3: Medical problems in pregnancy Flashcards
Which groups of women are more likely to die during pregnancy?
Women with co-morbidities
Ethnic minority women
Overweight / obese women (cardiovascular disease risk i.e VTE)
What cardiovascular diseases are common causes of death in pregnancy?
Hypertension
Cardiac disease i.e MI
VTE i.e DVT, PE, stroke, MI
Diabetes
What cardiovascular changes occur in pregnancy?
Increased heart rate, contractility, stroke volume –> CO
Decreased BP and TPR
Why is the prevalence of heart disease in pregnancy increasing?
Increased maternal age
More obese women
More women with pre-existing or congenital heart disease
What is a major risk factor for ischaemic heart disease in women?
Pregnancy
:/
What innocent cardiovascular signs and symptoms are seen in pregnant women?
Innocent murmur
Palpitations
Which anticoagulant is teratogenic?
Warfarin
LMWH isn’t, so swap it
Which cardiovascular disease is often fatal if carried into pregnancy?
Pulmonary hypertension
What is Eisenmenger’s syndrome?
Right-to-left shunt caused by PH secondary to a congenital heart defect e.g VSD
Which
a) endocrine
b) genetic disorders are associated with congenital heart disease?
a) Diabetes
b) Marfan’s syndrome (aortic root dilation -> regurg)
+ a million more
Palpitations occuring during pregnancy are usually ___.
benign
What cardiac investigations should be done for a woman presenting with palpitations?
ECG
If dodgy, do echo
Which endocrine diseases may cause palpitations in pregnant women?
Hyperthyroidism
Phaeochromocytoma
Which NYHA class of cardiovascular disease is a contraindication for pregnancy?
3+
make sure the woman is using contraception
What respiratory changes occur during pregnancy?
Increased oxygen consumption
Increased tidal volume BUT NOT respiratory rate
Decreased functional residual capacity (lungs are compressed by pregnancy)
What blood gas changes occur during pregnancy?
% O2 increases
% CO2 decreases
So blood pH increases
Palpitations is a common cardio complaint in pregnancy.
What is a common respiratory complaint?
SOB
Which chronic respiratory condition is often seen in pregnant women?
Asthma
Why do many pregnant women experience a deterioration in their asthma early in pregnancy?
Concerns re: medication effect on baby (steroids, inhalers)
so they stop using them and their asthma gets worse
What should women on long-term steroids be given during childbirth?
IV steroids e.g hydrocortisone
bc. they will have adrenal insufficiency
Can women continue on their inhalers during childbirth?
Yes
What is the most common direct cause of maternal death in pregnancy?
Venous thromboembolism
i.e DVT
Where exactly do DVTs tend to occur in pregnant women?
Left leg
Iliac / femoral vein
When in the course of pregnancy does DVT tend to occur?
Post-birth
Virchow’s triad for venous thromboembolism includes epithelial damage, hypercoagulability and venous stasis.
How do pregnant women fulfill these factors?
Epithelial damage - rapid cardiovascular changes
Venous stasis - lying down a lot, especially in hospital
Hypercoagulability - some women have thrombophilia
Which type of drug is given as prophylaxis for DVT in pregnant women?
Anti-coagulant
NOT warfarin - LMWH
What congenital disease, causing hypercoagulability, causes DVT in pregnancy?
Thrombophilia
What LMWH is used for pregnant women in Tayside?
Dalteparin
What influences the dose of dalteparin given to pregnant women to prevent VTE?
Maternal weight
What investigation is used to diagnose DVT in pregnant women?
Duplex ultrasound
like a doppler for your leg
What biochemical test used for DVT and PE is useless in pregnancy?
D dimers
always raised
Which investigations are used to diagnose PE in all patients?
CT pulmonary angiogram
V/Q scan
CTPA and V/Q scans are used to diagnose PE.
What’s the problem with this in pregnant women?
CTPA involves a radiation dose to the woman and increases breast cancer risk
V/Q scan involves a radiation dose and increases risk to baby
Which anti-coagulant drug is teratogenic?
What should you change it to?
Warfarin
LMWH e.g dalteparin
Can mothers breastfeed while on warfarin or LMWH?
Yes
Which rheu disease causes recurrent miscarriage and skin changes?
Anti-phospholipid syndrome (APS)
APS causes which blood disorder in women?
Thrombophilia
Which three autoantibodies are seen in APS?
Anti Lupus anticoagulant
Anti cardiolipin
Anti beta 2 glycoprotein
What are the signs of APS?
Recurrent miscarriage
Recurrent early-onset pre-eclampsia
How is APS managed?
If found during late pregnancy it’s probably not treatable
but can be subsequently treated with aspirin and LMWH + regular monitoring (USS)
Which neuro disorder is common in pregnant women?
Epilepsy
What symptom of epilepsy is responsible for pregnancy complications?
Seizures
trauma, premature rupture, premature delivery
Many of the ___ used to treat epilepsy are teratogenic.
drugs
Which anti-epilepsy drug is most likely to cause congenital malformations?
Sodium valproate
but they’re all dodgy
The more anti-epilepsy drugs a pregnant woman is on, the more likely they are to develop what?
Foetal abnormalities
Which drug is used to prevent neural tube defects in pregnant women?
In what doses?
Folic acid
400 micrograms normal risk
5 milligrams increased risk (e.g on antiepileptic drugs)
What disease other than epilepsy causes seizures in pregnant women?
Eclampsia
How are epileptic seizures terminated in labour?
Benzodiazepines
These are majorly teratogenic but the baby’s being delivered at that point
What state increases your risk of virtually every complication of pregnancy?
Obesity
What dose of folic acid should obese women take?
Why?
5 milligrams
Increased risk of neural tube defects
