Problems in Pregnancy

Question 1

What may cause a large for dates pregnancy?

Answer 1

Wrong dates
Foetal macrosomia
Polyhydramnios
Diabetes
Multiple pregnancy
Obesity

Question 2

At which birth weight is c-section recommended if the baby is large for gestational age?

Answer 2

5kg

Question 3

What is polyhydramnios?

Answer 3

An excessive amount of amniotic fluid.

Question 4

What is the most common form of twinned pregnancy?

Answer 4

Dizygotic (70% of cases).

Arising from 2 separate eggs being fertilised by 2 separate sperm

Question 5

What increases risk of all pregnancy complications?

Answer 5

Diabetes

Question 6

What is the most common cause of iatrogenic prematurity?

Answer 6

Pre-eclampsia

Question 7

What is pre-eclampsia?

Answer 7

A condition arising during pregnancy characterised by high BP, proteinuria and oedema.

Question 8

Do all 3 classic symptoms of pre-eclampsia always appear?

Answer 8

No, this does not rule out diagnosis.

Question 9

Can pre-existing hypertension be diagnosed during pregnancy?

Answer 9

No, needs to be diagnosed prior to pregnancy or 3 months after (if not returned to a normal level).

Question 10

Pregnancy-induced hypertension occurs when?

Answer 10

The 2nd half of pregnancy.

Question 11

What occurs in pre-eclampsia physiologically?

Answer 11

Diffuse vascular endothelial dysfunction alongside circulatory disturbance.

Question 12

At which gestation is early pre-eclampsia diagnosed?

Answer 12

Before 34 weeks.

Question 13

At which gestation is late pre-eclampsia diagnosed?

Answer 13

After 34 weeks.

Question 14

What are the 2 stages of pre-eclampsia?

Answer 14

Abnormal placental perfusion

Maternal syndrome

Question 15

What is seen in HELLP syndrome?

Answer 15

Haemolysis
Elevated liver enzymes
Low platelets

Question 16

What can commonly be the first marker of pre-eclampsia?

Answer 16

Elevated serum urate.

Question 17

How should pre-eclampsia be investigated?

Answer 17

U+Es
LFTs
FBC
Coagulation screen
Check BP

Question 18

What can be given to reduce the risk of pre-eclampsia?

Answer 18

Low dose aspirin.

This is safe to take in pregnancy.

Question 19

When should a patient with pre-eclampsia be admitted?

Answer 19

If BP > 170/110mmHg, or BP>140/90mmHg with ++ proteinuria
Abnormal biochemistry
If symptoms are significant
Upon initiation of antihypertensive treatment
If there are signs of foetal compromise

Question 20

What does a MAP > 150mmHg indicate?

Answer 20

There is a significant risk of a cerebrovascular accident.

Question 21

At which Bp should antihypertensive treatment be initiated in pregnancy?

Answer 21

> 150/100mmHg

If > 170/110mmHg, treat immediately.

Question 22

What drugs are used to treat hypertension in pregnancy?

Answer 22

Methyldopa
Labetalol
Nifedipine

Question 23

When is methyldopa contraindicated?

Answer 23

In patients with depression.

Question 24

When is labetalol contraindicated?

Answer 24

in asthmatic patients.

Question 25

Is it possible to cure pre-eclampsia?

Answer 25

yes, only achievable by delivering the baby. Important to stabilise the mother first.

Question 26

When is delivery of the baby indicated in pre-eclampsia?

Answer 26

At-term gestation (37 weeks) Inability to control BP Rapid deterioration of the mother Progression to eclampsia

Question 27

What is eclampsia?

Answer 27

A seizure in association with hypertension occurring during pregnancy.

Question 28

What form of seizure is seen in eclampsia?

Answer 28

Tonic clonic seizure

Question 29

How is eclampsia treated?

Answer 29

Magnesium sulfate infusion. This can be given prophylactically.

Question 30

Which age group most commonly suffers from eclampsia?

Answer 30

Teenagers

Question 31

What is defined as small for gestational age?

Answer 31

An infant born with a birthweight below the 10th centile.

Question 32

What is defined as a low birthweight?

Answer 32

Infant <2.5kg at birth.

Question 33

Is small for gestational age, the same thing as a low birthweight?

Answer 33

No.

Question 34

What is foetal growth restriction?

Answer 34

Failure of the foetus to achieve its genetic growth potential. Suggestive of a pathological obstruction.

Question 35

Is SGA always a sign of pathology?

Answer 35

No, around 70% are meant to be small. Try not to overtreat.

Question 36

Treatment for SGA is initiated if below which centile?

Answer 36

3rd centile.

Question 37

Are SGA babies more likely to be stillborn?

Answer 37

Yes

Question 38

At which gestation should the measurement of the symphysis-fundal height begin?

Answer 38

24 weeks. If below the 10th centile, refer.

Question 39

How is SGA diagnosed?

Answer 39

USS Measurement of the abdominal circumference Estimated foetal weight

Question 40

What is uterine artery notching a risk factor for?

Answer 40

Foetal growth restriction

Question 41

If SGA is detected, how often should measurements be taken?

Answer 41

Every 2 weeks.

Question 42

How should pre-eclampsia/uterine artery notching treated prophylactically?

Answer 42

150mg of aspirin taken nightly from 12 weeks gestation.

Question 43

What are the main tools used to measure foetal growth?

Answer 43

Umbilical artery doppler | Abdominal circumference

Question 44

When should babies found to be between the 3rd and 10th centile be delivered?

Answer 44

39 weeks gestation

Question 45

When should babies below the 3rd centile be delivered?

Answer 45

Between 37 and 37+6 weeks.

Question 46

What should be given to reduce complications and promote foetal lung maturity in premature babies?

Answer 46

Steroids

Question 47

How should labour be monitored in SGA babies?

Answer 47

Continuous CTG