Obstetrics Pg No 403 -412
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Questions and Answers

What is the primary use of Magnesium Sulphate?

  • Treatment of infections
  • Management of diabetes
  • Prevention and treatment of seizures in hypertensive pregnant females (correct)
  • Pain relief during labor

    • Magnesium Sulphate has a wide therapeutic range.

    False

    What are the contraindicated antihypertensives in pregnancy?

    ACE Inhibitors, Diazoxide, Diuretics, ARBS, and β-blockers (except Labetalol)

    The loading dose of Magnesium Sulphate for IM administration is ___ gms.

    <p>10</p> Signup and view all the answers

    Match the following components related to Magnesium Sulphate administration:

    <p>Intramuscular Dose = 10 gms of 50% MgSO4 Intravenous Dose = 4 gms of 20% MgSO4 Contraindicated Antihypertensives = ACE Inhibitors Preparation for IV Dose = 4 ampoules of MgSO4 + 1 ml NS</p> Signup and view all the answers

    What is the most common cause of liver failure in pregnant females?

    <p>Acute Fatty Liver of Pregnancy (AFLP)</p> Signup and view all the answers

    Acute Fatty Liver of Pregnancy (AFLP) is typically diagnosed during the first trimester.

    <p>False</p> Signup and view all the answers

    List one symptom of Acute Fatty Liver of Pregnancy (AFLP).

    <p>Nausea or vomiting</p> Signup and view all the answers

    The mortality rate associated with Acute Fatty Liver of Pregnancy (AFLP) is approximately _____.

    <p>10%</p> Signup and view all the answers

    Match the following features with their respective descriptions related to Acute Fatty Liver of Pregnancy (AFLP):

    <p>Jaundice = Symptom of liver failure Ascites = Fluid accumulation in the abdomen Hepatic encephalopathy = Neurological dysfunction due to liver failure Disseminated Intravascular Coagulation (DIC) = Abnormal blood clotting condition</p> Signup and view all the answers

    Which of the following is a consequence of acute fatty liver of pregnancy?

    <p>Jaundice</p> Signup and view all the answers

    A heterozygous deficiency of the LCHAD enzyme occurs only in the fetus.

    <p>False</p> Signup and view all the answers

    What is the risk factor related to twin pregnancies in the context of acute fatty liver of pregnancy?

    <p>Previous history of AFLP</p> Signup and view all the answers

    Homozygous deficiency of LCHAD enzyme in the fetus leads to the accumulation of __________ in the maternal circulation.

    <p>intermediate products of fatty acid metabolism</p> Signup and view all the answers

    Match the condition with its associated complication:

    <p>Acute Fatty Liver of Pregnancy = Liver failure Heterozygous deficiency of LCHAD = Fatty acid accumulation Twin pregnancy = Increased risk of AFLP LCHAD deficiency in fetus = Metabolic disruption</p> Signup and view all the answers

    What is produced initially in response to Rh antigen during the first pregnancy?

    <p>IgM</p> Signup and view all the answers

    In the first pregnancy, the presence of Rh antigens in the maternal circulation poses a risk of hemolytic disease for the fetus.

    <p>False</p> Signup and view all the answers

    What reaction occurs if fetal-maternal hemorrhage happens in subsequent pregnancies with an Rh-positive fetus?

    <p>IgG antibodies formed quickly can cross the placenta, leading to hemolytic disease of the fetus.</p> Signup and view all the answers

    In the case of Rh-negative mothers, Rh type of the ______ must be assessed during the first antenatal visit.

    <p>husband</p> Signup and view all the answers

    Match the following terms with their correct descriptions:

    <p>Rh-positive fetal circulation = Fetal blood contains Rh antigen IgM = Cannot cross the placenta IgG = Can cross the placenta in subsequent pregnancies Feto-maternal hemorrhage = Mixing of maternal and fetal blood</p> Signup and view all the answers

    Which of the following is NOT a fetal complication during pregnancy?

    <p>Polyhydramnios</p> Signup and view all the answers

    Anti-D is beneficial in Rh-positive unsensitized pregnancies.

