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Repro > Problems in Pregnancy > Flashcards

Problems in Pregnancy Flashcards

1
Q

What is pre-existing hypertension?

A

Where the woman has had hypertension before her pregnancy.

This is likely if hypertension in early pregnacy

Can also be retrospective diagnosis if BP values have not returned to normal within 3 months of giving birth

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2
Q

What is pregnancy induced hypertension?

A

High blood pressure in pregnancy.

Seen in the 2nd half of pregnancy and usually resilves within 6 weeks of giving birth

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3
Q

What can be present in pre-eclampsia?

A
  • Hypertension
  • Proteinuria (=/+ 0.3g/L)
  • Oedema
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4
Q

What is pre-eclampsia?

A

A pregnancy specific, multi-system disorder with unpredictable, variable and widespread manifestations.

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5
Q

Where is the cut off for early and late pre-eclampsia?

A

34 weeks

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6
Q

What are the 2 stages of pre-eclampsia?

A
  • Stage 1= abnormal placental perfusion
    • placental ischaemia
  • Stage 2= maternal syndrome
    • an anti-angiogenic state associated with endothelial dysfunction
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7
Q

Pre-eclampsia is a multi-system disorder. What systems can be involved?

A
  • CNS
  • Renal
  • Hepatic
  • Haematological
  • Pulmonary
  • Cardiovascular
  • Placental
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8
Q

What is HELLP syndrome?

A

A rare life-threatening condition seen in pregnancy that is associated with pre-eclampsia. Causes RBCs to break down as well as liver problems

Haemolysis, Elevated Liver Enzymes, Low Platelets

High morbidity/mortality

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9
Q

What is eclampsia?

A

A tonic-clonic seizure occuring with the features of pre-eclampsia

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10
Q

What is the management of severe PET/Eclampsia?

A

Control BP

Stop/prevent seizures

Fluid balance

Delivery

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11
Q

What is given in seizure treatment/prophylaxis?

A

Magnesium Sulphate

  • Loading= 4g IV over 5 minutes
  • Maintenence= IV infusion 1g per hour
  • Further seizures= 2g

If persistant seizures consider diazepam 10mg IV

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12
Q

What are some anti-hypertensives that can be used in the treatment of pre-eclampsia?

A

IV labetolol

IV hydralazine

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13
Q

What is the commonest chronic medical disorder to complicate pregnancies?

A

Asthma

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14
Q

What test is carried out if DVT is suspected in pregnancy?

A

Compression duplex ultrasound

  • If normal but clinical suspicion is high then repeat in 1 week to exclude extending calf vein thrombosis
  • If iliac vein thrombosis suspected (whole leg swollen + back pain) the consider MRI venography
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15
Q

What alternative should be used in pregnancy instead of warfarin?

A

LMWH- convert by 6 weeks

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16
Q

Why shouldn’t warfarin be used in pregnancy?

A

Crosses placenta and is teratogenic

  • Midface hypoplasia
  • Stippled chondral calcification
  • Short proximal limbs
  • Short phalanges
  • Scoliosis
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17
Q

What can be given for post-natal anticoagulation?

A

Heparin or Warfarin- neither are contraindicated in breastfeeding

Commence warfarin 5th postnatal day

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18
Q

What is APS?

A

Anti-phospholipid syndrome

An aqquired thrombophillia with variable presentation and severity

Can result in pregnancy complication

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19
Q

What antibodies are seen in APS?

A

Antiphospholipid antibodies (aPL)- autoantibodies that react with phospholipid component of the cell membrane

Anticardiolipin antibodies (aCL)

Lupus anticoagulant (LA)

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20
Q

True or False?

Anti-epileptic medication is contraindicated in pregnancy?

A

False

AEDs containing Valproate are associated with a higher risk but others are safe

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21
Q

What is a normal sympheseal-fundal height?

A

After around 24 weeks, the fundal hight for a normally growing baby should match the the number of weeks pregnancy +/- 2cm

e.g. for a 27 week pregnant, expect the fundal hight to be around 27cm

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22
Q

What are some possible reasons why a SFH might be large for dates?

A
  • Wrong dates
  • Fetal macrosomia
  • Polyhydraminios
  • Diabetes
  • Multiple pregnancy
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23
Q

What is fetal macrosomia?

A

‘big baby’

Signs are large fundal hight and polyhydramonios

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24
Q

What is polyhydramnios?

A

Excess amniotic fluid

Amniotic fluid index > 25cm

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25
Q

What condition can cause polyhydraminios?

A

Diabetes

26
Q

What are some foetal causes of polyhydramnios?

