Antenatal Care: Pre-Existing Medical Conditions Flashcards
What should be offered to epileptic women prior to conception
Folic acid (5mg) from 3 months to 12W
What is the least-teratogenic anti-epileptic
Carbamezapine
What is the advice about anti-epileptic medication during pregnancy
Continue medication, unless sodium valproate - then consider switching
If a women is on CYP450 inducing anti-epileptics, what should she be offered during last 4W and why
Vitamin K. To enable development of foetal vitamin-K coagulation factors, preventing haemorrhage disease of new-born
What is given postpartum to neonates of epileptic women and why
1mg vitamin K = prevent haemorrhage disease new-born
Why should epileptic women remain for 24h in hospital post-delivery
Highest risk of seizures is post-delivery
What does phenytoin during pregnancy cause
Cleft palate
What % of diabetes in pregnancy is GDM
88
What % of diabetes in pregnancy is T1DM
7.5
What % of diabetes in pregnancy is T2DM
5
What HbA1c should be aimed for pre-conception
Hba1C <43 (6.1%)
Explain diabetic medications prior to pregnancy
Metformin can be continued. Others should be stopped and switched to insulin. Find alternatives for ACEI and statins, if women is on them.
What is the regimen of growth scans in diabetic women
Growth scan every 4W from 28W
What should diabetic women be offered at 12W and why
Aspirin (75mg) to prevent pre-eclampsia as these women are at a higher risk
When should you aim for delivery in diabetic women
38W
What may be offered prior to delivery in diabetic women
Corticosteroids
Can you breast feed with metformin
Yes
What defines pre-existing HTN in pregnant women
BP >140/90mmHg before 20W
Explain physiological changes in BP during pregnancy
BP initially decreases up to 24W as vascular resistance decreases. It then increases due to rise in stroke volume
How should HTN be managed in pregnancy
Labetalol or Methyldopa
What is target BP in pregnancy if women has HTN
<150/90 or <140/90 if end-organ damage
What should women with HTN be given at 12W and why
Aspirin (75mg) to reduce risk pre-eclampsia
Why should a women be switched from methyldopa after delivery
Increased risk of post-natal depression
What are 4 risks of HTN during pregnancy
- Pre-eclampsia
- Placental abruption
- Foetal growth restriction
- Stroke
What is antiphospholipid syndrome
Individual has autoantibodies to phospholipids on cells
How can the aetiology of antiphospholipid syndrome be divided
Primary
Secondary
What are secondary causes of antiphospholipid syndrome
SLE
RA
Systemic sclerosis
What is the main feature of antiphospholipid syndrome during pregnancy
Recurrent miscarriages during first-trimester
How many antiphospholipid syndrome present during pregnancy
Arterial or venous thrombosis
Pre-eclampsia
What are the criteria to test for antiphospholipid syndrome
> 3 miscarriages
Unusual thrombosis - eg. unprovoked DVT
Recurrent thrombosis
What antibodies are used to identify antiphospholipid syndrome
Anti cardio-lipid antibodies
If a women with antiphospholipid syndrome with the following complications how should she be managed
a. recurrent pregnancy loss
b. previous IUGR or pre-eclampsia
c. Thrombosis
a. LMWH, aspirin in future pregnancies
b. aspirin from 12W
c. LMWH
What are complications of antiphospholipid syndrome during pregnancy
IUGR
Miscarriage
Pre-Eclampsia
Venous thrombosis
