Obstetric

Question 1

During a normal pregnancy blood count changes may occur in blood count changes for which cells?

Answer 1

Mild anaemia (diluational anaemia) - Red cell mass increases - Plasma volume increases (more than the rbc mass) Macrocytosis - may cause folate and B12 deficiency Neutrophilia Thrombocytopenia - increase in platelet size due to increased turnover

Question 2

Iron requirement increases during pregnancy Why does this happen?

Answer 2

300mg for fetus 500mg for maternal increased red cell mass RDA 30mg Increase in daily iron absorption 1-2mg to 6mg

Question 3

Iron requirement increases during pregnancy What may iron deficiency cause?

Answer 3

IUGR Low birth weight Premature heart defects

Question 4

Iron requirement increases during pregnancy What iron and folate supplements in pregnancy are suggested?

Answer 4

60mg iron and 400ug folic acid during pregnancy

Question 5

Anaemia in pregnancy definition?

Question 6

What is thrombocytopenia in pregnancy defined as?

Answer 6

Platelet cound falls in pregnancy - 175-199 non pregnant - 225-249

Question 7

Causes of thrombocytopenia in pregnancy? (4)

Answer 7

Physiological gestational fall - primary pre-eclampsia (HELLP - haemolysis, elevated liver, low platelets) Immune thrombocytopenia ITP - slightly more common in pregnancy but can occur anytime MAHA syndromes (microangiopathic syndromes) others : BM failure, hypersplenism, DIC, leukaemia

Question 8

How much thrombocytopenia is acceptable for delivery?

Answer 8

> 50x10^9

Question 9

How much thrombocytopenia is acceptable for epidural delivery?

Answer 9

> 70x10^9 >50 usually for normal delivery

Question 10

if thrombocytopenia is more severe (<70x10^9) is it more likely to be normal gestational or pathological?

Answer 10

More likely to be pathological e.g. ITP or pre-eclampsia

Question 11

What happens to thrombocytopenia after delivery for each following condition? Gestational thrombocytopenia Preeclampsia Immune thrombocytopenia

Answer 11

Gestational thrombocytopenia = 2 - 5 days post delivery Preeclampsia = remits following delivery Immune thrombocytopenia = falls for 5 days after delivery

Question 12

How to treat thrombocytopenia of lower levels : >50? 20-50? <20?

Question 13

What is MAHA syndomes causing thrombocytopenia?

Answer 13

Deposition of platelets in small blood vessels e.g. placenta Cardical signs : fragmentation (shistocytes) and destruction of RBC within vasculature Delivery does not change this syndrome

Question 14

What is seen on blood flm with MAHA syndomes causing thrombocytopenia?

Answer 14

Deposition of platelets in small blood vessels e.g. placenta Cardical signs : fragmentation (shistocytes) and destruction of RBC within vasculature Delivery does not change this syndrome

Question 15

how many TTP type MAHA syndrome affect symptoms?

Answer 15

TTP (pentad S/S: MAHA, fever, renal impairment, neurological impairment, thrombocytopenia)

Question 16

What is the leading cause of maternal death in the UK?

Answer 16

VTE

Question 17

Which leg often has the blood clot in pregnant women?

Answer 17

Left leg

Question 18

Why may pro-thombotic environment be created in pregnancy?

Question 19

What is the largest predictor of incidence of PE during pregnany?

Answer 19

High BMI >25

Question 20

How does VTE cause most maternal deaths?

Answer 20

PE - embolism

Question 21

Which is the highest risk time for PE?

Answer 21

post partum 6 weeks and 1st trimester

Question 22

How to manage patients with BMI >25 prophylaxis for PE?

Answer 22

Heparin from 1st trimester

Question 23

Why is D Dimer not useful for pregnancy?

Answer 23

often elevated in pregnancy - only used for exclusion

Question 24

Which factors increase risk of thrombosis?

Question 25

Prevention plan for thromboembolic disease in pregnancy?

