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Repro > Complications in Pregnancy 2 > Flashcards

Complications in Pregnancy 2 Flashcards

Hypertensive Disorders Thrombosis Diabetes

1
Q

Define Chronic Hypertension

A

Hypertension pre-pregnancy or at booking

Diastolic BP 90-99 Systolic 140-149 - Mild
100-109 150-159 - Moderate
> 110 > 160 - Severe

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2
Q

Define Gestational Hypertension

A

Pregnancy induced

Blood pressure change after 20 weeks

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3
Q

Define Pre-eclampsia

A

New hypertension after 20 weeks with significant proteinuria

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4
Q

How to measure proteinuria for diagnosis of pre-eclampsia

A

Automated reagent strip protein
Spot urinary protein: creatinine ratio greater than 30 mmg/mol
24 hour urine protein collection >30mg per day

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5
Q

Advice to women with chronic hypertension for pre-pregnancy care

A

Change Antihypertensive medication -ACEis, ARBs, diuretics
Low dietary sodium
Aim to keep BP below 150/100

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6
Q

What should be monitored for in pregnant women with essential chronic hypertension?

A

Monitor foetal growth
Monitor for super-imposed pre-eclampisa
Placental abruption - higher incidence

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7
Q

Criteria to diagnose Pre-eclampsia

A

Mild HT on 2 occasions more than hours apart
Moderate to severe HT
+ proteinuria >300mgs / 24 hrs

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8
Q

2 Ways a women may be predisposed to pre-eclampsia

A

Immunologically
Genetically
- secondary invasion of mothers arterioles by trophoblasts impaired; reduced perfusion of placenta
-imbalance between vasodilators and vasoconstrictors

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9
Q

Risk factors for pre-eclampsia

A 
First pregnancy
Extremes of maternal age
Pre-eclampsai in previous pregnancy
Pregnancy interval > 10 years
 BMI >35
Family history
Multiple pregnancy
Underlying conditions
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10
Q

Which underlying conditions pose a risk to developing pre-eclampsia?

A

Hypertension
Diabetes
Renal disease
Autoimmune eg SLE, Antiphospholipid antibodies

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11
Q

General complications of pre-eclampsia

A

Multisystem multi-organ disorder - affects renal, liver, vascular, cerebral and pulmonary systems

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12
Q

Maternal complications of pre-eclampsia

A 
Eclampsia
Cerebral haemorrhage or stroke
DIC
Renal Failure
Pulmonary oedema
Cardiac failure
HELLP - Haemolysis, Elevated Liver enzymes, Low Platelets
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13
Q

Fetal complications of pre-eclampsia

A 
Impaired placental perfusion
IUGR
Distress
Prematurity
Increased Perinatal mortality
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14
Q

Signs and symptoms of Pre-eclamptic Toxaemia

A 
Severe hypertension and proteinuria
Clonus/brisk reflexes
Papilloedema
Epigastric tenderness
Reducing urine output
Convulsions (ECLAMPSIA)
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15
Q

Biochemical results of PET

A

Raised liver enzymes
Raised urea and creatinine
Raised urate

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16
Q

Haematology Results for PET

A

Low Platelets
Low Haemoglobin
DIC

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17
Q

Management of PET

A

Monitor BP and urine protein
Bloods -FBC, LFT, Renal function (serum urea, creatinine, urate), Coagulation
Fetal investigations

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18
Q

What fetal investigations are used in management of PET

A

Scans for growth

Cardiotocography

19
Q

Conservative management of PET

A

Close observation
Antihypertensives
Steroids for fetal lung maturity if less than 36 weeks

20
Q

Management if patient unstable in PET

A

Caesarean

Risk can continue into puerperium - monitor post-delivery

21
Q

Rate of PET

A

5-8%pregnant women

22
Q

Of the percentage of women who have PET in pregnancy, how many will experience seizures?

