Antenatal - Medical conditions and drugs in pregnancy Flashcards
hypothyroidism in pregnancy
untreated/under treated hypothyroidism in pregnancy can lead to miscarriage, anaemia, SGA and pre-eclampsia
hypo treated with levothyroxine which can cross the placenta
dose needs to be increased during pregnancy - by at least 25-50mcg - titrated based on TSH level aiming for low-normal TSH
hypertension in pregnancy
medications that need to be stopped:
ACEi, angiotensin receptor blockers, thiazide and thiazide like diuretics
medications that are not known to be harmful: Labetalol, CCBs, alpha-blockers
epilepsy in pregnancy
folic acid 5mg daily from before conception
ideally should be controlled by single epileptic drug
SAFE = levetiracetam, lamotrigine, carbamazepine
AVOID = sodium valproate, phenytoin
rheumatoid arthritis in pregnancy
well controlled at least 3 months before becoming pregnant
often symptoms improve during pregnancy and may flare after delivery
SAFE = hydroxychloroquine 1st line, sulfasalazine, corticosteroids, (TNF alpha is also safe)
AVOID = methotrexate
whats the deal with NSAIDs in pregnancy
avoided unless really necessary - as they block prostaglandins which are important for maintaining the ductus arteriosus in the fetus and neonate
particularly avoided in 3rd trimester as they can cause premature closure of ductus arteriosus and can delay labour
beta blockers in pregnancy
labetalol is most frequently used
can cause FGR, hypoglycaemia and bradycardia in neonate,
ACEi and angiotensin II receptor blockers
can cross the placenta and enter fetus
affect kidneys in the fetus and reduce production of urine
cause hypocalvaria which is an incomplete formation of the skull
can cause oligohydramnios, miscarriage, fetal death, hypocalvaria, renal failure and hypotension in neonate
opiates in pregnancy
cause withdrawal symptoms in neonate after birth causing neonatal abstinence syndrome which presents between 3-72 hours after birth with irritability, tachypnoea, high temp and poor feeding
warfarin in pregnancy
avoided in pregnancy
causes fetal loss, congenital malformations, particularly craniofacial problems, bleeding, postpartum haemorrhage, fetal haemorrhage, intracranial bleeding
sodium valproate in pregnancy
avoided
causes neural tube defects, developmental delay
valproate pregnancy prevention programme
lithium in pregnancy
avoided in pregnancy or those planing pregnancy unless other options have failed
particularly avoided in 1st trimester
when it is used need to monitor closely
avoided in breastfeeding - enters breast milk and is toxic to infant
SSRIs in pregnancy
most commonly used antidepressants in pregnancy
can cross the placenta
balance risks and benefits
risk in pregnancy:
- First-trimester - congenital heart defects
- First-trimester use of paroxetine has a stronger link with congenital malformations
- Third-trimester use has a link with persistent pulmonary hypertension in the neonate
- Neonates can experience withdrawal symptoms, usually only mild and not requiring medical management
Isotretinoin (roaccutane) in pregnancy
retinoid medication used to treat severe acne
contraindicated in pregnancy - miscarriage and congenital defects
rubella in pregnancy
congenital rubella syndrome is caused by maternal infection with rubella virus during 1st 20 weeks
women planning to be pregnant should have MMR vaccine - can be tested for rubella immunity if needed and given 2 doses of MMR 3 months apart
pregnant women cant have MMR vaccine as its live
what are some features of congenital rubella syndrome
- Congenital deafness
- Congenital cataracts
- Congenital heart disease (PDA and pulmonary stenosis)
- Learning disability
chickenpox in pregnancy
mothers who have previously had chickenpox are immune and safe
women not immune to varicella may be offered the varicella vaccine before/after pregnancy
when not sure about immunity, test VZV IgG levels (positive = safe)
when they are not immune, can be treated with IV varicella immunoglobulins as prophylaxis against developing chickenpox - given within 10 days
when the rash starts - oral aciclovir if they present within 24 hours and >20 weeks gestation
congenital varicella syndrome occurs when infection occurs in first 28 weeks of gestation
describe some features of congenital varicella syndrome
- Fetal growth restriction
- Microcephaly, hydrocephalus and learning disability
- Scars and significant skin changes located in specific dermatomes
- Limb hypoplasia (underdeveloped limbs)
- Cataracts and inflammation in the eye (chorioretinitis)
listeria in pregnancy
gram-positive bacteria which causes listeriosis
more likely in pregnant women compared with non-pregnant individuals
asymptomatic, flu-like illness or pneumonia or meningoencephalitis
high rate of miscarriage or fetal death
transmitted in unpasteurised dairy products, processed meat and contaminated foods
avoid high risk foods like blue cheese
tx = amoxacillin and gentamicin
congenital cytomegalovirus
occurs due to CMV infection in mother during pregnancy
spread through saliva or urine of asymptomatic children
most cases do not cause congenital cytomegalovirus
features - FGR, microcephaly, hearing and vision loss, LD, seizures
congenital toxoplasmosis
infection with toxoplasma gondii parasite
usually asymptomatic
primarily spread by contamination with faeces from a cat that is a host
risk higher in later pregnancy
classic triad = intracranial calcification, hydrocephalus, chorioretinitis
parvovirus B19 in pregnancy
fifth disease, slapped cheek syndrome, erythema infectiosum
self limiting and usually fades over 1-2 weeks
non-specific viral symptoms followed by a rash 2-5 days later
exposure counts as 15 mins in the same room or face to face contact with someone who has the virus
complications in pregnancy - miscarriage, fetal death, severe fetal anaemia, hydrops fetalis, maternal pre-eclampsia-like syndrome
fetal anaemia is caused by parvovirus infection of the erythroid progenitor cells in the fetal bone marrow and liver - infection causes them to produce faulty blood cells that have shorter life span = less red blood cells results in anaemia = leads to heart failure known as hydrops fetalis
treatment - supportive and refer to fetal medicine to monitor for complications and malformations
what is pre-eclampsia-like syndrome (aka mirror syndrome)
rare complication of severe fetal heart failure
triad of hydrops fetalis, placental oedema and oedema in the mother
also features of hypertension and proteinuria
woman suspected of parvovirus infection need tests for IgM, IgG, and rubella antibodies (as a differential)
zika in pregnancy
spread by aedes mosquitos and sex with somone who is infected with the virus
no symptoms, minimal symptoms or mild-flu like illness
can lead to congenital zika syndrome in pregnancy - microcephaly, FGR, ventriculomegaly and cerebellar atrophy
pregnant woman who may have contracted the virus should be tested with viral PCR and antibodies to zika virus
refer to fetal medicine for close monitoring
no treatment for virus
measles in pregnancy
increased risk of preterm or intrauterine death
passed on during delivery - immunoglobulin infusion around delivery to prevent sub acute sclerosing panencephilitis
clostridium perfringes
caused by unsafe abortions
endometritis - sepsis - myglobinurea - aki - death
TB in pregnancy
high tb prevalence - give bcg vaccine
keep mother and baby separate till baby has jab
isoniazid infusion until mantoux test is positive
GBS
treat with IV benzylpenicillin
for women:
- positive high vaginal swab for GBS
- history of baby with GBS
- bacteruria
- fever
- <37 weeks
- chorioamnitis
antipsychotics
increased psychosis risk from possible higher prolactin
clozapine not given in breastfeeding
atypical - oral glucose tolerance testing
depot injections good in pregnancy
asthma
avoid LTRAs
less attacks but may be breathless from gravid uterus
CF
delivery vaginally
SLE
aspirin from positive test to birth