Question 26

Treatment plan for thromboembolic disease in pregnancy?

Question 27

Why does Warfarin need to be stopped prior to pregnancy?

Answer 27

Is teterogenic so need to wean off Can cause chondrodysplasia punctata - fetal abnormality

Question 28

Why can LMWH be used in pregnancy but Warfarin cannot be used?

Answer 28

LMWH does not cross the placenta Warfarin does (is teratogenic) avoid specifically in weeks 6-12

Question 29

Antiphospholipid syndrome is a thrombophilia associated with pregnancy When is antiphospholipid syndrome usually diagnosed? *1 history feature + 1 diagnostic test

Answer 29

After 3+ (recurrent) miscarriage + lipid anticoagulant or anticardiolipin antibodies are detected Other than recurrent miscarriage it also could be: - 1 or more pretern birth before 34 weeks

Question 30

Antiphospholipid syndrome is a thrombophilia associated with pregnancy How to treat antiphospholipid syndrome?

Answer 30

After 3+ (recurrent) miscarriage + Lupid anticoagulant or anticardiolipin antibodies are detected Heparin and aspirin

Question 31

What are placental causes of PPH?

Answer 31

Placenta praevia Placenta Accrete

Question 32

What is PPH defined as?

Answer 32

500ml + loss 5% pregnancies may have more than 1L

Question 33

Mechanisms of PPH can be determined by the 4Ts?

Answer 33

Tone (uterine atony) = major cause Tissue Trauma (major cause) Thrombin

Question 34

Other than the 3 Ts and placental abnormalities what else can cause PPH?

Answer 34

Haematological factors: Dilutional coagulopathy after resus DIC in abruption amniotic fluid embolism

Question 35

What in pregnancy may predispose to DIC?

Answer 35

Coagulation changes as Tissue factor and Factor 7a can come into contact and start the cascade

Question 36

in DIC in pregnancy, decompensation (bodys point of failure to maintain haemostasis) is worsened by which conditions?

Answer 36

Amniotic fluid embolism Pre-eclampsia also sepsis and placental abruption

Question 37

What is amniotic fluid embolism?

Answer 37

When tissue factor from amniotic fluid enters maternal blood stream. causes shivers, vomiting, shock

Question 38

how to treat amniotic fluid embolism?

Answer 38

use misoprostol to induce labour

Question 39

Screening for haemoglobinopathies is vital to avoid birth of children with which conditions?

Answer 39

Alpha 0 thalassemia / Hb Barts (in utero death) Beta 0 thalassemia (transfusion dependent) HbSS / SCD (sickle clell)

Question 40

What inheritence pattern do haemoglobinopathies have?

Answer 40

All are recessive (thalassemia A and B and sickle cell)

Question 41

How does Sickle cell women do in pregnancy?

Answer 41

prophylactic transfusion

Question 42

Differences between Iron deficiency anaemia and thalassaemia trait?

Answer 42

Iron def: normal or low Hb with low MCH and low RBC Trait : normal Hv with low Hb and increased RBC

Question 43

Differences between Iron deficiency anaemia and thalassaemia trait? Hb?

Answer 43

iron def : Hb is normal or low thalassaemia : Hb is normal

Question 44

Differences between Iron deficiency anaemia and thalassaemia trait? MCH?

Answer 44

iron def : Low in proportion to Hb thalassaemia : lower for same Hb

Question 45

Differences between Iron deficiency anaemia and thalassaemia trait? RBC?

Answer 45

iron def : low or normal thalassaemia : increased

Question 46

Which of the following statements is correct? o In gestational thrombocytopenia, the baby’s platelet count is usually affected o Thrombocytopenia is rarely found in association with pre-eclampsia o Thrombotic thrombocytopenic purpura remits spontaneously following delivery o Platelet count may fall following delivery in babies born to mothers with ITP

Answer 46

Platelet count may fall following delivery in babies born to mothers with ITP