Pregnancy Complications

Question 1

How is already existing essential HTN managed during pregnancy

Answer 1

Review at pre-conception
Change medications if contraindications (ACEi are contraindicated in pregnancy)

Question 2

When does pregnancy induced HTN happen

Answer 2

Late pregnancy - >32/40

Question 3

Management of pregnancy induced hypertension

Answer 3

Bp control (keep under 140/90)
Diet and exercise
Medications if needed - libetalol, nifedine (2nd line)

BP and urine dip for proteinuria in every appt due to risk of pre-eclampsia

Question 4

RF of pre-eclampsia

Answer 4

HTN, DM, obesity

Question 5

Symptoms and signs of pre-eclampsia

Answer 5

Headache and visual disturbances (floaters)
RUQ pain (liver)
- Acute onset oedema
Hyper-reflexia and clonus (cerebral oedema!!!)
- Proteinuria - urine test
- rising BP

Question 6

Pre-eclampsia management

Answer 6

Refer to maternity unit - antihypertensives

Risk still high after giving birth so continue antihypertensives for 1-2 wks and ween off in GP

Question 7

What is eclampsia?

Answer 7

Development of grand mal seizures in a woman with pre-eclampsia

Question 8

Eclampsia management

Answer 8

Obstetric emergency - immediate delivery

Question 9

Gestational diabetes risk factors

Answer 9

previous gestational diabetes
BMI > 30
Family history of DM
Ethnicity - asian, african

Question 10

Gestational diabetes symptoms

Answer 10

asymptomatic usually
urine dip test incidental finding

Question 11

Gestational diabetes investigations

Answer 11

Oral glucose tolerance test (GTT) at 24-28 wks if risk factors

Question 12

Risks of gestational diabetes

Answer 12

Large for gestational age
Shoulder dystocia
Stillbirth
T2DM for mother risk

Question 13

Gestational diabetes management

Answer 13

BM monitoring
Diet advice
If not controlled +/- metformin +/- insulin
Delivery by induction at 40 wks if still not delivered

Stop diabetes meds after delivering by check blood glucose 6-12 wks after and annually due to risk of developing T2DM

Question 14

Causes of antepartum haemorrhage?

Answer 14

• Ectroption
• Provoked (sex/speculum)
• Placenta praevia - placenta covering cervix causes painless bleeding
• Placental abruption (placenta detaches from uterus) - painful bleeding and reduced foetal movements - requires urgent referral to maternity unit

Question 15

What is SROM?

Answer 15

Spontaneous rupture of
membranes (SROM) - Breaking of amniotic sac (membrane) = leaking of
amniotic fluid (liquor)

Can happen before or during
labour

Question 16

Management of SROM?

Answer 16

If not in active labour within 24
hours of SROM = induction to
reduce risk of infection

Question 17

What is PROM?

Answer 17

Preterm rupture of
membranes (PROM) -
<37/40

Question 18

Management of PROM?

Answer 18

Induction of labour depends on
gestation

If <34/40 - consider continuing
wih pregnancy with low threshold for induction of evidence of infection -
temperarture/offensive liquid/raised WCC
- Prophylactic antibiotics given (erythromycin)

Question 19

Placenta praevia management

Answer 19

Since placenta convering internal os (fully or partially) - delivery via c section

Question 20

Indications for induction of labour

Answer 20

• Post dates (41+5 and over)
• Gestational diabetes
• Pre-eclampsia triad (proteinuria, rising BP and oedema)
• PROM (pre-term rupture of membrane)
• Concerns about baby (reduced fetal movements etc)

Question 21

Management if labour stops progressing?

Answer 21

• Maternal position change
• Medications i.e. oxytocin
• Instrumental delivery - vacuum/ forceps
• Emergency caesarean section

Question 22

Effects of shoulder dystocia on baby?

Answer 22

• Brachial plexus injury
  (stretching of nerves in the
  neck) - Erb’s palsy (stretching
  of nerves in the neck)
• If significant delay in delivery -
  neurodevelopmental delay

Question 23

What are some post natal complications?

Answer 23

POSTNATAL COMPLICATIONS
* Post-partum Haemorrhage
* PVB > 24 hours post delivery
* Infection = Uterine, Perineal, Mastitis