6 - Obs - Other Medical Disorders in Pregnancy - Epilepsy + Thyroid disease in pregnancy Flashcards
Epilepsy
? control can deteriorate in preg, esp in ?. SIgnif cause of ? death, continue ? trt. Risk of ??? is incr largely due to ?therapy – ? dependent, higher w ? drugs and higher w certain drugs eg ?
Newborn has 3% risk of dev ?
? assessment is ideal - mgmt -> control w ? drugs at ? dose, with ? acid supplement.
?wk scan important to exclude ? abnormality
seizure labour maternal antiepileptic NTDs drug dose multiple valproate
epilepsy
preconceptual
minimal
lowest
folic (5mg/d)
20
fetal
Epilepsy - drugs
- avoid ?
- ? and ? are safest. incr dose if inadequate ??
- from 36 weeks ? ? 10mg given ?
valproate carbamazepine lamotrigine seizure control Vit K orally
thyroid - ? clearance increases
? more common
? thyroxine prod starts at ? weeks - therefore maternal ??? incr in ? preg
iodine goitre fetal 12 TSH early
Hypothyroidism.
Most in UK are ?, but can be due to ? deficiency. Untrt disease is ? as ? is usual, but ass w high ? mort.
Subclinical hypothyr ass w ? , ? deliv and ? impairment in childhood. Also ass w slight incr risk of ?
HRT w ? is important and TSH levels monitored ?wkly. In normal preg TSH is ?, so dose incr until ?
hashimotos iodine rare anovulation perinatal miscarriage preterm intellectual preeclampsia thyroxine 6 lowered delivery
Hyperthyroidism.
Usually ?
Untrt disease ? as ? usual. Untrt disease incr ? mort. Antithyroid Abs also cross ?, rarely can cause neonatal ?
and goitre. In mother thyrotoxicosis may improve in ? preg but if poorly controlled risk of ‘thyroid storm’ where mum gets ? Sx and ?? near/at delivery. Sx may be confused w those of ?.
Hyperthyroid trt w ? (PTU) – crosses placenta and can cause neonatal ?, therefore ?
poss dose used and TFT done ?.
graves' rare anovulation perinatal placenta thyrotoxicosis later acute HF preg Propylthiouracil hypothyroidism lowest monthly
Postpartum Thyroiditis
Common (?-?%), can cause postnatal ?.
RFs inc ? Abs and T1DM. In affected pts there’s transient subclinical ?, usually 3m ?, followed by 4m of hypothyroid. ? in 20%.
5-10% depression antithyroid hyperthyroidism postpartum permanent
