PET Flashcards
(99 cards)
1
Q
A
2
Q
Def of PET
A
3
Q
RF for PET
- Maternal Specific
A
4
Q
RF for PET
- Pregnancy Specific
A
- Vesicular mole
- Multifetal Pregnancy
- Polyhydraminos
- Seasonal variation: More common in winter
5
Q
Maternal Specific RF for PET
- Age
A
< 20 or > 35 years.
6
Q
Maternal Specific RF for PET
- Gravidity & Parity
A
More in primigravidas specially elderly primigravidas.
7
Q
Maternal Specific RF for PET
- Race
A
More in black races
8
Q
Maternal Specific RF for PET
- SES
A
Low
9
Q
Etiology of PET
A
Theories Include:
- Increased Pressor Effect
- Abnormal Placentation
- Genetic Factors
- Immunological Factors
- Inflammatory Factors
- Biochemical Factors
10
Q
Theories of PET
- Increased Pressor Effect
A
11
Q
Complications of PET
A
Maternal & fetal
12
Q
Maternal Complications of PET
A
13
Q
Maternal Complications of PET
- ICH
A
Due to severe HTN.
14
Q
Maternal Complications of PET
- Remote Complications
A
15
Q
Maternal Complications of PET
- HELLP Syndrome
A
16
Q
Def of HELLP Syndrome
A
Fatal condition characterized by:
- Hemolysis: Bilirubin ≥ 1.2 mg/dl.
- Elevated Liver enzymes: SGOT > 70 IU/L.
- Low Platelet count: < 100000/mm3.
17
Q
DDx of HELLP Syndrome
A
Acute fatty liver in pregnancy.
Thrombotic thrombocytopenic purpura.
Hemolytic uremic syndrome.
Hepatitis (viral or drug induced).
18
Q
Maternal Mortality in HELLP Syndrome
A
80-90%.
19
Q
RR in HELLP Syndrome
A
5%
20
Q
Fetal Complications in PET
A
21
Q
Prediction of PET
- Hx
A
High risk factors (from history since 1st antenatal visit).
22
Q
Prediction of PET
- Ex
A
23
Q
Prediction of PET
- Vascular Reactivity Tests
A
24
Q
Prediction of PET
- Labs
A
↑↑ serum uric acid, hypocalciuria & ↑↑ fibronectin levels.
25
Prediction of **PET**
- Uterine Artery Doppler
To detect uteroplacental hypoperfusion
26
Clinical Signs of **PET**
Signs: Preeclampsia is a disease of signs & it has the following 3 cardinal signs:
- HTN
- PTNuria
- Edema
27
Clinical Signs of **PET**
- HTN
28
Clinical Signs of **PET**
- PTNuria
29
Clinical Signs of **PET**
- Edema
30
Clinical Symptoms of **PET**
31
Clinical Symptoms of **PET**
- Epigastric Pain
Due to distension of liver capsule.
32
Clinical Symptoms of **PET**
- Headache
Due to HTN & cerebral edema.
33
Clinical Symptoms of **PET**
- Persistent N&V
Due to cerebral edema, congestion of gastric mucosa or liver affection.
34
Investigations for **PET**
- Labs
35
**Assessment of Severity** of PET
36
Def of **Imminent eclampsia (preeclamptic state)**
Worse type of severe preeclampsia which will end in eclampsia if not urgently treated.
37
Dx of **Imminent eclampsia (preeclamptic state)**
38
TTT of **Imminent eclampsia (preeclamptic state)**
Immediate control & TOP èin 6 hours.
39
DDx of **PET**
- Causes of HTN with pregnancy
- Causes of proteinuria with pregnancy
- Causes of edema with pregnancy
40
DDx of **PET**
- Causes of HTN with Pregnancy
Preeclampsia (commonest cause) & eclampsia.
Gestational HTN
Chronic HTN.
2ry HTN: As in chronic nephritis, coarctation of aorta & Cush ing syndrome.
41
DDx of **PET**
- Causes of PTNuria with pregnancy
Preeclampsia & eclampsia.
Contamination of specimen e vaginal discharge (commonest cause) .
UTI.
Renal hypoxia: As in CHF & severe anemia.
Hyperemesis gravidarum: Rarely occurs in severe cases.
Orthostatic proteinuria.
42
DDx of **PET**
- Causes of edema with Pregnancy
Preeclampsia & eclampsia.
Gestational edema.
Local causes: Leading to unilateral edema as inflammations or DVT.
Generalized edema: Cardiac, hepatic, renal, nutritional or angioneurotic edema.
Orthostatic edema.
43
Prevention of **PET**
44
Plan of TTT of **Mild PET**
45
Plan of TTT of **Severe Preclampsia**
46
Plan of TTT of **Imminent Eclampsia**
Immediate control & TOP ein 6 hours.
