Obstetrics I - OSCE > PET > Flashcards

PET Flashcards

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1
Q
A
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2
Q

Def of PET

A
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3
Q

RF for PET

  • Maternal Specific
A
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4
Q

RF for PET

  • Pregnancy Specific
A
  • Vesicular mole
  • Multifetal Pregnancy
  • Polyhydraminos
  • Seasonal variation: More common in winter
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5
Q

Maternal Specific RF for PET

  • Age
A

< 20 or > 35 years.

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6
Q

Maternal Specific RF for PET

  • Gravidity & Parity
A

More in primigravidas specially elderly primigravidas.

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7
Q

Maternal Specific RF for PET

  • Race
A

More in black races

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8
Q

Maternal Specific RF for PET

  • SES
A

Low

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9
Q

Etiology of PET

A

Theories Include:

  • Increased Pressor Effect
  • Abnormal Placentation
  • Genetic Factors
  • Immunological Factors
  • Inflammatory Factors
  • Biochemical Factors
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10
Q

Theories of PET

  • Increased Pressor Effect
A
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11
Q

Complications of PET

A

Maternal & fetal

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12
Q

Maternal Complications of PET

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13
Q

Maternal Complications of PET

  • ICH
A

Due to severe HTN.

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14
Q

Maternal Complications of PET

  • Remote Complications
A
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15
Q

Maternal Complications of PET

  • HELLP Syndrome
A
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16
Q

Def of HELLP Syndrome

A

Fatal condition characterized by:

  • Hemolysis: Bilirubin ≥ 1.2 mg/dl.
  • Elevated Liver enzymes: SGOT > 70 IU/L.
  • Low Platelet count: < 100000/mm3.
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17
Q

DDx of HELLP Syndrome

A

 Acute fatty liver in pregnancy.

 Thrombotic thrombocytopenic purpura.

 Hemolytic uremic syndrome.

 Hepatitis (viral or drug induced).

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18
Q

Maternal Mortality in HELLP Syndrome

A

80-90%.

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19
Q

RR in HELLP Syndrome

A

5%

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20
Q

Fetal Complications in PET

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21
Q

Prediction of PET

  • Hx
A

High risk factors (from history since 1st antenatal visit).

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22
Q

Prediction of PET

  • Ex
A
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23
Q

Prediction of PET

  • Vascular Reactivity Tests
A
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24
Q

Prediction of PET

  • Labs
A

↑↑ serum uric acid, hypocalciuria & ↑↑ fibronectin levels.

