7) Pregnancy and Extragenital Diseases Flashcards
What are the Extragenital Diseases that can occur during Pregnancy?
- Rh Sensitisation
- Hyper / Hypo-thyroidism
- SLE / Myasthenia Gravis
- Thrombophillia
- DVT
- Acute Abdomen
- TORCH Syndrome
- UTIs
- Diabetes
Describe Rh Sensitisation
- When Rh-NEGATIVE Mother is exposed to Rh-+VE Fetal RBCs, triggering immune response
- Causing Hemolytic Disease of Newborn
- Mother produces antibodies, in response to the exposing –> crosses placenta + attacks Fetal RBCs (Hemolysis)
What Risks Contribute to Rh Sensitisation, and what are the Complications?
RISK FACTORS
- Miscarriage / Abortion
- Ectopic Pregnancy
- Antepartum Hemorrhage (Placenta Previa / Abruption)
- Abdominal trauma
COMPLICATIONS
- Fetal Hydrops (fluid accumulation in fetal tissues)
- Intrauterine Fetal Death
What is the Diagnosis / Treatment for Rh Sensitisation?
DIAGNOSIS
- Paternal Blood Type Testing
- Antibody Screening
TREATMENT = Administer Rh Immunoglobulin
- Given at 28 -32 Gestational Weeks
- Given Within 72h delivery if baby is Rh-+VE
Describe Hyper + Hypo-thyroidism in Pregnancy
HYPERTHYROIDISM - Increased TH**; Decreased* TSH
- CFs in Pregnancy = Tachycardia, Poor Weight Gain, Hyperemesis Gravidarum
- Complications for HYPER = Thyrotoxicosis, Preeclampsia, Abortion, Fetal ARDS
- Tx for HYPER = Propylthiouracil, or Methimazole
HYPOTHYROIDISM - Decreased TH**; Increased* TSH
- CFs in Pregnancy = Bradycardia, Neuropsychiatric Retardation
- Complications for HYPO = Preeclampsia, Placental Abruption, Intrauterine Fetal Death, Fetal Hypothyroidism
Describe SLE and Myastenia Gravis in Pregnancy
SLE - Chronic, autoimmune Disease
- CF in Pregnancy = *Painful + Swollen Joints / lymph nodes, fever, rash
- Complications for SLE = Preeclampsia, Thrombosis, Intrauterine Death of Fetus, Abortion
- Tx for SLE = Prednisolone, and Aspirin
Myasthenia Gravis - Skeletal Muscle Weakness
- Complications for MG = MATERNAL / FETAL DEATH!, Preterm Birth, Fetal ARDS, Difficult Sucking
- Tx for MG = anticholinesterase agents
NB! Delivery CAN BE Normal / C-Section
What is TORCH Syndrome
Toxoplasmosis
Other - Hepatitis, HIV
Rubella
CMV
Herpes Simplex
Describe Toxoplasmosis in Pregnancy
- Due to T. Gondii
- Presented w/ bilateral lymphadenopathy, rashes + headaches
COMPLICATIONS =
- Spontaneous Abortion
- Hydrocephaly
- Chorioretinitis
- Brain Calcifications
Tx for ToX = Spiramycin
Describe Hepatitis & HIV in Pregnancy
HEPATITIS
- Hep-B causes trans-placental infection
- In this case, mother’s should be given Hep-B Immune Globulin + 1st Dose Vaccine
HIV - usually risk of vertical transmission
- Delivery MUST BE C-Section
Describe Rubella in Pregnancy
RUBELLA
- Mother may only experience mild 3-day rash w/ posterior auricular adenopathy
COMPLICATIONS
- Abortions
- Fetal Death
- Congenital Malformations - Microcephaly, Heart Damage, Deafness, Mental Retardation
NB! IF affected AFTER 26 GW, there’s NO HIGHER RISK
Describe CMV in Pregnancy
CYTOMEGALOVIRUS
- Occur utero, intrapartum or via breast milk
COMPLICATIONS
- Hemolytic Anemia
- Hydrocephaly, Microcephaly
- Fetal Death
Describe Herpes Simplex in Pregnancy
HERPES SIMPLEX - Due to HSV-1 + 2
- Fetus is infected during delivery - Onset of sx happen 10-12 weeks Post-Partum
COMPLICATIONS =
- Encephalitis
- Microcepahly
- Chorioretinitis
- Brain Atrophy
Tx for HSV = Acyclovir
NB! C-Section IF ACTIVE Lesions
Describe Diabetes in Pregnancy
GESTATIONAL DIABETES
- RFs = Obesity, Genetics, PCOS
- INCREASED Oestrogen / Progesterone –> INCREASED Insulin Secretion
- Chronic Fetal HYPERGLYCEMIA –> XS Fetal Growth, and Delayed Pulmonary Maturation
- Tx for GDM = *Insulin Pump
NB! C-Section is REQUIRED - due to shoulder dystocia
What are the COMPLICATIONS of GESTATIONAL DIABETES?
MATERNAL
- ***Preeclampsia
- Diabetic Ketoacidosis
- Polyhydraminos
- Post-Partum Hemorrhage
- Blindness, Nephropathy
FETAL
- Miscarriage
- Abnormal Intrauterine Growth - Macrosomia, Growth Restriction
NEONATAL
- ARDS
- Hypocalcemia, Hypoglycemia
- Hyperbilirubinemia
Explain GLUCOSE TOLERANCE TEST for Pregnant Women*
- Done during 24th - 28th Gestational Weeks
CRITERIA
- Fasting Glucose = MORE / EQUAL to 5.1 mmol / l
- After 1h = MORE / EQUAL to 10 mmol / l
- After 2h = MORE / EQUAL to 8.5 mmol / l