47
Lines of TTT of **PET**
- Expectant treatment
- Control of HTN
- Prevention & control of convulsions
- Termination of pregnancy
- Postnatal care
- Treatment of complications
48
Expectant TTT of **PET**
49
Expectant TTT of **PET**
- Rest
Complete physical & mental rest.
50
Expectant TTT of **PET**
- Diet
High protein & CHO e low Na+ diet.
51
Expectant TTT of **PET**
- Sedation
Benzodiazepines or phenobarbitone.
52
Expectant TTT of **PET**
- Observation
53
Control of HTN in **PET**
- Indications
Severe cases (antihypertensives have doubtful value in mild cases)
54
Control of HTN in **PET**
- Rationale
Prevention of maternal complications & not fetal complications ( dec BP → dec placental perfusion → fetal distress & may be IUFD).
55
Control of HTN in **PET**
- Precautions
Dec BP should be gradual & DBP should be around 100 mmHg (below that → dec placental perfusion).
56
Control of HTN in **PET**
- Disadvantages
57
Control of HTN in **PET**
- Used Drugs
**Parenteral drugs:**
- Hydralazine
- Labetalol
- Diazoxide
**Oral Drugs:**
- Methyl DOPA
- Nifidiopine
- Adrenergic blockers (Atenolol)
- Mono-Hydralazine
- Prazosin
58
Control of HTN in **PET**
- Hydralazine
59
Control of HTN in **PET**
- Labetalol
A & non-selective B-adrenergic blocker → VD.
60
Control of HTN in **PET**
- Diazoxide
Used in severe resistant HTN as a last resort.
61
Control of HTN in **PET**
- Methyl DOPA
62
Control of HTN in **PET**
- Nifidipine
63
Control of HTN in **PET**
- Mono-hydralazine
Weak antihypertensive used in combination
é ß blockers to inc their efficacy & dec their side effects.
64
Control of HTN in **PET**
- Prazosin
Weak antihypertensive - used in combination é other drugs.
65
TTT of **PET**
- Prevention & control of convulsions
- Magnesium sulfate (MgSo4): Drug of choice
- Diazepam (valium)
- Phenytoin (Epanutin)
66
Prevention & control of convulsions in **PET**
- Action of MgSO4
1. Curare like action on motor end plate → paralysis of peripheral muscles.
2. Weak CNS depressant.
3. Mild VD & diuretic.
4. inc PGI2 production & dec platelet aggregation.
67
Prevention & control of convulsions in **PET**
- Indications of MgSO4
Used to prevent convulsions in cases in which delivery is decided.
68
Prevention & control of convulsions in **PET**
- Routes of MgSO4
IV (preferred rout), IM (painful) or SC (not used now).
69
Prevention & control of convulsions in **PET**
- Doses of MgSO4
70
Prevention & control of convulsions in **PET**
- Duration of MgSO4
Maintenance therapy is continued for 24 h after delivery.
71
Prevention & control of convulsions in **PET**
- Monitoring of MgSO4
72
Prevention & control of convulsions in **PET**
- SE of MgSO4
73
Maternal SE of MgSO4
74
Maternal SE of MgSO4
- Toxicity
75
Maternal SE of MgSO4
- Drug Interactions
1. Enhances action of curare like drugs.
2. Synergistic action if given é CCB.
76
Fetal SE of MgSO4
dec beat to beat variability in FHR pattern
77
Neonatal SE of MgSO4
Hypermagnesemia, hypotonia & poor suckling.
78
Antidote of MgSO4
Ca++ gluconate.
79
Stroganoff method
Use of MgSo4 + morphine.
80
Indications of TOP in **PET**
81
Methods of TOP in **PET**
Vaginal & CS
82
Vaginal Delivery in **PET**
- Prerequisities
83
Vaginal Delivery in **PET**
- Precautions
84
Postnatal Care in **PET**
- Observation
85
Signs of Improvement in Postnatal Care in **PET**
86
Def of **Eclampsia**
Occurrence of tonic-colonic convulsive seizures that can't be attributed to other causes in woman e preeclampsia.
87
RF for **Eclampsia**
As pre-eclampsia.
88
Types of **Eclampsia**
- Acc to time of occurence
89
Types of **Eclampsia**
- Acc to recurrence
90
Complications of **Eclampsia**
…
91
Dx of **Eclampsia**
92
Criteria of severity of eclampsia (Eden's criteria)
93
DDx of **Eclampsia**
- Causes of Convulsion with pregnancy
94
DDx of **Eclampsia**
- Causes of Coma with pregnancy
95
TTT of **Eclampsia**
- During Fit
- In Between Fits
96
TTT of **Eclampsia**
- During Fit
97
TTT of **Eclampsia**
- In between Fits
- General measures
- Prevention of further attacks of convulsions
- Control of HTN
- Termination of pregnancy
- Postnatal care
- Treatment of complications
98
General Measures of TTT of **Eclampsia** in between fits
- Observation
99
TTT of **Eclampsia** in between fits
- TOP
