complications in pregnancy Flashcards
what is pre-eclampsia
hypertension + end-organ dysfunction +/- proteinuria in pregnancy
why does pre-eclampsia happen
spiral arteries of placenta form abnormally and the resistance in them increases
when can pre-eclampsia occur
20+ weeks gestation
what is chronic hypertension
hypertension that existed before 20 weeks gestation
what is gestational hypertension
hypertension occurring after 20wks gestation
what are lacunae
pools of blood
formed when spiral arteries break down and maternal blood flows into the pools of blood and out though uterine veins
form at about 20wks
what are risk factors for pre-eclampsia
hypertension previous hypertension in pregnancy autoimmune conditions diabetes CKD 40+ BMI > 35 over 10 years since last pregnancy multiple pregnancy first pregnancy FH
what is the prophylaxis for pre-eclampsia
aspirin from 12 weeks if the patient has a high risk factor or more than one moderate risk factor
how does pre-eclampsia present
triad of hypertension, proteinuria, oedema
headache visual disturbances nausea vomiting reduced urine output brisk reflexes
what investigations could you do in pre-eclampsia
blood pressure urine dipstick - proteinuria 1+ LFTs - raised liver enzymes protein : creatinine >30mg/mmol albumin : creatinine >8mg/mmol FBC low platelets, low Hb, raised bilirubin, raised urea, raised creatinine, raised urate coagulation tests CTG for fetus
how do you manage pre-eclampsia
routinelly monitor BP, symptoms, proteinuria
labetolol is first line
nifedipine is second line
methyldopa is third line
IV hydralazine if severe
IV magnesium sulphate in labour to prevent seizures
fluid restriction
give steroids if the baby needs to be delivered <36wks
how do you manage gestational hypertension
aim for 135/85
urine dipstick weekly
bloods weekly
what is HELLP syndrome
complication of severe pre-eclampsia/eclampsia
haemolysis
elevated liver enzymes
low platelets
what is eclampsia
onset of seizures (tonic clonic) in pregnancy or within 10 days of delivery
what are features of eclampsia
hypertension
proteinuria
thrombocytopenia
raised AST
how do you manage eclampsia
medical emergency
IV magnesium sulphate
what is gestational diabetes
carbohydrate intolerance that first comes on in pregnancy
reverts back to normal after delivery
what is a normal OGTT result
fasting < 5.6mmol/l
at 2 hours <7.8mmol/l
what are risk factors for gestational diabetes
history of GD previous macrosomic baby >4.5kgs BMI>3 family history polyhydramnios
what is the screening test for gestational diabetes and when would you do it
oral glucose tolerance test
for patients with risk factors
what effect can diabetes have in each trimester, labour and in baby
1st - malformations
3rd - intrauterine death
labour - obstruction
neonatal - baby will be hypoglycaemic
how do you manage gestational diabetes
28-36wks 4x US scans per week to monitor fetal growth
insulin +/- metformin
glibenclamide if insulin or metformin can’t be used
if a patient has pre-existing diabetes and gets pregnant what should the management be
5mg folic acid daily from pre-conception to 12wks
retinal and renal assessment
induce labour at 38-40wks
maintain BG in labour with IV dextrose insulin infusion
what are complications of diabetes in pregnancy
baby - hypoglycaemia, shoulder dystocia, respiratory distress, still birth, jaundice
patient - pre-eclampsia, worsening of nephropathy, retinopathy, hypoglycaemia, infections
SROM
spontaneous rupture of membranes
what changes happen in the blood during pregnancy (hypercoagulable state)
increase in fibrinogen, factors VIII, VW, platelets
decrease in antithrombin III and fibrinolysis
what are risk factors for VTE in pregnancy
older age increased BMI IV drug use dehydration infections haemorrhage sickle cell disease operative delivery
what is prophylactic care for VTE
TED stockings
advise increased mobility
hydration
if at increased risk - LMWH
how can VTE present
usually unilateral and in calf dilated superficial veins muscle tenderness increased girth of leg pain in calf redness PE: SOB, cough, hypoxia, pleuritic chest pain, tachycardia, haemodynamic instability, tachypnoea, fever
what investigations could you do in VTE
ECG blood gas doppler V/Q scan lung scan CXR CT pulmonary angiogram
how do you manage VTE
LMWH started ASAP, stopped 6wks after delivery
can switch to warfarin after delivery
ROM
rupture of membranes
amniotic sac has ruptured
PROM
prelabour rupture of membranes
amniotic sac has ruptured before onset of labour
P-PROM
preterm prelabour rupture of membranes
amniotic sac rupture before labour and before 37wks gestation
what is premature birth
birth before 37wks gestation
baby is nonviable before 24wks
under 28wks is extreme preterm
what are risk factors for preterm labour
multiple pregnancy polyhydraminos APH pre-eclampsia infection APH
what are prophylaxis options for preterm labour
progesterone - given to patients with cervical length less than 25mm between 16-24wks
cervical cerclage - stitch in cervix, is cervical length <25mm between 16-24wks with previous premature birth or cervical trauma
how can you confirm rupture of membranes (ROM)
speculum examination - pooling of amniotic fluid in vagina
IGFBP-1
how do you treat ROM
erythromycin 250mg 4x daily for 10 days
induction of labour from 34wks
what is preterm labour with intact membranes
preterm labour with intact membranes
painful contractions
how do you diagnose preterm labour with intact membranes
speculum to assess cervical dilatation
how do you manage preterm labour
CTG or intermittent auscultation to monitor foetus tocolysis - nifedipine corticosteroids before 35wks IV magnesium sulphate delayed cord clamping
what is antepartum haemorrhage
haemorrhage in genital tract after 24wks but before delivery
what can cause antepartum haemorrhage
placenta praevia
placental abruption
lesions - cervical erosions of polyps
vasa praevia
