chronic conditions during preg Flashcards
antenatal advice for mothers with epilepsy
take folic acid 5mg
aim for monotherapy
(risk of uncontrolled epilepsy outweighs risk of medication to the fetus)
sodium valporate + phenytoin drugs and their effects during pregnancy
sodium val - neural tube defects
phenytoin - assoc with cleft palate
which anti-epileptic is considered the least teratogenic
carbamazepine
lamotrigine dose during pregnancy
may need to be increased
(rate of congenital malformations are low)
breastfeeding in mums taking antiepileptics
generally considered safe
- except barbiturates (phenobarbital, primidone, topirmate)
effect of pregnancy on thyroxine levels
increase in levels of thyroxine-binding globulin (TBG)
–> causes increase in total thyroxine but does NOT affect the free thyroxine level
thyrotoxicosis in pregnancy commonest cause + consequence
untreated can increase risk of fetal loss, maternal heart failure + premature labour
commonest cause = Graves
transient gestational hyperthyroidism
activation of the TSH receptor by hCG
- hCG levels will fall in second + third trimester
management of thyrotoxicosis
propylthiouracil in 1st trimester
- is assoc with increaseed risk of severe hepatic injury
- used in place of carbimazole - assoc with increased risk of congen abnormalities
what level should maternal free thyroxine be kept at
should be kept in upper 3rd of normal –> avoid fetal hypothyroidism
block+replace + radioiodine contraindicated in preg
is thyroxine safe to use in preg + breastfeeding
yes !
hypOthyroidism in pregnancy
thyroxine safe
serum thyroid stimulating hormone measured in each trimester + 6-8wks postpartum
thyroxine dose in pregnancy
increase dose
- by up to 50% as early as 4-6wks of preg
obesity in pregnancy definition
> =30 BMI at first antenatal visit
“Explain that they should not try to reduce this risk by dieting while pregnant and that the risk will be managed by the health professionals caring for them during their pregnancy”
maternal risk of obesity
miscarriage
VTE
gestational diabetes
pre-eclampsia
dysfunctional/induced labour
PPH
wound infections
(higher c-section rates)
fetal risks of obesity
congenital anomaly
prematurity
macrosomia
stillbirth
increased risk of developing metabolic disorders - obesity
neonatal death
management of obesity in pregnancy
5mg (high dose) folic acid
OGTT at 24-28wks
if BMI >=35 - birth in consultant-led obstetric unit
> =40 - antenatal consultation with obstetric anaethetist + plan made
who gets an OGTT at 24-28wks
BMI >=30
previous macro baby (>=4.5kg)
prev gestational diabetes
1st degree rel with diabetes
ethnicity - south asian, black african, caribbean, middle eastern
early OGTT (<24wks) - if prev GDM (at booking)
when are pregnant women screened for anaemia
- booking visit (8-10wks)
- 28wks
Hb cut off for anaemia treatment based on trimester
1st = <110
2nd/3rd = <105
postpartum = <100
management of anaemia in pregnancy
oral ferrous sulfate/fumarate
- should be continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished
factors which reduce vertical transmission of HIV
maternal ART
mode of delivery - csection
neonatal ART
infant bottle feeding
mode of delivery in HIV +ve pregnant wome
vag delivery recommended if viral load <50 copies/ml at 36weeks
–> >=50 = csection
zidovudine infusion should be stated 4hrs before csection
should HIV +ve women breast feed
nah adivsed not to
neonatal antiretroviral therapy
zidovudine orally to if viral load <50
> =50 = triple ART
therapy should continue for 4-6weeks
rheumatoid arthritis + pregnancy
poorly controlled should be advised to defer conception until more stable
RA sx improve in preg but only resolve in a small minority
refer to obstetric anaethetist due to risk of atlanto-axial subluxation
Rheumatoid drugs considered safe in pregnancy
sulfasalazine + hydroxychloroquine
methotrexate needs stopped at least 6 months prior to conception
- low-dose corticosteroids may be used to control sx
- NSAIDs until 32wks - after risk of ealry close of ductus arteriosus
