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Problems in Pregnancy Flashcards

(103 cards)

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1
Q

what is defined as pre-term birth

A

Delivery between 24 and 36+6 weeks

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2
Q

what can cause a pre-term birth

A

infection

over distention [Multiple, polyhydraminos]

vascular [placental abruption]

intercurrent illness [UTI/pyelonephritis, appendicitis, pneumonia]

cervical incompetence

idiopathic

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3
Q

risk factors for pre-term birth

A 
previous pre term labour
multiple
uterine anomalies
age
parity (=0 or >5)
poor socio-economic status
smoking/drugs [esp cocaine]
low BMI [<20]
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4
Q

what is definition of small for gestational age (SGA)

A

Infant with a birthweight that is less than 10th centile for gestation corrected for maternal height, weight, fetal sex and birth order

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5
Q

what is another cause of the baby being less than 10th centile

A

IUGR

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6
Q

what is IUGR

A

Intra Uterine Growth Restriction

i.e. poor growth

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7
Q

what are the 3 factors that contribute to IUGR

A

maternal
fetal
placental

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8
Q

what are the maternal factors that can cause IUGR

A

Lifestyle: Smoking, Alcohol, Drugs

Height and weight

Age

Maternal disease e.g. HTN

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9
Q

what are the fetal factors that can cause IUGR

A

Infection e.g. rubella, CMV, toxoplasma

Congenital anomalies e.g. absent kidneys

Chromosomal abnormalities e.g. Down’s syndrome

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10
Q

what are the placental factors that can cause IUGR

A

infarcts
abruption

often secondary to hypertension

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11
Q

what is the two sub categories of IUGR

A

symmetrical

asymmetrical

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12
Q

what is symmetrical IUGR

A

small head

small abdomen

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13
Q

what is asymmetrical IUGR

A

normal head

small abdomen

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14
Q

consequences of IUGR in labour/antenatal

A

risk of hypoxia

risk of death

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15
Q

consequences of IUGR in post natal

A 
Hypoglycaemia
Effects of asphyxia
Hypothermia
Polycythaemia
Hyperbilirubinaemia
Abnormal neurodevelopment
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16
Q

what are the clinical features seen that are suggestive of IUGR

A

Predisposing factors
Fundal height less than expected
Reduced liquor/amniotic fluid
Reduced fetal movements

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17
Q

what can be used to assess the fetal heartbeat

A

Cardiotocography

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18
Q

what can be seen on a cardiotocoaphy that indicates good reflex reactivity of the fetal circulation

A

Accelerations

- an increase in fetal HR at the start of a uterine contraction returning to baseline rate before next contraction

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19
Q

what can cause loss of baseline variability seen on Cardiotocography and why is this worrying

A

loss of baseline variability may be caused by sedative or analgesic drugs

in general, the less baseline variability present the greater the possibility of asphyxia

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20
Q

what other reading on the Cardiotocography suggests fetal asphyxia

A

any deceleration whose lowest point is past the peak of contraction [i.e. decelerations with lag time]

associated with asphyxia = longer the lag time, more serious the fetal asphyxia

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21
Q

what is the causes of large for dates pregnancy

A

wrong dates
multiple pregnancy
diabetes
polyhydramnios

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22
Q

what is the definition of polyhydramnios

A

excess amniotic fluid

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23
Q

what are cause of polyhydramnios

A 
Monochorionic twin pregnancy
Fetal anomaly
Maternal diabetes
Hydrops fetalis 
Ideopathic
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24
Q