    <p>False</p> Signup and view all the answers

    What is a possible result of fetal hemolysis?

    <p>Hepatosplenomegaly and bone marrow hyperplasia</p> Signup and view all the answers

    _____ is indicated in cases of fetal anemia.

    <p>CTG (Cardiotocography/Non-stress test)</p> Signup and view all the answers

    Match the following complications with their descriptions:

    <p>Fetal anemia = Potential for severe heart failure PIH = Pregnancy-induced hypertension Hydrops fetalis = Fluid accumulation in fetal compartments Twin-to-twin transfusion syndrome = Unequal blood distribution between twins</p> Signup and view all the answers

    Which of the following is NOT one of the features of HELLP syndrome?

    <p>High white blood cell count</p> Signup and view all the answers

    Jaundice is a common symptom of HELLP syndrome.

    <p>True</p> Signup and view all the answers

    What is the typical time frame for the appearance of HELLP syndrome during pregnancy?

    <p>Third trimester</p> Signup and view all the answers

    The presence of fragmented red blood cells is a criterion for hemolysis in HELLP syndrome, which includes ___ cells and schistocytes.

    <p>burr</p> Signup and view all the answers

    Match the following risk factors with their corresponding descriptions:

    <p>Multigravida females = More prone to developing HELLP syndrome Severe pre-eclampsia = Complication that often leads to HELLP syndrome Third trimester = Typical appearance period for HELLP syndrome Elevated liver enzymes = One of the hallmarks of HELLP syndrome</p> Signup and view all the answers

    What is the maximum dose of Magnesium Sulphate that can lead to cardiac arrest?

    <p>24 meq/L</p> Signup and view all the answers

    Oliguria is a sign of Magnesium Sulphate toxicity.

    <p>False</p> Signup and view all the answers

    What is the antidote for Magnesium Sulphate toxicity?

    <p>Calcium gluconate</p> Signup and view all the answers

    The loading dose of Magnesium Sulphate in the Zuspan regimen is ___ gm diluted in 100 ml IV fluid.

    <p>4-6</p> Signup and view all the answers

    Match the following Magnesium Sulphate toxicity levels with their respective effects:

    <p>9-10 meq/L = Loss of knee jerk 12 meq/L = Respiratory depression 15 meq/L = Cardiac arrhythmia 24 meq/L = Cardiac arrest</p> Signup and view all the answers

    Which of the following is a primary feature of meconium aspiration syndrome?

    <p>Bile acid reaches the amniotic fluid</p> Signup and view all the answers

    Increased serum bile acid levels indicate a higher risk of meconium aspiration syndrome.

    <p>True</p> Signup and view all the answers

    What can occur as a result of meconium accumulation in the fetal heart?

    <p>Cardiac arrest</p> Signup and view all the answers

    The serum bile acid levels are considered the best investigation if they are greater than _____ micromoles/L.

    <p>10</p> Signup and view all the answers

    Match the following steps in the development of meconium aspiration syndrome with their descriptions:

    <p>Bile acid reaches amniotic fluid = Initial step leading to irritation Fetus swallows amniotic fluid = Ingests fluid with bile salt Meconium passes in amniotic fluid = Can lead to respiratory distress Accumulates in fetal heart = Risk of cardiac arrest</p> Signup and view all the answers

    What is the typical time frame during pregnancy when Rh antigens begin to form?

    <p>38 days</p> Signup and view all the answers

    Rh-negative mothers have a low risk if their fetus is Rh-positive.

    <p>False</p> Signup and view all the answers

    What risk exists for a Rh-negative mother carrying a Rh-negative fetus?

    <p>Low risk</p> Signup and view all the answers

    If a Rh-negative mother gives birth to a Rh-positive child, there is a ___% chance of the child being Rh-positive.

    <p>50</p> Signup and view all the answers

    Match the following scenarios with their corresponding risk levels:

    <p>Rh-ve mother, Rh+ve fetus = High risk Rh-ve mother, Rh-ve fetus = Low risk</p> Signup and view all the answers

    Which of the following drugs is not a first-line antihypertensive for PE?

