Week 4 part 2 Flashcards Preview

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Flashcards in Week 4 part 2 Deck (90):
1

What are the effects of diabetes on pregnancy?

1. Miscarriage
2. Fetal malformations cardiac, neural tube, caudal regression syndrome
3. IUGR/macrosomia
4. Unexplained IUD
5. PET

2

mEDICATIONS for diabetse in pregnancy>

Diet, metformin, insulin

3

When should labour be induced with diabetes?

At 37-38 weeks

4

Diabetes causes fetal macrosomia - what risk does this have?

Shoulder dystocia

5

Diabetes causes polyuria, polyhydramnios - what risk does this have?

Preterm labout/malpesntation/cord prolase

6

Diabetes causes increased O2 demands and polycythaemia - what risk does this have?

Risk of unexplained term still birth

7

Diabetes causes neonatal hypoglycaemia - what risk does this have?

Risk of cerebral palsy

8

Is PCOS a risk factor for gestational diabetes mellitus?

Yes

9

In pregnancy with pre-existing DM when should labour be induced?

At 37-38 weeks

10

Major cause of obsetric litigation?

Macrosomia

11

What is LSCS recommended in DM where macrosomia and EFW greatr than 4000g?

Macrosomia

12

What fetal effect of DM causes fetal malpresentations and possible increased risk preterm labouir?

Polyhydramnios

13

What does hyperinsulinaema in fetus cause risk of?

CP

14

wHAT IS THE leading cause of maternal death?

VTE - venous thromboembolism

15

wHAT ARE medications for VTE in pregnancy?

LMWH

16

Is pregnancy pro-thrombotic?

Yes

17

Virchows triad in preganncy

Stasis - secondar to venous compression by pregnant uterus
Hypercoagulability - effects of pregnancy
Vascular damage - varicose veins

18

Evolutionary - why is pregnancy a pro-coaguable state?

To decrease risk of post partum haemorrhage

19

Pregnancy is a pro coaguable state - what factors are increased?

7,8,9,10,12 and fibrinogen, increased platelets

20

Pregnancy is a pro coguable state - what factors are decreased?

Factor 11 and antithrombin 3

21

Three risk factors for VTE (preexisting)?

Obesoty
greater than 35 years of age
Smoker

also parity >3, elective CS, FH, varicose veins, systemic infection, immoblity, PET, twins

22

In pregnancy, if four or more risk factors for VTE?

Prophylaxis in first trimester

23

3 risk factors for VTE in pregnancy?

Prophylaxis from 28 weeks

24

Postnatally, if any previous VTE, anyone requiring antenatal LMWH, high risk thrombophilia, low risk thrombophilia + FH - what is managed?

High riSK - at least 6 weeks [pstnatal prophylactic LMWH

25

With DVT - what investigation is NOT done in pregnancy?

D-dimer - do ultrasound instead and give therapeutic heparin - treat then see!

26

What is the therapeutic dose of LMWH in pregnancy?

1mg twice daily OR once daily - continue until 3 months after delibery ot 6 months after treatment

27

Why is heparin safe in pregnancy?

Doesnt cross placenta - no anticoagulation effect on fetus

28

Side effects of heparin in pregnancy?

Haemorrhage
Hypersensitiity
HIT - heparin induced thrombocytopenia
Osteopenia

29

In PE in pregnancy what do u give before investigating?

Heparin

30

What mght PE cause on CXR in pregnancy?1.

1. Atelectasis - collapse of lung
2. Effusion
3. Focal opacities
4. Regional oligaemia
5. Pulmonary oedema

31

In poregnancy, if PE CXR is abnormal and high clinical suspicion what is done?

CTPA

32

In pregnancy, if CXR for PE is negative what is done?

Bilateal compression duplex dopplers

33

What is a risk factor in pregnancy when fetting CTPA done for potential PE?

History of breast cancer

34

With VTE for pregnancy - when is heaprin stopped?

Whwen in labour

35

If using warfarin in pregnancy for VTE when is it stopped?

6 weeks before labour start D2/3 - avoid in pregnancy 6-12 weeks teratogenic, miscarriage, neurological problems, still borth

36

Is warfarin ok with breast feeding?

YES

37

How is the dose of levothyroxine changed in pregnnacy for hypothyroid women?

Increased by 25-50mcg in first trimester
TFT every trimester

38

What are the effect of hyperthyroid on pregnancy?

1. IUGR
2, Preterm labour
3. Thyroid storm

39

What medications are used for hyperthyroid in pregnancy?

Carbimazole and propothyouracil
Beta-blockers (propanalol) - IUGR

40

What is the commonest chronic medical illness to complicate pregnancy?

Asthma

41

What does the increased resp rate in pregnancy cause?

Resp alkalosis

42

Resp changes in pregnancy

Inceased O2 emand
Tital volume increase
Inspiratory capacity increases
Residual volume decreases
Expiratory reserve decreases
Reduction in functional residual capacity (diaphragmatic elevation, increase in subcostal angle)

43

What respiratory related things are unchanged in pregnancy?

FEV1 and PEFR

44

What are the major malformations with epilepsy in pregnancy?

1. NTD
2. orofacial
3. Heart defects

45

Why is there an increaesd chance of seizure in first trimester
?

