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Year 2: Week 1: Pregnancy Concerns > Problems in Pregnancy > Flashcards

Problems in Pregnancy Flashcards

1
Q

What is pre-eclampsia

A

new HT presenting after 20 weeks gestation with significant proteinuria

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2
Q

Symptoms of pre-eclampsia

Signs

A 
severe headaches 
visual problems (blurry, flashing lights, double vision)
persistent new epigastric pain 
vomiting 
breathlessness
sudden swelling of face, hands, feet
Signs:
liver tenderness
low platelet count 
abnormal ALT or AST 
clonus 
HELLP (haemolysis, elevated liver enzymes, low platelets) 
pailloedema 
reduced foetal movements
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3
Q

Urgent obstetric admission if: (pre-eclampsia)

A

new HT after 20 weeks
+ urine dipstick protein
or pre-eclampsia symptoms
or BP 160/110

(other women with new HT, seek urgent specialist advice)

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4
Q

First line treatment for pre-eclampsia

Second line

A

labetalol 100mg 2x

methyldopa or nifedipine

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5
Q

What is eclampsia

A

pre-eclampsia plus ne or more seizures

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6
Q

Risk Factors for gestational diabetes

A 
previous history of GDM
BMI >30
prev baby weighing 4.5kg+
FH of type 2 or GDM 
south asian/black caribbean/middle eastern 
PCOS
previous stillbirth
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7
Q

what is OGTT

A

oral glucose tolerance test: offered to women with risk factors for GDM between 24-28 weeks (bloods taken at fasting and 2 hours after glucose load)

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8
Q

when should hyperemesis gravidarum have ceased?

A

week 20

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9
Q

common hyperemesis gravidarum presentation

A

persistent vomiting
weight loss
dehydration and electrolyte imbalance
ketouria (<2+ ketones)

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10
Q

Management of hyperemesis gravidarum

A 
avoid food/smells triggers
eat plain crackers in AM 
eat blank, small, frequent, meals low in carb and fat but high protein 
ginger
acupressure
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11
Q

(hyperemesis gravidarum)

seek urgent medical care if:

A

very dark urine, or no urination for 8+ hours

abdo pain

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12
Q

If anti-emetic required in pregnancy, give what

A 
antihistamine (cyclizine or oral promethazine)
or prothiazine (oral prochlorperazine)
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13
Q

oral metclopamide and ondanzetron shouldn’t be prescribed to pregnant women for longer than 5 days - why?

A

Long QT syndrome

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14
Q

How many appointments would someone be offered for first pregnancy vs subsequent?

A

10 vs 7

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15
Q

Who should be given anti-D?

A

all Rhesus D neg women who don’t have immune anti-D during 3rd trimester

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16
Q

2 vaccinations offered to everyone during pregnancy?

A 
seasonal flu 
whooping cough (between 16-32 weeks)
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17
Q

When is first USS pregnant?

A

10-13 weeks

  • checks gestational age
  • detect multiple pregnancies
  • confirm viability
  • detect gross foetal abnormalities
  • provide component of Down’s screening if desired (via nuchal translucency measurement)
18
Q

Next USS offered?

A

at 18-20 weeks

  • to reassure no gross structural abnormalities
  • to determine placental morphology and localisation
  • confirm foetal growth appropriate
19
Q

How is foetal growth monitored?

A

symphysis-fundal height poltting

20
Q

Pre-eclampsia risk factors

A 
40 or older
nulliparity
interval of 10 years pregnant
FH 
Previous Hx 
BMI >30
Pre-existing vascular disease (eg. HT)
pre-existing renal disease
diabetes 
lupus or antiphospholipid syndrome
multiple pregnancy
21
Q

Screen for pre-eclampsia at every appointment how

A

BP

urinalysis

22
Q

What effect can NSAIDs have on foetus in third trimester?

A

premature closure of ductus arteriosus

23
Q

is the cut off for anaemia in pregnancy lower/higher in third trimester?

A

lower (105)

1/2nd: 110

(Normal 120)

24
Q

2 physiological changes to urogenital tract in pregnancy

what resultant effect does this have

A

bladder volume increases
detrusor tone decreases

= increased urinary stasis,. compromised ureteric valves, vesicoureteric reflux
= increased UTI risk

25
Q

Which organism accounts for most UTIs?

A

E. coli

26
Q

What is acute cystities?

A

dysuria, frequency, urgency and suprapubic pain withOUT systemic illness
often in women with asymptomatic bacteriuria

27
Q

Treating acute cystities

A

hydration and antibiotics

28
Q

Pyelonephritis is infection of what

A

renal papilla

29
Q

Symptoms of pyelonephritis

A

like acute cystities but with sepsis (tachycardia, hypotension, tachyapnoea, pyrexic)
loin pain
urinary symptoms

30
Q

Investigations for pyelonephritis

A 
MSU
USS of renal tract 
FBC
Renal function tests
blood culture 
CRP
31
Q

Name 3 causes of bleeding in early pregnancy

A
  • implantation bleeding (physioloigcal)
  • miscarriage
  • ectopic pregnancy
  • cervical causes (Ectropon/polyp, cancer)
    Colar pregnancy
32
Q

Types of miscarriage (pre 22 weeks)

A

threatened - if pregnancy remains viable
missed - if nonviable
incomplete - products of conception partly expelled
complete - products completely expelled
recurrent - 3 or more consecutive

33
Q

Medical / Surgical management of miscarriage

A

MEdical: mifepristone and misoprostal
Surgical: evacuation of uterus by suction evacuation or curettage

34
Q

Hydatiform mole
Signs
Diagnosis

A

growth of an abnormal fertilized egg or an overgrowth of tissue from the placenta

  • bleed early
  • expulsion of grape like tissues
  • pregnancy symptoms

HIGH levels of beta hCG and confirmed by histology

35
Q

Definition of antepartum haemorrhage

A

bleeding from genital tract after 22nd week of pregnancy

36
Q

Name 3 causes of antepartum haemorrhage

A 
placental abruption 
placenta pravaeia 
cervicitis 
trauma 
vasa previa 
vulvo-vaginal varicosities 
genital tumours 
infection
37
Q

Define placenta praevia

A

(partly or completely inserted in lower uterine segment)

grades 1-4

38
Q

Define placenta abruption

A

bleeding after premature separation of normally situated placenta
can be revealed or conceleaed (if obvious bleed/not)

39
Q

Define preterm labour

A

before 37 weeks

40
Q

Risk factors for preterm labour

A

multiple pregnancies
Hx of preterm labour
polyhydramnios
infection

41
Q

3 things may be given to manage preterm labour

A

tocolysis (to slow labour to administer steroids and in-utero transfer)
steroids (for foetal lung amturation)
magnesium sulphate (for neuro protection)

42
Q

What is obstetric cholestasis

A

pruritus (often hands/feet) in absence of skin rash with abnormal liver function tests (both resolve after birth)

Year 2: Week 1: Pregnancy Concerns (5 decks)

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