A

0.05%

23
Q

Treatment of seizures in PET

A

Magnesium sulphate bolus and IV infusion
Control BP- IV labetolol, Hydrallazine if greater than 160/110
Avoid fluid overload - 80ml/hr

24
Q

Prophylaxis for PET

A

Low dose aspirin after 12 weeks in subsequent pregnancy

25
Q

Which type of diabetes is becoming more prevalent in women bearing children?

A

Type 2

Women are bearing children at later ages

26
Q

Why do the insulin requirements increase in diabetics during pregnancy?

A

Human placental lactogen, progesterone and HCG are all anti-insulin

27
Q

What can occur in the fetus should increased insulin requirements of diabetic mother not be treated?

A

Glucose will cross placenta causing hyperinsulinaemia in the fetus
Results in macrosomia

28
Q

What are the risks to the baby post-delivery if the mother has diabetes?

A

Greater risk of respiratory distress and hypoglycaemia

29
Q

5 implications of diabetes on mother, fetus and neonate

A 
Foetal congenital abnormalities
Miscarraige
Foetal macrosomia, polyhydramnios
Operative delivery, shoulder dystocia
Stillbirth, increased perinatal mortality
30
Q

Complications of diabetes in pregnacny

A

Increased likelihood of pre-eclampsia
Worsening of maternal nephropathy, retinopathy, hypoglycaemia
Reduced awareness of hypos
Infection
Neonatal- impaired lung maturity, hypoglycaemia, jaundice

31
Q

Management of diabetes preconception

A

Glycaemic control
Folic acid
Dietary advice
Retinal and renal assessment

32
Q

Management of diabetes during pregnancy

A

Optimise glucose control
Gauge levels of anti-diabetic meds needed
Address risk of hypos and awareness
Monitor ketonuria and infection
Repeat retinal assessments at 28 adn 34 weeks
Monitor fetal growth

33
Q

Management of diabetes during pregnancy/prior to labour

A

Monitor for PET
Consider induction
Consider caesarean if signs of macrosomia
Maintain BG in labour with dextrose and insulin
Continuous CTG monitoring in labour

34
Q

Management of diabetes after delivery

A

Feed baby soon after birth to prevent neonatal hypoglycaemia

Return mother to pre=-pregnancy diabetic regimen

35
Q

Risk factors for Gestational Diabetes

A

Increased BMI over 30
Previous macrosomic baby
Previous GDM
Family history of diabetes
High risk group- Asian
Polyhydramnios or big baby in current pregnancy
Recurrent glycosuria in current pregnancy

36
Q

Screening for Gestational Diabetes

A

HbA1c if risk factor present
OGTT
Repeat OGTT at 24 and 28 weeks

37
Q

Management of Gestational Diabetes

A

Control sugars - diet, metformin, insulin
Post-delivery check ; OGTT 6-8 weeks later
Yearly HbA1c checks

38
Q

Why is there increased risk of VTE in pregnant women?

A

Hypercoagulable state
Stasis - Progesterone,mobility may decrease later in pregnancy
Vascular damage during delivery /CS

39
Q

What causes the increased hypercoagulable state in pregnant women?

A

Increased fibrinogen, factor VIII, vWF, platelets
Decreased anticoagulants - antithrombin III
Increase in fibrinolysis

40
Q

What factors increase the risk of VTE in pregnancy?

A 
Older women, parity
Increased BMI
Smokers
IV drug user
PET
Dehydration- hyperemesis
Decreased mobility
Infection
Operative delivery, prolonged labour
Haemorrhage, blood loss >21
Previous VTE/Thrombophilia/Strong fam hx of VTE
Sickle cell disease
41
Q

Management of VTE in pregnancy

A

Thrombo-Embolic-Deterrent (TED) stockings
Advice on mobility and hydration
If 3 or more risk factors - prophylactic anticoagulation

42
Q

Signs and Symptoms of VTE

A 
Pain in calf
Increased girth of leg
Calf muscle tenderness
Breathlessness
Pain on breathing
Cough
Tachycardia
Hypoxic
Pleural rub
43
Q

Investigations of VTE

A 
Blood Gas
ECG
Doppler
V/Q Scan
CTPA

Treat with anticoagulation

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