Hyperemesis and haemodilution

46

When might yo take vitamin K in epilepsy in pregnanyc/

If taking hepatic enxyme inducing anticonvulsants

47

In epilepsy in pregnanhcy - when are seizures highest risk?

In peripartum period

48

Effects of epilepsy on pregnancy: status epilepticus?

Less than 1% pregnancies but dangerous for mother and baby - treat vigourously

49

What epileptic drug has major malformation of fetus like orofacial clefts?

Phenytoin

50

What two epileptic drugs cause cardiac defects in fetus?

Phenytoin and valproate

51

In fetus: v-shaped eyebrows, lowset ears, broad nasal bridge, irregular teeth, hypertelorism, hypoplastic nails + distal digits

fetal anticonvulsant syndrome

52

if taking phenytoin, valproate nd carbamazepine - what is risk to fetus?

50%

53

are benzodiazepines teratogenic?

no

54

with anticonvulsants what is the mechanism of teratogenesis thought to be?

folate deficiency

55

Preconceptually - what is management of epilespy in pregnancy?

TRake folic acid 5mg a day for at least 12 weeks prior to conception

56

What scans are done for management of epilepsy in pregnancy?

Detailed fetal scan at 18-20 weeks with detailed fetal cardiac scan at 22 weeks

57

If on enzyme inducers in pregnancy what drug should be given orally from 34-36 weeks?

Vit K 10-20mg

58

In epilepdy in pregnancy what should neonate have 1mg of postpartum?

IM vit K

59

What percentage of women conceive?

80%

60

Who is the patient referred to if in pregnanyc: psychosis, severe anxiety, depression, suicidal, self-neglect, symptoms interfering with AOLs, history of bipolar or schizophrenia, history of puerperl psychosis, psycotropic meds?

Psychiatry team for psychotherapy

61

Pervasive or episodic fearfulness, avoidance and autonomic arousal
Often concurrent depression
Phobias, obsessive compulsive, post traumatic stress

Anxiety disorders

62

What do anxiety disorders predict?

Post natal depression

63

What drug should be avoided when treatint anxiety disorders in pregnancy and why?

Benzos - cleft and neonatal withdrawal

64

What do 50% of bipolar women go on to develop postnatally if it isnt getting treatd?

Episode of bipolar and risk of suicide
Baby can be affected by bipolar 1 in 7

65

Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of valproate?

1. NTD
2. craniofacial defects
3. CV abnormality
4. IUGR
5. Reduced IQ
6. Cleft

66

Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of carbamazapine?

Facial dysmorphism
Cardiac abnormalities
Fingernail hypoplasia
NTD

67

Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of lamotrigine?

Cleft
Steveen Johnson syndrome to baby if breastfed

68

What mood stabiliser for bipolar in pregannncy can cause vit k deficiency and haemorrhagic disease of newborn?

Carbamazepine

69

What anomalies can lithium cause to newborn?

Cardiac abnormalities, risk maternal toxicity, Ebsteins anomaly
Nenoatal hypotonia, hypothyroidism, hypoglycaemia

70

Is lithium used for BPAD in pregnanyc allowed for breastfeeding?

NO it is contraindicated

71

What is risk of schizophrenai to child?

10%

72

For treating schizoprenia in pregnancy what can atypicals such as clozapine, olanzapine, risperidone and quetiapine cause?

Gestational diabetes
IUGR

73

For treating schizoprenia in pregnancy: are tpyical antipsychotics safe?

Yes

74

For treating schizoprenia in pregnancy: which atypical is contraindicated in breast feeding?

Clozapine

75

What condition in pregnancy causes this: IUGR, prematurity, hypokalaemia, hyponatraemia, metabolic alkalosis, miscarriage, premature delivery

Eating disorders - bulimia nervosa, anoerxia

76

Who is mikld-moderate depression in pregnancy treated by?

GP

77

Who is severe depression in pregnancy treated by?

Psychiatry

78

What two drugs are not used to treat depression in pregnancy and why?

Venlafaxine - hypertension
Paroxetitine - cardiac abnormalities

79

What two antidepressants have high levels in breast mild?

Citalopram and fluoxetine SSRIs

80

Which antidepressant SSRI is ok for breastfeeding?

Sertraline

81

Are antidepressants amitriptyline and nortryptiline safe in pregancy and okay for breast feeding?

Yes

82

What condition do 10% of women get after pregnancy and the onset is 2-6 weeks?

Postnatal depression

83

What condition do 50% of women get after pregnancy?

Baby blues

84

Brief period of emotional instability, tearful, irritable, anxiety and poor sleep?

Baby blues - 3-10 days self-loimiting

85

Usually presents within 2 weeks of delivery
Early symptoms are sleep disturbance and confusion, irrational ideas
Mania, delusions, hallucinations, confusion

Puerperal psychosis

86

Name some risk factors for puerperal psychosis? (0/1% of women)

1. Bipolar 50%
2. 1st degree relative with history

87

Management of puerperal psychosis?

An emergnency - admit toi specialist mother-baby unit, antidepressantsm antipsychotics, mood stabilisers and ECT

88

facial deformities, lower IQ, neurodevelopmental delay, epilepsy, hearing, heart and kidney defects

Faetal alcohol sybdrome

89

Are cocaine, amphetamine and ecstasy teratogenic?

Yes

90

Should you be breastfeeding if alcohol greaster than 8, HIV or cocaine?

No