Problems in Pregnancy

Question 1

how does maternal hyperglycaemia affect the fetus

Answer 1

fetal hyperinsulinaemia

Question 2

what does fetal hyperinsulinaemia lead to

Answer 2

Increased fetal growth

Question 3

what are the effects of increased fetal growth

Answer 3

Increased oxygen demands
Neonatal hypoglycaemia
Polyhydramnios

Question 4

what does hypoglycaemia put neonates at risk of

Answer 4

cerebral palsy

Question 5

what does macrosomia put fetus at risk of

Answer 5

shoulder dystocia

Question 6

when is labour induced in mother with pre-existing diabetes

Answer 6

37-38 weeks

Question 7

which ethnicities are more at risk of gestational DM

Answer 7

South asian, middle eastern, African

Question 8

what diabetes meds are safe in pregnancy

Answer 8

Metformin

Insulin

Question 9

when is labour induced in mothers with gestational DM

Answer 9

38 weeks

Question 10

Treatment of venous-thrombo embolism

Answer 10

LMWH

Question 11

Why is pregnancy a pro-thrombotic state

Answer 11

Virchow’s triad:

stasis: secondary to venous compression by pregnant uterus

Hypercoagubility: effects of pregnancy

Vascular damage: varicose veins

Question 12

what causes the hypercoagulability

Answer 12

Increased levels of factor 7,8,9,10,12
Increased fibrinogen
Increased platelets
Decreased levels of factor 11 and antithrombin 3

Question 13

Investigation of DVT in pregnancy

Answer 13

Duplex USS

Question 14

Is D-Dimer assessment safe in pregnancy?

Answer 14

NO

Do duplex ultrasound for suspected DVT

Question 15

Treatment of DVT in pregnancy

Answer 15

Heparin

Question 16

which leg is DVT more common in

Answer 16

Left

Question 17

Rule of treating a DVT in pregnancy

Answer 17

Treat then see- therapeutic heparin before confirmation if diagnosis is suspected

Question 18

prophylaxis for DVT

Answer 18

TED stockings

Question 19

why is heparin good in pregnancy

Answer 19

does not cross the placenta

safe for fetus

Question 20

side effects of heparin

Answer 20

Haemorrhage
Hypersensitivity
Heparin induced thrombocytopenia
Osteopenia

Question 21

Investigation for suspected PE

Answer 21

1st line: CTPA

2nd line: Xray

Question 22

Next step if CTPA for suspected PE is negative

Answer 22

bilateral compression duplex dopplers

Question 23

why should an Xray be performed in a suspected PE

Answer 23

PE may also cause effusion, pulmonary oedema ect

Question 24

Can heparin be continued in labour

Answer 24

no it should be stopped

Question 25

If a woman has a thrombotic event in pregnancy, how long should she remain on LMWH

Answer 25

Remainder of pregnancy 6 Weeks post natal total 3 months at least

Question 26

why is warfarin avoided

Answer 26

teratogenic avoided weeks 6-12 stopped 6 weeks before labour

Question 27

can you breastfeed on warfarin

Answer 27

YES | used after pregnancy

Question 28

management of pregnant lady with hypothyroidism

Answer 28

INCREASE levothroxine by 25-50mcg in first trimester | repeat thyroid function test every trimester

Question 29

management of pregnant lady with hyperthyroidism

Answer 29

PTU in 1st trimester Carbimazole in 2nd/3rd trimester Beta blockers (propanolol)

Question 30

effects of uncontrolled maternal hyperthyroidism on the fetus

Answer 30

IUGR Pre-term labour Thyroid storm (severe hyperthyroidism, resp + cardiac collapse, exaggerated reflexes)

Question 31

treatment of a thyroid storm

Answer 31

lugols iodine steroids beta-blockers (labetolol) fluids

Question 32

effects of uncontrolled hypothyroidism on the fetus

Answer 32

Neurological underdevelopment Prematurity Pre-eclampsia, post partum haemorrhage

Question 33

respiratory changes seen in pregnancy

Answer 33

``` Increased resp rate - causes respiratory alkalosis Increased oxygen demand Tidal volume increases Residual volume decreases expiratory reserve decreases ```

Question 34

what is unchanged in pregnancy with regards to respiration

Answer 34

FEV1 | PEFR

Question 35

Management of asthma in pregnancy

Answer 35

optimise control | use of B2 agonist +/- inhaled corticosteroids

Question 36

What is the worry with epilepsy in pregnancy

Answer 36

major fetal malformations due to drug treatment: neural tube defects, heart defects

Question 37

why is there increased chance of seizures in first trimester

Answer 37

due to hyperemesis and haemodilution

Question 38

what needs to be given to women taking hepatic enzyme inducing anticonvulsants (carbamazepine, phenytoin)

Answer 38

vitamin K 10-20mg from 34-36 weeks

Question 39

when is risk of seizure highest

Answer 39

peripartum period

Question 40

why is there deterioration of epileptic control in pregnancy

Answer 40

Decreased drug levels due to nausea + vomiting, increased volume of distribution and drug clearance lack of drug absorption during labour Hyperventilation during labour

Question 41

which anti-epileptic drugs are most associated with neural tube defects

Answer 41

carbamazepine | valproate

Question 42

which anti-epileptic drug is most associated with orofacial defects

Answer 42

phenytoin

Question 43

which anti-epileptic drugs are most associated with cardiac defects

Answer 43

valproate | phenytoin

Question 44

malformations seen in fetal anticonvulsant syndrome

Answer 44

Dysmorphic features (V shaped eye brows, low-set ears, broad nasal bridge, irregular teeth) Hypertelorism (wide apart set eyes) Hypoplastic nails and distal digits

Question 45

what do epileptic women need to take pre-conceptually

Answer 45

5mg folic acid

Question 46

why should anti-epileptic drugs be continued in labour

Answer 46

increased risk of fits around time of delivery

Question 47

post-partum management of neonate with epileptic mother

Answer 47

1mg IM Vit K

Question 48

asian woman with jaundice + pruritis

Answer 48

obstetric cholestasis

Question 49

ursodeoxycholic acid

Answer 49

tx of itchy jaundice