Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
31 Cards in this Set
- Front
- Back
|
How is pre-eclampsia diagnosed?
|
BP >140/90
24-hour urinary protein of >0.3g |
|
|
List 3 symptoms and 3 signs of pre-eclamspia which would, in conjuction, be an indiation for hospital admission.
|
Symptoms:
- headaches - blurred vision - epigastric pain signs: - proteinuria of 1+ or >0.3g/24hs - diastolic blood pressure >100 mmHg - suspected foetal compromise |
|
|
What are the risk factos for pre-eclamsia? List at least 5 factors
|
1. nulliparous
2. previous family history 3. extremes of age (<20 or >35) 4. obesity 5. diabetes 6. hypertension |
|
|
Describe tge patophysiology of pre-eclampsia.
|
It is caused by the inability of trophoblastic cells to invade the spiral arteries effectively. Consequently, the arteries fail to dilate sufficiently, leading to under perfusion of the placenta.
This is temporarily compensated by elevating the maternal blood pressure and increasing blood flow to the placenta. This leads to the damage of the hepatic (HELLP syndrome) |
|
|
What is HELPP syndrome?
|
Haemolysis
Elevated Liver enzymes Low platelets Proteinuria (liver) coagulation systems (thrombocytopenia, DIC) |
|
|
How severe pre-eclampsia is defined?
|
proteinuria
diastolic BP >100mmHg maternal complications |
|
|
True or False?
10% of patients with pre-eclampsia develop full eclampsia (grand mal seizures). |
F, eclampsia is a complication of severe pre-eclampsia that occurs in about 1% of cases.
|
|
|
What is gestational diabetes?
|
temporary form of diabetes that affects pregnat women who have never suufer from diabetes before. It describes a transient elevation of glucose that dissapears after pregancy. Afects 2% of all pregant women.
|
|
|
What are the risk factors for gestational diabetes?
|
- family history of type 2 diabetes
- previous history of gestational diabetes - increasing maternal age - obesity - ethnicity - smoking |
|
|
What are the main possible complications in gestational diabetes?
|
- increased risk of congenital abnormalities
- pre-term labour - polyhydramnios - increased foetal mortality and morbidity |
|
|
List 8 symptoms of UTI in pregancy?
|
1. dysuria
2. frequency 3. urgency 4. nocturia 5. haematuria 6. suprapubic discomfort 7. tenderness 8. cloudy or foul-smelling urine |
|
|
What are the main possible complications of unterated UTI in pregancy?
|
- pylonephritis (feve, rigors,nausea,vomiting,loin pain) - 20%
- premature baby |
|
|
Miscarriage - True or false:
Up to 20% of all pregancies miscarry with 80% ocurring in the first trimester. |
True
|
|
|
What are the legal requirements for abortion?
|
<24 weeks
2 doctors must consent and state that to continue with the pregancy would: - endanger the life of the mother - endanger the physical or mental health of the mother - be a risk to the physical or mental health of the siblings - risk that the foetus would be born handicapped. |
|
|
30 year old epileptic patient comes to a pre-conception clinic, asks you should she continue her sodium valproate? What do you do?
|
Advice her to change to carbamazepine
|
|
|
List, in order of safety, the following anti-epileptic drugs in pregancy. List the main effects each can have on the fetus.
Phenytoin, Phenobarbitone, carbamazepine, sodium valproate. |
1. Carbamazepine: safest, 1% risk of neural tube defects, mainly cardiac/hypospadias defects.
2. Sodium valproate: 1.5% of NTD, similar risks for cardiac. Lower IQ/cranio-facial defects 3. Phenytoin - 1.8% of NTD - cleft palate/congenital malformations 4. Phenobarbitone: 2.5-6% risk of malformations |
|
|
32 YO has a proven DVT at 36/40 pregant. What would you prescribe for her? If this women was postnatal, would the treatment be any different? Why?
|
Low molecular heparins e.g. Clexane
- used for DVT/PE. Not known to cross placenta. - Safe in breastfeeding - once a day treatment ------------------------------------------- Unfractionated heparin: safe in pregancy and breastfeeding as long as you measure the levels. It is an IV infusion and quick to reverse. - Warfarin: Crosses the placenta, causes fetal bleeding and facial malformations. Safe in breastfeeding. |
|
|
A 35/40 pregant woman is diagnosed with symphysis-pubis dysfunction. She requires analgesia, which one of the following would you prescribe and way?
