Flashcards in Week 4 part 2 Deck (90)
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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
