Chronic disease in pregnancy Flashcards by aderonke adesanoye

Warfarin effects in pregnancy

It is tertogenic= fetal warfarin syndrome

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Effects of 1st trimester exposure to warfarin

Physical abnormalities

Nasal hypoplasia
Short limbs and digits

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Effects of 2nd-3rd trimester exposure to warfarin

CNS abnormalities

Hydrocephalus
Hypotonia
Intellectual disability

Ocular
- Cataracts

Stillbirth

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Greater risk of VTE occurs …

Immediately after delivery/ 6-weeks post-partum

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Pre-existing risk factors for VTE in pregnancy

Previous VTE/ FH

Obesity

Thrombophilia

Smoking

HTN, DM, hypercholesterolaemia

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Obstetric risk factors for VTE

Multiple pregnancies

Pre-eclampsia

C-section

Prolonged labour

Ovarian hyperstimulation syndrome

Post-partum haemorrhage >1L

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Mechanical thromboprophylaxis only is indicated when?

Antenatally in score >3

Post-natally for score 2+.

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Surgical management of VTE

IVC filter

- Indicated when medical fails

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1st line pharamacological management of VTE in pregnancy is…

LMWH= enoxaparin (clexhane)

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The enoxaparin dose for a pregnant woman <50Kg is..

40mg BD or 60 mg OD

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The enoxaparin dose for a pregnant woman 50-69Kg is..

60mg BD or 90mg OD

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The enoxaparin dose for a pregnant woman 70-89Kg is..

80mg BD or 120mg OD

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The enoxaparin dose for a pregnant woman 90-109Kg is..

100mg BD or 150mg OD

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The enoxaparin dose for a pregnant woman 110-125Kg is..

120mg BD or 180mg OD

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The last dose of LMWH must be given at least ______ before an epidural and next dose given at least ______ post epidural

12 hours before

4 hours post

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The last dose of unfractionated heparin must be given at least ______ before an epidural and next dose given at least ______ post epidural

At least 4 hours before

1 hour post.

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Medical management of massive PE

Unfractionated heparin

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VTE prophylaxis should be started at ______ if there are ______

From 28 weeks, If there are 3 risk factors

1st trimester if there are 4+ risk factors

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_______ period carries the highest risk for the exacerbation of seizure frequency

Immediate post-partum

Obstetric risks of epilepsy in pregnancy

Spontaneous miscarriage
APH/PPH
Hypertension
Induced labour
C-section
IUGR

What AED are considered safest in pregnancy

Carbamazepine

Keppra

Lamotrigene

What AED are considered least safe in pregnancy

Sodium valproate

Topiramate

_______ is given to minimised congenital defects associated with AED in pregnancy

High dose (5mg) folic acid
- From before pre-conception

Delivery plan for women with epilepsy

Must be done in hospital

- Continue with AEB during labour

Babies born to epileptic mums taking enzyme inducing AEB should have _______ to prevent ______

Vitamin K IM | - Prevents haemorrhage disease of new born

Examples of enzyme-inducing AEBs

Carbamazepine Phenytoin Phenobarbital Topiramate

Contraception preferred for women with epilepsy

IUD/ IUS/ Depot injection | - Not affected by enzyme-inducing AEDs

Definitons of anaemia in pregnancy

First trimester - <110 Second - <105 Post-partum - <100

When is anaemia screened for in pregnancy

Booking 24 weeks - Multiple pregnancy 28 weeks

Risks associated with anaemia in pregnancy

Increased risk of PPH Puerperal sepsis Symptoms impacting daily activities Foetus/ infant - IUGR/ low birth weight - Pre-term - Delay in cognition and language

Most common cause of anaemia in pregnancy is...

Iron deficiency anaemia

Management of iron-deficiency anaemia in pregnancy

Dietary - 27mg recommended daily intake towards end of pregnancy Foods: meat, fish, poultry, vitamin c

Recommened daily dose of elemental iron

40-80mf ferrous sulphate/ ferric salts

Contraindications of IV iron

Decompensated liver disease Bacteraemia 1st trimester Previous anaphylaxis/ transfusion reaction

All pregnant women are advised to take _____ daily supplement of folic acid

400mcg

Folate deficiency in pregnancy is associated with _____ defects

Neural tube

Features of obstetric cholestasis

Pruritus with no rash - Especially in palms and soles Reduced appetite Abdominal pain Signs - Dark urine - Pale, greasy stools - Jaundice (uncommon)

Obstetric cholestasis usually presents when?

Third trimester

The biggest complication of obstetric cholestasis is...

Stillbirth

What population has the highest risk of obstetric cholestasis

South-Asian

Symptomatic relief in obstetric cholestasis

Ursodeoxycholic acid Pruritis - Emollients Insomnia - Antihistamines

Women with obstetric cholestasis have to have induced labour at...

37 weeks | - Due to risk of stillbirth

Investigations of obstetric cholestasis

Bloods - LFTs: abnormal liver enzymes, - FBC - Urea Abdominal ultrasound Rule out other causes - Viral Hepatitis - Primary biliary cirrhosis - Acute fatty liver of pregnancy

Risks of obstetric cholestasis in pregnancy [5]

Dermatitis Pre-term birth Neonatal morbidity/ stillbirth Meconium aspiration C-section

Definition of hyperemesis gravidum

Vomiting in pregnancy leading to - 5% pre-pregnancy weight loss - Dehydration - Electrolyte imbalance

Complications of hyperemesis gravidum

Wernicker's encephalopathy Mallory-Weiss tear Fetal: small for gestation, pre-term birth