- paracetamol Diclofenac/ibuprofen/NSAIDs Tramadol Codeine |
prescribe paracetamol - safe to use in pregancy/and when breasfeeding
-------------------------------------- Tramadol: embriotoxic and fetotoxic. Transmitted across placenta and in breast milk NSAIDS: Unsafe in pregancy due to risk of premature closure of ductus arteriosis in fetus. Safe in breastfeeding women. Codeine: can cause respiratory malformations, and therefore does cross placenta. Passes into breast milk but considered to be safe. |
|
|
What teratogenic drug used for antiemetic, now used in lymphoma, causes limb abnormalities (phocomelia) and polyneuropathy?
|
thalidomide
|
|
|
What teratogenic drug is associated with Ebsteins anomaly?
|
Lithium
|
|
|
What teratogenic drug is associated with skeletal deformities and fetal teeth discoloration?
|
Tetracycline
|
|
|
What 3 teratogenic substances are associated with sensorineural deafness, blindness, hydrocephalus, malformed ears and absent thymus?
|
Gentamycin
Alcohol Recreational drugs |
|
|
List 6 causes of vaginal bleeding in pregancy (3 <24 weeks and 3>24 weeks)
|
Early (<24 wks)
- miscarriage - ectopic pregancy - hydatidiform mole Late (>24 wks) - placenta abruption - placenta praevia - uterine rupture |
|
|
List causes of abdominal pain in pregnacy that are related to the pregancy - 2 causes in the first trimester, 1 in the second and 5 in the third.
|
1st
- Ectopic pregancy - miscarriage 2nd - miscarriage 3rd - labour - false labour - Pre-term labour - Placental abruption - Uterine rupture |
|
|
List 5 other causes of abdominal pain in pregancy which are not directly due to the fetus.
|
1. Appendicitis
2. Cholecystitis 3. GORD 4. Urinary tract infection (UTI) 5. Gastroenteritis |
|
|
What are the 4 main indications for induction?
|
1- post dates
2- Pre-labour rupture of membranes 3- Pre-eclampsia 4- Plus diabetes |
|
|
What is Terbutaline? What does it do? What is used for?
|
- It is a B-adrenergic receptor agonist
- relaxes myometrial smooth muscle - opposes the action of syntocinon - used as a tocolytic in cases of uterine hyperstimulation |
|
|
True or false?
Induction should be offered to all women 24 hours after spontaneous rupture of membranes if labour has not ensued. |
true
|
|
|
Vaginal birth after caesarean (VBAC) carries risk of scar dehiscence of -
1. xxx in spontaneous labour 2. xxx induction/augmentation with syntocinon 3. xxx induction with prostin. |
1. 1:200
2. 1:100 3. 1:20 |
|
|
Types of miscarriage:
1. all products of conception have been expelled 2. cervical is open 3. pregnancy is still viable and cervical os is closed 4. incomplete 5. contents of the uterus are infected 6. gestational sac containing a fetal pole without a heartbeat / or empty sac |
1. complete
2. inevitable 3. threatened 4. some products of conception has been expelled from uterus. 5. septic 6. delayed |
|
|
What are the 3 main options for management of miscarriage?
|
1- conservative - wait and see
2- Medical - antiprogesterone (Mifepristone) followed by prostaglandin (misoprostol). 3- Surgical - ERPC |
