Chronic disease in pregnancy Flashcards
Warfarin effects in pregnancy
It is tertogenic= fetal warfarin syndrome
Effects of 1st trimester exposure to warfarin
Physical abnormalities
- Nasal hypoplasia
- Short limbs and digits
Effects of 2nd-3rd trimester exposure to warfarin
CNS abnormalities
- Hydrocephalus
- Hypotonia
- Intellectual disability
Ocular
- Cataracts
Stillbirth
Greater risk of VTE occurs …
Immediately after delivery/ 6-weeks post-partum
Pre-existing risk factors for VTE in pregnancy
Previous VTE/ FH
Obesity
Thrombophilia
Smoking
HTN, DM, hypercholesterolaemia
Obstetric risk factors for VTE
Multiple pregnancies
Pre-eclampsia
C-section
Prolonged labour
Ovarian hyperstimulation syndrome
Post-partum haemorrhage >1L
Mechanical thromboprophylaxis only is indicated when?
Antenatally in score >3
Post-natally for score 2+.
Surgical management of VTE
IVC filter
- Indicated when medical fails
1st line pharamacological management of VTE in pregnancy is…
LMWH= enoxaparin (clexhane)
The enoxaparin dose for a pregnant woman <50Kg is..
40mg BD or 60 mg OD
The enoxaparin dose for a pregnant woman 50-69Kg is..
60mg BD or 90mg OD
The enoxaparin dose for a pregnant woman 70-89Kg is..
80mg BD or 120mg OD
The enoxaparin dose for a pregnant woman 90-109Kg is..
100mg BD or 150mg OD
The enoxaparin dose for a pregnant woman 110-125Kg is..
120mg BD or 180mg OD
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
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.
Medical management of massive PE
Unfractionated heparin
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
_______ 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