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25
Prediction of **PET** - Uterine Artery Doppler
To detect uteroplacental hypoperfusion
26
Clinical Signs of **PET**
Signs: Preeclampsia is a disease of signs & it has the following 3 cardinal signs: - HTN - PTNuria - Edema
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Clinical Signs of **PET** - HTN
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Clinical Signs of **PET** - PTNuria
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Clinical Signs of **PET** - Edema
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Clinical Symptoms of **PET**
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Clinical Symptoms of **PET** - Epigastric Pain
Due to distension of liver capsule.
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Clinical Symptoms of **PET** - Headache
Due to HTN & cerebral edema.
33
Clinical Symptoms of **PET** - Persistent N&V
Due to cerebral edema, congestion of gastric mucosa or liver affection.
34
Investigations for **PET** - Labs
35
**Assessment of Severity** of PET
36
Def of **Imminent eclampsia (preeclamptic state)**
Worse type of severe preeclampsia which will end in eclampsia if not urgently treated.
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Dx of **Imminent eclampsia (preeclamptic state)**
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TTT of **Imminent eclampsia (preeclamptic state)**
Immediate control & TOP èin 6 hours.
39
DDx of **PET**
- Causes of HTN with pregnancy - Causes of proteinuria with pregnancy - Causes of edema with pregnancy
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DDx of **PET** - Causes of HTN with Pregnancy
 Preeclampsia (commonest cause) & eclampsia.  Gestational HTN  Chronic HTN.  2ry HTN: As in chronic nephritis, coarctation of aorta & Cush ing syndrome.
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DDx of **PET** - Causes of PTNuria with pregnancy
 Preeclampsia & eclampsia.  Contamination of specimen e vaginal discharge (commonest cause) .  UTI.  Renal hypoxia: As in CHF & severe anemia.  Hyperemesis gravidarum: Rarely occurs in severe cases.  Orthostatic proteinuria.
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DDx of **PET** - Causes of edema with Pregnancy
 Preeclampsia & eclampsia.  Gestational edema.  Local causes: Leading to unilateral edema as inflammations or DVT.  Generalized edema: Cardiac, hepatic, renal, nutritional or angioneurotic edema.  Orthostatic edema.
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Prevention of **PET**
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Plan of TTT of **Mild PET**
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Plan of TTT of **Severe Preclampsia**
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Plan of TTT of **Imminent Eclampsia**
Immediate control & TOP ein 6 hours.
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Lines of TTT of **PET**
- Expectant treatment - Control of HTN - Prevention & control of convulsions - Termination of pregnancy - Postnatal care - Treatment of complications
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Expectant TTT of **PET**
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Expectant TTT of **PET** - Rest
Complete physical & mental rest.
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Expectant TTT of **PET** - Diet
High protein & CHO e low Na+ diet.
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Expectant TTT of **PET** - Sedation
Benzodiazepines or phenobarbitone.
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Expectant TTT of **PET** - Observation
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Control of HTN in **PET** - Indications
Severe cases (antihypertensives have doubtful value in mild cases)
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Control of HTN in **PET** - Rationale
Prevention of maternal complications & not fetal complications ( dec BP → dec placental perfusion → fetal distress & may be IUFD).
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Control of HTN in **PET** - Precautions
Dec BP should be gradual & DBP should be around 100 mmHg (below that → dec placental perfusion).
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Control of HTN in **PET** - Disadvantages
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Control of HTN in **PET** - Used Drugs
**Parenteral drugs:** - Hydralazine - Labetalol - Diazoxide **Oral Drugs:** - Methyl DOPA - Nifidiopine - Adrenergic blockers (Atenolol) - Mono-Hydralazine - Prazosin
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Control of HTN in **PET** - Hydralazine
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Control of HTN in **PET** - Labetalol
A & non-selective B-adrenergic blocker → VD.
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Control of HTN in **PET** - Diazoxide
Used in severe resistant HTN as a last resort.
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Control of HTN in **PET** - Methyl DOPA
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Control of HTN in **PET** - Nifidipine
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Control of HTN in **PET** - Mono-hydralazine
Weak antihypertensive used in combination é ß blockers to inc their efficacy & dec their side effects.
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Control of HTN in **PET** - Prazosin
Weak antihypertensive - used in combination é other drugs.
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TTT of **PET** - Prevention & control of convulsions
- Magnesium sulfate (MgSo4): Drug of choice - Diazepam (valium) - Phenytoin (Epanutin)
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Prevention & control of convulsions in **PET** - Action of MgSO4
1. Curare like action on motor end plate → paralysis of peripheral muscles. 2. Weak CNS depressant. 3. Mild VD & diuretic. 4. inc PGI2 production & dec platelet aggregation.
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Prevention & control of convulsions in **PET** - Indications of MgSO4
Used to prevent convulsions in cases in which delivery is decided.
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Prevention & control of convulsions in **PET** - Routes of MgSO4
IV (preferred rout), IM (painful) or SC (not used now).
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Prevention & control of convulsions in **PET** - Doses of MgSO4
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Prevention & control of convulsions in **PET** - Duration of MgSO4
Maintenance therapy is continued for 24 h after delivery.
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Prevention & control of convulsions in **PET** - Monitoring of MgSO4
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Prevention & control of convulsions in **PET** - SE of MgSO4
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Maternal SE of MgSO4
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Maternal SE of MgSO4 - Toxicity
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Maternal SE of MgSO4 - Drug Interactions
1. Enhances action of curare like drugs. 2. Synergistic action if given é CCB.
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Fetal SE of MgSO4
dec beat to beat variability in FHR pattern
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Neonatal SE of MgSO4
Hypermagnesemia, hypotonia & poor suckling.
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Antidote of MgSO4
Ca++ gluconate.
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Stroganoff method
Use of MgSo4 + morphine.
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Indications of TOP in **PET**
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Methods of TOP in **PET**
Vaginal & CS
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Vaginal Delivery in **PET** - Prerequisities
83
Vaginal Delivery in **PET** - Precautions
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Postnatal Care in **PET** - Observation
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Signs of Improvement in Postnatal Care in **PET**
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Def of **Eclampsia**
Occurrence of tonic-colonic convulsive seizures that can't be attributed to other causes in woman e preeclampsia.
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RF for **Eclampsia**
As pre-eclampsia.
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Types of **Eclampsia** - Acc to time of occurence
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Types of **Eclampsia** - Acc to recurrence
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Complications of **Eclampsia**
…
91
Dx of **Eclampsia**
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Criteria of severity of eclampsia (Eden's criteria)
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DDx of **Eclampsia** - Causes of Convulsion with pregnancy
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DDx of **Eclampsia** - Causes of Coma with pregnancy
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TTT of **Eclampsia**
- During Fit - In Between Fits
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TTT of **Eclampsia** - During Fit
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TTT of **Eclampsia** - In between Fits
- General measures - Prevention of further attacks of convulsions - Control of HTN - Termination of pregnancy - Postnatal care - Treatment of complications
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General Measures of TTT of **Eclampsia** in between fits - Observation
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TTT of **Eclampsia** in between fits - TOP
Obstetrics I - OSCE
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