what is Hydrops fetalis

A

abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema

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25
what are Sx of polyhydramnios
discomfort labour membrane rupture cord prolapse
26
Ix of polyhydramnios
ultrasound
27
in relation to multiple pregancies, what does zygosity mean
refers to number of eggs fertilised to produce twins
28
in relation to multiple pregancies, what does chorionicity refer to
membrane pattern of the twins
29
what type of twins are at a higher risk of pregnancy complications
monochorionic/monozygous
30
what is meant by monovular zygosity
one ovum + one sperm fertilised 1 zygote splits into 2 think identical twins
31
what is meant by binovular zygosity
two ova + two sperm fertilised 2 zygotes think non-identical twins
32
what type of chorionicty will dizygotic twins always have
Dichorionic Diamniotic i.e. no contact been amniotic fluid/sacs or membrane
33
what are the types of chorionicty monozygotic twins can have
Monochorionic Diamniotic Monochorionic Monoamniotic
34
what is Monochorionic Diamniotic
One membrane but two separate amniotic sacs
35
what is Monochorionic Monoamniotic
one membrane with one amniotic sac between the 2 fetus
36
how can we tell the chrionicity before birth
ultrasound - shape and thickness of membrane - twin peak at 12 weeks
37
how are multiple pregnancies diagnosed
usually ultrasound @ 12 weeks Also - exaggerated pregnancy Sx e.g. excessive sickness - high AFP - large for dates uterus - feeling more than 2 fetal poles
38
what can cause perinatal mortality in multiple pregnancies
``` Congenital anomalies Pre term labour Growth restriction Pre eclampsia Antepartum haemorrhage Twin to twin transfusion ```
39
Mx of multiple pregnancies
More frequent antenatal visits Detailed anomaly scan @ 18 weeks Regular scans from 28 weeks for growth Routine iron supplementation Warning to mother risk and signs of pre term labour
40
Delivery of multiple pregnancies
Triplets or more – Caesarean section Twins if twin one cephalic aim for vaginal delivery
41
what is the definition of gestational diabetes
carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy
42
what are the consequences of gestational diabetes
Overgrowth of insulin sensitive tissues and macrosomia Hypoxaemic state in utero Short term metabolic complications Fetus has an increased long term risk of obesity, insulin resistance and diabetes
43
what is seen in a fetus when the mother has GDM
hyperinsulinaemia | - decreased arterial O2 and increased EPO
44
when is GDM screened for
at 28 week gestation
45
what are the diagnostic values of GDM
Fasting >=5.1 mmol/l | 2 hour >=8.5 mmol/l
46
what are risk factors of GDM
``` Family history of diabetes Previous big baby Previous unexplained still birth Recurrent glycosuria Maternal obesity Previous gestational diabetes ```
47
what complications of diabetes in pregnancy is specific to pre-existing DM
Congenital anomalies Miscarriage Intra uterine death
48
what are the other complications of diabetes in pregnancy
``` Pre eclampsia Polyhydramnios Macrosomia Shoulder dystocia Neonatal hypoglycaemia ```
49
Mx of GDM
1st line = diet, weight control, exercise 2nd line = Metformin/Insulin
50
at what week are women with large for dates babies offered to be delivered on
38 weeks gestation
51
what should women with pre existing diabetes be offered during pregnancy
Fetal anomaly scan at 18 weeks Regular eye checks for retinopathy
52
what affects does hypertension have on the kidneys
``` decreased GFR proteinuria increased serum uric acid increased creatinine/potassium/urea oliguria/anuria acute renal failure ```
53
what affects does hypertension have on the liver
RUQ pain abnormal liver enzyme hepatic capsule rupture HELLP syndrome
54
what is HELLP syndrome
HELLP syndrome is a subtype of severe pre-eclampsia characterised by haemolysis (H), elevated liver enzymes (EL), and low platelets (LP)
55
how can HTN affect the placenta
IUGR placental abruption intrauterine death
56
what cardio medication should be stopped in pregnancy
ACEi | ARBs
57
what medication is used to Tx HTN in pregnancy
1st line = Labetalol 2nd line = Methyldopa 3rd line = Nifedipine [usually add if mono therapy fails]
58
when should Tx be started in HTN in pregnancy
when BP is ≥150 mmHg systolic and/or ≥100 mmHg diastolic
59
what is the target BP control
Aim for BP <150/80-100 mmHg If target organ damage aim for BP <140/90 mmHg < 140/90 consider reducing dose < 130/90 Reduce dose
60
if there is pre-eclampsia, when should the baby be aimed to be delivered
at 37 weeks
61
gestational diabetes but the neonate are risk of hypoglycaemia - what does this put that at risk of
cerebral palsy
62
when is a labour induced in pre-existing DM
37-38 weeks
63