A
  • Anomoly- GI atresia, cardiac, tumours
  • Monochorionic twin pregnancy
  • Hydrops fetalis- Rh isoimmunisation
  • Viral infection (toxoplasmosis, CMV)
27
Q

What investigations are carried out in a woman with polyhydramnios?

A
  • OGTT
  • Serology- toxoplasmosis, CMV, parovirus
  • Antibody screen
  • USS- fetal survey- lips, stomach
28
Q

Define gestational diabetes

A

Carbohydrate intolerence resulting in hyperglycaemia of variable severity with onset or first recognition during pregnanct

29
Q

What is SGA?

A

Small for Gestational Age

30
Q

IUGR?

A

Intra Uterine Growth Restriction

31
Q

FGR?

A

Fetal Growth Restriction

32
Q

Define preterm delivery?

A

Before 37 weeks gestation

Extreme preterm is between 24 - 27+6 weeks

Very preterm is 28 - 31+6 weeks

Moderate to late preterm is 32 - 36+6 weeks

33
Q

What is LBW?

A

Low birth weight

below 2.5kg regardless of gestation

34
Q

What categories can IUGR be divided into?

A

Symmetrical and Asymmetrical

35
Q

What are the maternal factors for SGA?

A
  • Lifestyle- smoking, alcohol, drugs
  • Height and weight
  • Age
  • Maternal disease e.g. hypertension
36
Q

What are some fetal factors that can cause SGA?

A
  • Infection- rubella, CMV, toxoplasma
  • Congenital anomalies e.g. absent kidneys
  • Chromosomal abnormalities e.g. Down’s Syndrome
37
Q

What does symmetrical IUGR suggest?

A

Both head and body are small

Congenital, chromosomal, intrauterine infection, environmental

38
Q

What does asymmetrical IUGR suggest?

A

Small body compared to normal sized head

PET, placental causes and smoking. Sign of redistribution

39
Q

What counts as bleeding in early pregnancy?

A

Less than 24 weeks

40
Q

What counts as bleeding in late pregnancy?

A

In the UK it is bleeding from 24 weeks onwards

US is 20 weeks + and WHO is 22 weeks +

41
Q

What is antepartum haemorrhage?

A

Bleeding in or from the genital tract that occurs from 24 weeks pregnancy up until birth of baby.

42
Q

What are some causes of antepartum haemorrhage?

A
  • Placental- placenta praevia, placental abruption
  • Uterine problem- uterine rupture
  • Local causes- ectropion, polyp, infection, carcinoma
  • Vasa Praevia
  • Indeterminate
43
Q

How is APH quantified?

A
  • Spotting
  • Minor
  • Major- 500-1000ml
  • Massive- 1000ml and/or shock
44
Q

What is a woody hard uterus a sign of?

A

Placental abruption

45
Q

What is placental abruption?

A

When the placenta separated from the uterus before birth in a previously normally implanted uterus.

46
Q

What are some symptoms of placental abruption?

A

Vaginal bleeding, lower abdominal pain, low BP

47
Q

What is a couvelaire uterus?

A

Occurs when loosening of the placenta (placental abruption) causes bleeding into the myometrium

48
Q

True or False?

The pain felt with placental abruption comes in waves similar to a contraction

A

False

Women will complain of continous abdominal pain

49
Q

What is placenta praevia?

A

When the placenta lies over the internal os of the cervix

50
Q

What counts as a low lying placenta?

A

Term used after 16/40 weeks when the placental edge is less than 20mm from the internal os on TV or TA ultrasound

51
Q

What is placenta Accreta?

A

A condition that occurs when the placenta grows too deeply into the uterine wall.

52
Q

What is placenta increta?

A

Where the placenta invades into the myometrium

53
Q

What is placenta percreta?

A

When the placenta invades through the uterus to the bladder

54
Q

What is vas praevia?

A

Unprotected fetal vessels that traverse part of the membranes, below the presenting part of the fetus and very close to the internal os

Vessels will rupture during labour or amniotomy

55
Q

What are the types of vas previa?

A

Type 1- When vessel is connected to a velamentous umbilical cord

Type 2- When the vessel connects to the placenta with an accessory lobe

56
Q

What is the treatment of APH in vas previa?

A

Emergency C-section

57
Q

What is post-partum haemorrhage?

A

Blood loss of over 500ml following the birth of a baby

58
Q

What is the difference between primary and secondary PPH?

A

Primary occurs within 24 hours of delivery

Secondary occurs between 24 hours and 6/52 post delivery

59
Q

What is minor PPH?

A

Between 500 and 1000ml without shock

60
Q

What is major PPH?

A

Over 1000ml and/or signs of shock and on-going bleeding

61
Q

What are the 4 Ts of PPH?

A
  • Tone (70%)
  • Trauma (20%)
  • Tissue (10%)
  • Thrombin (<1%)

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