    <p>Verapamil</p> Signup and view all the answers

    Overcorrection of blood pressure can lead to decreased utero-placental perfusion.

    <p>True</p> Signup and view all the answers

    What is the target systolic blood pressure for antihypertensive treatment in PIH?

    <p>130-140 mmHg</p> Signup and view all the answers

    The maximum dose of Labetalol administered intravenously is _____ mg.

    <p>220</p> Signup and view all the answers

    Match the following antihypertensive drugs with their type of administration:

    <p>Labetalol = IV Hydralazine = IV Nifedipine = Oral Methyldopa = Oral</p> Signup and view all the answers

    Study Notes

    Magnesium Sulphate

    • Used to prevent and treat seizures in pregnant women with high blood pressure
    • Works by reducing cerebral edema, acting on NMDA receptors, decreasing oxidative stress, and stabilizing membrane potential
    • Has a narrow therapeutic range of 4 to 7 mg
    • Pritchard regimen is a common treatment regimen in India

    Pritchard Regimen

    • Loading Dose:
      • Intramuscular (IM): 10 grams of 50% magnesium sulphate (5 grams in each buttock)
      • Intravenous (IV): 4 grams of 20% magnesium sulphate
    • Maintenance Dose: 5 grams of 50% solution every 4 hours in alternating buttocks
    • Contraindications:
      • Deep tendon reflexes (knee jerk) absent
      • Respiratory rate less than 12/minute
      • Urine output less than 100 cc/4 hours

    Antihypertensives in Pregnancy

    • Contraindicated:
      • ACE inhibitors
      • Diazoxide
      • Diuretics (except in chronic hypertension before 20 weeks)
      • ARBs (eg: Losartan)
      • Beta-blockers (except Labetalol)

    Acute Fatty Liver of Pregnancy (AFLP)

    • Most common cause of liver failure in pregnant females
    • Typically occurs in the third trimester (30-36 weeks)
    • Symptoms include nausea, vomiting, and jaundice
    • Complications include fulminant liver failure, ascites, hepatic encephalopathy, and DIC
    • Mortality rate is 10%

    AFLP Risk Factors

    • Previous AFLP
    • Twin pregnancy

    AFLP Pathophysiology

    • Deficiency in the LCHAD enzyme (Long chain 3 hydroxyacyl co-enzyme A dehydrogenase) is crucial for long chain fatty acid metabolism
    • Deficiency leads to the accumulation of intermediate products of fatty acid metabolism in the fetus and mother

    AFLP Disease Occurrence

    • Fetus: Homozygous deficiency of LCHAD enzyme
    • Mother: Heterozygous deficiency of LCHAD enzyme

    AFLP Consequences

    • Liver failure:
      • Jaundice
      • Hepatic encephalopathy
      • Hypoglycemia
      • Increased ammonia
      • Risk of DIC
    • Pancreatitis
    • Endothelial cell injury
    • Renal failure: Increased serum urea and creatinine

    Rh Negative Pregnancy

    • First Antenatal Visit: ABO and Rh typing are performed for both mother and father
    • First Pregnancy:
      • If the fetus is Rh-positive, a feto-maternal hemorrhage (FMH) can occur, leading to the mixing of blood in the maternal circulation
      • The maternal immune system produces antibodies against the Rh antigen
      • IgM antibodies are produced initially and cannot cross the placenta
      • IgG antibodies are produced after delivery, so the first pregnancy is typically safe
    • Subsequent pregnancies:
      • If the fetus is Rh-positive and FMH occurs, the maternal immune system quickly produces IgM and IgG antibodies due to prior exposure
      • IgG can cross the placenta and cause hemolytic disease of the fetus
      • Antibodies against Rh antigen can cause fetal complications

    Fetal Complications

    • Fetal anemia
    • Jaundice
    • Heart failure
    • Hydrops fetalis
    • Hepatosplenomegaly and bone marrow hyperplasia
    • Erythroblastosis fetalis
    • Placentomegaly