when is a labour induced in GDM on insulin
may be at 41 weeks if normal BMs and fetal growth
64
what does macrosomia put the foetus at risk of
shoulder dystocia
65
Tx of VTE
LMWH
66
why is pregnancy thought to be pro-thrombotic
think Virchow's triad Stasis - Secondary to venous compression by pregnant uterus Hypercoagulability Vascular damage - Varicose veins
67
what causes hyper coagulability state in pregnancy
↑ levels factor 7,8,9,10,12 and Fibrinogen ↑ numbers of platelets ↓ levels factor 11 and antithrombin 3
68
in a suspected DVT, what investigation is not done in pregnancy
D-Dimer
69
Ix of DVT in pregnancy
Duplex ultrasound
70
Tx of DVT in pregnancy
Heparin
71
what is the rule about Tx of a suspected DVT in pregnancy
Treat then see
72
what can be prophylaxis for DVT
TED stockings
73
why is heparin good in pregnancy
doesn't cross the placenta so safe for the foetus
74
side effects of heparin
haemorrhage Heparin induced thrombocytopenia osteopenia
75
how does Heparin induced thrombocytopenia present
early in 5 days usually mild
76
Ix for suspected PE
1st line = CTPA 2nd line = X-ray If CTPA -ve = bilateral compression Duplex Dopplers
77
why should an x-ray also be done in a suspected PE
as PE may also cause effusion, pulmonary oedema etc
78
should heparin be continued when in labour?
no should be stopped
79
if a women had a thrombotic episode during her pregnancy, how long should she remain on LMWH
Remainder of Pregnancy, 6 weeks postnatal, total 3 months at least.
80
why is warfarin not used at certain points in pregnancy
Avoided in pregnancy 6-12 weeks Teratogenic 5 %, miscarriage, neurological problems, still birth Stopped 6 weeks before labour
81
why is warfarin used after pregnancy
is OK with breast feeding
82
if a women has hypothyroid and becomes pregnant, what is the management
increase Levothroxine by 25-50mcg in first trimester Repeat TFTs every trimester
83
if a women has hyperthyroid and becomes pregnant, what is the management
``` Carbimazole / PTU Beta Blockers (propranolol) ``` TFT every trimester Growth scans
84
what are the effects on the pregnancy of hyperthyroid in the mother
IUGR, preterm labour Thyroid storm
85
how does the pregnancy effect the mother's hyperthyroid
Gets worse due to HCG in first trimester | Improves second and third trimesters
86
what are resp changes seen in pregnancy
Increased resp rate- Causes resp alkalosis increased oxygen demand tidal volume increases residual volume decreases expiratory reserve decreases
87
what is unchanged in pregnancy in regards to respiration
FEV1 | PEFR [peak flow]
88
Mx of asthmatics in pregnancy
optimise control | use of B2 agonist +/- inhaled corticosteroids
89
what is the concern of epilepsy in pregnancy on the effect it will have on the foetus
major malformations due to the drug treatment | - neural tube defects, orofacial and heart defect
90
why is there an increased chance of seizures in the 1st trimester
due to hyperemesis and haemodilution
91
what needs to be given to mothers taking hepatic enzyme inducing anticonvulsants
Vitamin K at 36 weeks
92
what is the effect of the pregnancy on the woman's epilepsy
in 25% increase in seizure frequency If seizure free unlikely to have seizures UNLESS stops medications
93
when is risk of seizure highest
in peripartum period
94
why is there deterioration of control of epilepsy in pregnancy
Decreased drug levels due to nausea and vomiting Decreased drug levels due to ↑volume of distribution and ↑drug clearance Lack of sleep towards term and during labour Lack of absorption of drugs during labour Hyperventilation during labour
95
what anticonvulsant is most associated with neural tube defects
valproate and carbamazepine
96
what anticonvulsant is most associated with orofacial clefts
phenytion
97
what anticonvulsant is most associated with cardiac clefts
phenytion and valproate
98
what minor malformations are seen in fetal anticonvulsant syndrome
``` Dysmorphic features (V-shaped eyebrows, lowset ears, broad nasal bridge, irregular teeth) ``` Hypertelorism [wide apart set eyes] Hypoplastic nails and distal digits
99
how does the teratogenic risk of anticonvulsants change
increases with number of drugs phenytion + valproate + carbamazepine = 50% risk to fetus
100
what do epileptic women need to take pre conceptually
5mg folic acid
101
what do epileptic women need to take during the pregnancy
continue folic acid Vit K 10-20mg orally from 34-36 weeks if on enzyme inducers due to reduce risks of fetal Vit K deficiency and Haemorrhagic Disease Newborn
102
should anti epileptic drugs be continued in labour
yes | as increase in fits around time of delivery
103
what is postpartum management in epileptic cases
Neonate should have 1mg IM Vit K

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