Pregnancy Complications (Pt 1)

Question 1

define eclampsia

Answer 1

progression of pre-eclampsia (>140/90mmHg) to eclamptic fits

Question 2

management of eclampsia

Answer 2

ABC approach 
place in left lateral tilt position 
IV magnesium sulphate
IV labetalol or hydralazine 
minimise fluid therapy

Question 3

define pre-eclampsia

Answer 3

new onset hypertension (>140/90mmHg) after 20wks of pregnancy with:

proteinuria
creatinine (90mmol/L)
increased transaminases

Question 4

risk factors of pre-eclampsia

Answer 4

nulliparity
>40yrs of age
obesity
multiple pregnancy

Question 5

investigations of pre-eclampsia

Answer 5

urinalysis
bloods
USS of foetus

Question 6

prophylaxis of pre-eclampsia

Answer 6

provide mother with 75-150mg aspirin from 12wks gestation

Question 7

conservative management of pre-eclampsia

Answer 7

diet modification
advise rest and avoidance of stressful situations
frequent BP and urine protein checks

Question 8

medical management of pre-eclampsia

Answer 8

anti-hypertensive medication (e.g. labetaolol, nifedipine or methyldopa)

Question 9

complications of pre-eclampsia

Answer 9

eclampsia
organ failure
HELLP syndrome

intra-uterine growth restriction
pre-term delivery

Question 10

define HELLP syndrome

Answer 10

presence of:
haemolysis
⬆️ liver enzymes
⬇️ low platelets (< 100x10)

Question 11

symptoms of HELLP syndrome

Answer 11

headache 
nausea and/or vomiting 
epigastric pain 
RUQ pain 
blurred vision 
peripheral oedema

Question 12

risk factors of HELLP syndrome

Answer 12

> 35yrs
nulliparity
previous gestational hypertension
multiple pregnancy

Question 13

management of HELLP syndrome

Answer 13

blood transfusion

foetus delivery

Question 14

define gestational diabetes

Answer 14

a state of insulin resistance induced by the metabolic strain of pregnancy that is diagnosed within the 24-28th wks of pregnancy

Question 15

risk factors of gestational diabetes

Answer 15

increased maternal age 
high BMI 
smoking 
PCOS 
non-caucasian ancestry

Question 16

clinical features of maternal gestational diabetes

Answer 16

polyuria
polydipsia
nocturia
fatigue

Question 17

clinical features of gestational diabetes in foetus

Answer 17

⬆️ syphysio-fundal height
⬆️ foetal weight
signs of polyhydraminos

Question 18

investigations of gestational diabetes

Answer 18

urine dipstick
fasting and random blood glucose
oral glucose tolerance testing (OGTT)

Question 19

initial management of gestational diabetes if fasting glucose <7mmol/L

Answer 19

trial diet and exercise for 1-2wks followed by metformin and then insulin

Question 20

initial management of gestational diabetes >7mmol/L

Answer 20

start insulin +/- metformin

Question 21

initial management of gestational diabetes if >6mmol/L + macrosomia

Answer 21

insulin +/- metformin

Question 22

delivery management in gestational diabetes

Answer 22

no delivery later than 40(+6) weeks gestation

if no spontaneous delivery prior, opt for C-section

Question 23

define molar pregnancy (hydatiform mole)

Answer 23

an imbalance in the number of chromosomes from mother and father, causing failure of conception

Question 24

describe complete molar pregnancy

Answer 24

formed from 1 sperm and an empty egg
has no genetic material
sperm replicates to form diploid paternal cell
causes no foetal tissue, just swollen and proliferated chorionic villi

Question 25

describe incomplete molar pregnancy

Answer 25

formed from 2 sperm and a normal egg has both maternal and paternal genetic material variable evidence of foetal tissue present

Question 26

clinical features of molar pregnancy

Answer 26

``` vaginal bleeding nausea hyperemesis gravidarum enlargened uterus thyrotoxicosis ```

Question 27

investigations of molar pregnancy

Answer 27

serum β-hCG trans-vaginal US - will show 'snowstorm' appearance

Question 28

management of molar pregnancy

Answer 28

urgent referral to specialist for potential complications suction curettage for uterus removal of tissue 2 weekly surveillance of serum and urine β-hCG

Question 29

next steps if β-hCG levels fail to fall following management of molar pregnancy

Answer 29

suspect choriocarcinoma and refer to specialist and provide methotrexate based chemotherapy

Question 30

following a molar pregnancy, how long should patients wait before trying to become pregnant again?

Answer 30

1 year