9

What signs might you find on examination of someone with pre-eclampsia?

Answer 9

• HTN

- Oedema - common in most pregnancies, but sudden, massive, and not postural in pre-eclampsia

Question 10

What are the maternal complications of pre-eclampsia?

Answer 10

• eclampsia - grand-mal seizures (probably due to cereberovascular vasospasm)
• cerebrovascular haemorrhage (treat BP)
• HELLP syndrome
• renal failure
• pulmonary oedema

Question 11

What causes mortality in eclampsia?

Answer 11

• hypoxia

- complications of severe disease

Question 12

How is eclampsia treated?

Answer 12

magnesium sulfate

Question 13

what are the fetal complications of pre-eclampsia?

Answer 13

IUGR

Placental abruption

Question 14

How do you investigate proteinuria?

Answer 14

first, bedside dipstick urinalysis.

if positive, protein:creatinine ratio. (previously 24hr urine collection)

Question 15

How do you monitor the fetus in pre-eclampsia?

Answer 15

• ultrasound scan to estimate fetal weight, assess growth

- umbilical artery doppler and cardiotocography (CTG) to evaluate fetal wellbeing

Question 16

what is the screening test for pre-eclampsia?

Answer 16

uterine artery doppler at 20 weeks gestation

Question 17

how do you prevent pre-eclampsia?

Answer 17

aspirin 75mg daily from 16 weeks (preferably in evening)

high dose vit D with calcium

Question 18

how do you manage pre-eclampsia?

Answer 18

labetalol
nifedipine
hydralazine
methyldopa
magnesium sulfate for eclampsia prevention/mgmt
steroids if preterm delivery to promote fetal pulmonary maturation

Question 19

how do you manage chronic HTN in pregnancy?

Answer 19

change previous medications (ACEi/ARB) as these are teratogenic to labetalol/nifedipine
aspirin to prevent pre-eclampsia

Question 20

what is obstetric cholestasis?

Answer 20

pruritus in the absence of skin rash PLUS abnormal LFTs

Question 21

why is obstetric cholestasis bad?

Answer 21

associated with

• sudden stillbirth (toxic effects of bile salts)
• meconium passage
• postpartum haemorrhage

Question 22

how is obstetric cholestasis treated?

Answer 22

ursodeoxycholic acid (UDCA) relieves itching and reduces bile salts

Question 23

why is vitamin K given to women with obstetric cholestasis?

Answer 23

• given from 36 weeks

- there is a maternal and fetal tendency to haemorrhage