Abnormal pregnancy Flashcards
Hypertension in pregnancy before __ weeks is not gestational but instead pre-existing hypertension.
20 weeks
What is the first line management in gestational hypertension?
Labetalol
What is first line gestation hypertension management in asthmatics?
Nifedipine
Define hyperemesis gravidarum:
Persistent vomiting in pregnancy which leads to greater than 5% weight loss of pre-pregnancy weight and ketosis
What anti-emetics are licensed for hyperemesis gravidarum
cyclizine
Metoclopramide
Promethazine
What antiemetic is not licensed for hyperemesis gravidarum but is reserved for when all other options fail?
Ondansetron IV
Aside from antiemetics what other medications can be given in hyperemesis gravidarum?
Steroids - prednisalone or hydrocortisone
Folic acid 5mg
Thiamine to prevent Wernicke’s encephalopathy
Thromboprophylaxis
How is pre-eclampsia defined?
Gestational induced hypertension and proteinuria of great than 0.3g/24hours
In gestational hypertension, at what point should you consider admitting to hospital?
If BP >160/110
If a patient requires LMWH during their pregnancy at what point post partum can it be discontinued?
minimum 6 weeks
If a patient undergoes a c-section do they require any anti-coagulation?
Yes. For 7 days postnatally the require anticoagulation with LMWH
What investigation normally used for DVTs and PEs isn’t very appropriate in pregnancy?
D-Dimers
They tend to be raised anyway due to pregnancy physiological changes
At what stage in the pregnancy is the foetus most at risk of damage is the mother is infected by rubella?
The first 16 weeks - risk is 80%
Afterwards it is <5%
List some risk factors (at least 5) for developing pre-eclampsia:
Previous pre-eclampsia Diabetes Smoking >20 a day BMI >35kg/m2 CKD Autoimmune disease FHx Age >40 Multiple pregnancy Chronic` hypertension Age gap between pregnancy >10years First child
What are some of the features of severe pre-eclampsia?
Headache Papilloedema Brisk reflexes Peripheral oedema BP >170 systolic RUQ pain HELLP sydrome
What medication is given to help with seizures in eclampsia?
Magnesium sulphate
How can you correct an overdose from magnesium sulphate?
Calcium gluconate
What medication is given in patients with gestational hypertension to reduce their risk of preeclampsia (give dose), or to any woman with risk for preeclampsia?
Aspirin 75mg
What is eclampsia?
Grand mal seizures occurring due to pre-eclampsia
In patients with preeclampsia what medication is given to benefit the foetus?
Steroids (dexamethasone)
What are the benefits of dexamethasone
Lung maturation
Reduced risk of neonatal death
Reduced risk of NEC
Reduced risk of intraventricular haemorrhage
What are some of the complications for a neonate when a mother has pre-existing diabetes?
Congenital anomalies
Miscarriage
Intrauterine death
How often should pregnant women with diabetes (any kind) monitor their blood sugars?
4x daily
What is the target fasting blood glucose in women with diabetes during pregnancy?
3.5 - 5.5 mmol.mol
What is the target blood glucose 1 hour post meal in pregnant women with diabetes?
<7.8mmol/mol
What are some clinical signs of gestational diabetes?
Polyhydramnios
Glycosuria
What are the clinical symptoms of gestational diabetes?
Polyuria
Polydipsia
Dysuria
What are some risk factors for developing GD
>BMI 30 Ethnicity (BAME more likely) Previous GD in pregnancy FHx Previous big baby
Give some complications assoc. with any kind of diabetes in oregnancy?
Large baby - complicated delivery Shoulder dystocia Macrosomia Neonatal hypoglycaemia Pre eclampsia
What are some of the main causes of PPROM?
Previous pre-term labour (20% risk after 1 previous episode, 40% risk after 2 episodes) Multiple pregnancy Smoking Uterine anomalies Parity (=0 or >5) Ethnicity Poor socio-economic status Drugs (especially cocaine)
What % of pregnancies suffer from obstetric cholestasis?
0.7%
What ethnic group is obstetric cholestasis most common in?
Asians
What are the main symptoms of obstetric cholestasis?
Itching - pruritus mainly contained to hands and soles of feet
Jaundice
Raised bilirubin
What medications can be given in obstetric cholestasis?
Ursodeoxycholic acid
Vitamin K
Antihistamines may ease pruritus
Topical emollients to stop itching
What investigations are appropriate for intrahepatic cholestasis of pregnancy? (Obstetric cholestasis)
Liver function tests
USS of liver
FBC
Serum bile acids
What are we trying to rule out when we USS liver and do a FBC and clotting screen in obstetric cholestasis?
HELLP syndrome
In cholestasis of pregnancy, the LFTs will be mainly normal with deranged bilirubin, and the USS and clotting ties will be normal
Why should mothers with cholestasis of pregnancy be induced at 37 weeks?
There is an increased risk of stillbirth
What does HELLP syndrome stand for?
Haemolysis
Elevated Liver enzymes
Low Platelets
What are some of the maternal consequences of pre-eclampsia?
Renal failure Pulmonary Oedema HELLP syndrome DIC Eclampsia Death
Define premature preterm rupture of the membranes (PPROM)
This is when the amniotic sac breaks before the onset of labour, before 37 weeks
What are some of the mechanisms that may lead to PPROM?
Infections weaken tensile strength of the foetal membranes
Cervical incompetence
Over distension of uterus
Vascular causes incl. placental abruption
For the neonate, what are some of the consequences of PPROM?
Infection
Death
Pulmonary hypoplasia
What is the main risk for the mother in PPROM?
Chorioamnioitis
On speculum examination, what would be seen in PPROM?
Vaginal pooling of blood in the vaginal posterior fornix
What are the main principles of management in PPROM?
Antibiotic cover to prevent chorioamnionitis Monitor vital signs for infection Tocolytics Maternal steroids Mg Sulphate
Why should co amoxiclav be avoided as antibiotic cover in PPROM?
It has an increased risk of causing NEC in neonates
What antibiotic is given 1st line as cover in PPROM?
Erythromycin
Before __ weeks foetal blood sampling cannot be carried out.
34 weeks
What is hydrops fetalis?
This is when there is fluid accumulation in 2 compartments or more of the foetus e.g. ascites, pericardial effusion, oedema, pulmonary oedema
If a mother has high levels of Rh d antibodies what is done with the foetus?
It is checked for anaemia by checking the middle cerebral artery
What are the consequences of neonatal anemia?
Heart failure leading to Hydrops fetalis