    Maternal Complications

    • Pre-eclampsia
    • Polyhydramnios

    Fetal Anemia

    • Indicators:
      • Cardiotocography (CTG)
      • Doppler of middle cerebral artery (MCA)
    • Causes:
      • Rh isoimmunized pregnancy
      • Vasa previa
      • Twin-to-twin transfusion syndrome

    Anti-D & Indirect Coomb's Test

    • Anti-D: Antibody against Rh antigen
    • Mechanism of Action: Anti-D in maternal blood neutralizes Rh-positive fetal RBCs, preventing the mother's immune system from being stimulated
    • Rh-negative maternal RBCs: Anti-D is administered externally to stop the immune system from producing antibodies
    • Rh-positive fetal RBCs: Anti-D is only beneficial in Rh-negative unsensitized pregnancies

    Liver Disorders in Pregnancy

    • HELLP syndrome:
      • Characterized by hemolysis, elevated liver enzymes, and low platelet count
      • Complication of severe pre-eclampsia
      • Often involves significant liver involvement and hemolysis
      • Raised blood pressure occurs in 80-85% of cases
      • More common in multigravida females

    HELLP Presentation

    • Typically appears in the third trimester
    • Common symptoms include abdominal pain (often in the right upper quadrant) and jaundice
    • Tennessee Criteria for Hemolysis:
      • Presence of fragmented red blood cells
      • Increased serum bilirubin levels greater than 2.12 mg/dL

    Magnesium Sulphate Toxicity

    • First sign: Loss of knee jerk (9-10 meq/L)
    • Other Symptoms:
      • Diaphoresis
      • Slurring of speech
      • Feeling of heat
    • At 12 meq/L: Respiratory depression → Respiratory arrest
    • At 15 meq/L: Cardiac arrhythmia
    • At 24 meq/L: Cardiac arrest
    • Antidote: Calcium gluconate 10 ml of 10% IV

    Magnesium Sulphate Uses

    • Prevent seizures
    • Severe pre-eclampsia
    • Impending pre-eclampsia
    • HELLP syndrome
    • Neuroprotection in preterm labor

    Meconium Aspiration Syndrome

    • Pathophysiology: Biles acids reach amniotic fluid, fetus swallows amniotic fluid, leading to bowel irritation and meconium passing into the amniotic fluid, ultimately leading to fetal cardiac arrest
    • Diagnosis: Serum bile acid levels greater than 10 micromoles/L

    Antihypertensives for Pre-eclampsia

    • Indications for medication:
      • Blood pressure less than 160/110 mmHg
      • Persistent blood pressure ≥ 150/100 mmHg
    • Target Blood Pressure:
      • Systolic: 130-140 mmHg
      • Diastolic: 80-90 mmHg

    First Line Drugs for Pre-eclampsia

    • Labetalol
    • Hydralazine
    • Nifedipine

    Other Drugs

    • Verapamil
    • Nitroglycerine
    • Ketanserin
    • Nimodipine

    Drugs for Severe Pre-eclampsia and Hypertensive Crisis

    • Labetalol (IV): 20mg IV, check BP in intervals of 15 min
    • Hydralazine (IV): 5mg IV, check BP in intervals of 20 min
    • Oral Nifedipine (Not Sublingual)

    Drugs for Chronic Hypertension

    • First-line drugs (Oral Route):
      • Methyldopa
      • Labetalol
      • Nifedipine

    Rh Negative Pregnancy

    • Rh Antigens: Located on the short arm of chromosome I
    • Types: C, c, D, E, e
    • Formation: Rh-negative blood stimulates the immune system in Rh-negative individuals to form Rh antibodies after approximately 38 days of gestation
    • Scenario 1: High risk if the mother is Rh-negative and the fetus is Rh-positive (50% chance)
    • Scenario 2: Low risk if both mother and fetus are Rh-negative

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    Description

    Test your knowledge on the use of magnesium sulphate in treating high blood pressure and preventing seizures during pregnancy. This quiz covers the Pritchard regimen, its administration, contraindications, and related antihypertensive medications. Discover the critical information needed for safe management in obstetrics.

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