Anaemia; acute fatty liver of pregnancy; Rhesus status Flashcards
Pregnant women are screened when for anaemia? [2]
Pregnant women are screened for anaemia at:
* the booking visit (often done at 8-10 weeks), and at 28 weeks
Label A-C
First trimester < 110 g/L
Second/third trimester < 105 g/L
Postpartum < 100 g/L
What is the mx of anaemia in pregnancy?
oral ferrous sulfate or ferrous fumarate
* treatment should be continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished
Urinary tract infections in pregnant women increase the risk of []. They may also increase the risk of other adverse pregnancy outcomes, such as [2]
Urinary tract infections in pregnant women increase the risk of preterm delivery. They may also increase the risk of other adverse pregnancy outcomes, such as low birth weight and pre-eclampsia.
With regards to UTIs, what are pregnant women screened for at a booking clinic [and why] [3]
Asymptomatic Bacteriuria:
- Asymptomatic bacteriuria refers to bacteria present in the urine, without symptoms of infection.
- at higher risk of developing lower urinary tract infections and pyelonephritis, and subsequently at risk of preterm birth.
- Pregnant women are tested for asymptomatic bacteriuria at booking and routinely throughout pregnancy.
Urinary tract infection in pregnancy requires [] days of antibiotics.
7 days
Which abx are safe for use in pregnancy (and when) [4]
Nitrofurantoin (avoid in the third trimester as as there is a risk of neonatal haemolysis)
Trimethoprim needs to be avoided in the first trimester as it is works as a folate antagonist.
- Folate is important in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (i.e. spina bifida). It is not known to be harmful later in pregnancy, but is generally avoided unless necessary.
Amoxicillin (only after sensitivities are known)
Cefalexin
Acute fatty liver of pregnancy is rare complication which may occur in the** []** or the period []
Acute fatty liver of pregnancy is rare complication which may occur in the third trimester or the period immediately following delivery.
What are the features, invetigations and management of acute fatty liver of pregnancy?
Features
* abdominal pain
* nausea & vomiting
* headache
* jaundice
* hypoglycaemia
* severe disease may result in pre-eclampsia
* ascties
Investigations
* ALT is typically elevated e.g. 500 u/l
Why does acute fatty live of pregnancy occur? [2]
Acute fatty liver of pregnancy results from impaired processing of fatty acids in the placenta
The most common cause is long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency in the fetus, which is an autosomal recessive condition.
Th LCHAD enzyme is important in **fatty acid oxidation, **breaking down fatty acids to be used as fuel. The fetus and placenta are unable to break down fatty acids. These fatty acids enter the maternal circulation, and accumulate in the liver.
TOM TIP: In your exams, elevated liver enzymes and low platelets should make you think of [] rather than acute fatty liver of pregnancy.
TOM TIP: In your exams, elevated liver enzymes and low platelets should make you think of HELLP syndrome rather than acute fatty liver of pregnancy. HELLP syndrome is much more common, but keep acute fatty liver of pregnancy in mind as a differential.
What is the management of acute fatty liver of pregnancy? [2]
Acute fatty liver of pregnancy is an obstetric emergency and requires prompt admission and delivery of the baby. Most patients will recover after delivery.
Management also involves treatment of acute liver failure if it occurs, including consideration of liver transplant.
What is the basic pathophysiology of rhesus negative pregnacies & haemolytic disease of newborn [+]
Women that are** rhesus-D positive** do not need any additional treatment during pregnancy.
When a woman that is rhesus-D negative becomes pregnant, we have to consider the possibility that her child will be rhesus positive
- he baby’s red blood cells display the rhesus-D antigen & The mother’s immune system will recognise this rhesus-D antigen as foreign and produce antibodies to the rhesus-D antigen
- The mother has then become sensitised to rhesus-D antigens.
During subsequent pregnancies:
- the mother’s anti-rhesus-D antibodies can cross the placenta into the fetus.
- If that fetus is rhesus-D positive, these antibodies attach themselves to the red blood cells of the fetus and causes the immune system of the fetus to attack them, causing the destruction of the red blood cells (haemolysis).
- The red blood cell destruction caused by antibodies from the mother is called haemolytic disease of the newborn.
The name rhesus refers to various types of rhesus antigens on the surface of red blood cells.
Describe how you prevent sensitisation of rh
intramuscular anti-D injections to rhesus-D negative women.
The anti-D medication works by attaching itself to the rhesus-D antigens on the fetal red blood cells in the mothers circulation,** causing them to be destroyed**
This prevents the mother’s immune system recognising the antigen and creating it’s own antibodies to the antigen. It acts as a prevention for the mother becoming sensitised to the rhesus-D antigen.
Anti-D injections are given routinely on which two occasions? [2]
28 weeks gestation
Birth (if the baby’s blood group is found to be rhesus-positive)
