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Reproduction > Complications of Pregnancy 2 > Flashcards

Complications of Pregnancy 2 Flashcards

1
Q

Define chronic hypertension in terms of pregnancy

A

Hypertension existing pre-pregnancy or at booking (= 20 weeks gestation)

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2
Q

Define mild, moderate and severe hypertension

A
  • Mild, 140-149/90-99
  • Moderate, 150-159/100-109
  • Severe, 160 or > / 110 or greater
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3
Q

2 hypertensive disorders in pregnancy

A
  • Gestational hypertension (AKA pregnancy induced hypertension PIH),
  • Pre-eclampsia
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4
Q

Define gestational hypertension and pre-eclampsia

A
  • Gestational hypertension, Hypertension that develops after 20 weeks of pregnancy (categorised as mild, moderate or severe)
  • Pre-eclampsia, Hypertension that develops after 20 weeks + significant proteinuria
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5
Q

3 ways of confirming significant proteinuria

A
  • Dipstick test: Urine protein estimation >1+
  • Spot urinary protein: Creatinine ratio >30 mg/mmol
  • 24hrs urine protein collection >300 mg/day
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6
Q

A risk factor for chronic hypertension in pregnancy

A

Older mothers

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7
Q

Aim of BP in patients with chronic hypertension in pregnancy

A

<150/100

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8
Q

Treatment for chronic hypertension in pregnancy

A
  • Beta-blockers (Labetalol)
  • Calcium channel blocker (Nifedipine)
  • Centrally acting antihypertensive drugs (Methyldopa)
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9
Q

What should be monitored during the a pregnancy with chronic hypertension

A

Foetal growth

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10
Q

What does chronic hypertension increase the risk of

A

Placental abruption

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11
Q

Criteria to diagnose pre-eclampsia

A

-Proteinuria (>300mg/24hrs or creatinine ratio >30mg/mmol or dipstick protein estimation >1+

-Mild HT on 2 occasions more than 4hrs apart
or Moderate to severe HT

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12
Q

Pathophysiology of pre-eclampsia

A
  • Secondary invasion of maternal spiral arterioles by trophoblast impaired, leading to reduced placental perfusion
  • Imbalance between vasodilators/vasoconstrictors in pregnancy

Immunological and a genetic disposition

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13
Q

Risk factors for pre-eclampsia

A
  • First pregnancy
  • Extremes of maternal age
  • Ore-eclampsia in previous pregnancy
  • BMI >35
  • Multiple pregnancy
  • FHx of pre-eclampsia
  • Chronic hypertension
  • Renal disease
  • Pre-existing diabetes
  • Autoimmune disorders (SLE, antiphospholipid antibodies)
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14
Q

6 maternal complications of pre-eclampsia

A
  • Eclampsia (seizures)
  • Stroke
  • HELLP (haemolysis, Elevated liver enzymes, low platelets)
  • DIC (disseminated intravascular coagulation)
  • Pulmonary oedema
  • Cardiac + renal failure
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15
Q

5 foetal complications of pre-eclampsia

A

Impaired placental perfusion leading to;

  • IUGR (Intrauterine Growth Restriction)
  • Foetal distress
  • Prematurity
  • Increased PN (?perinatal?) mortality
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16
Q

Symptoms of pre-eclampsia

A
  • Headache + blurred vision
  • Vomiting + epigastric pain and tenderness
  • Sudden swelling in face + hands
  • Severe hypertension + papillodema
  • Reducing urine output + >3+ proteinuria
  • Clonus/brisk reflexes + seizures (eclampsia)
  • Tenderness over liver
17
Q

Biochemical abnormalities of pre-eclampsia

A
  • Raised liver enzymes
  • Raised urea and creatinine
  • Raised urate
18
Q

Haematological abnormalities of pre-eclampsia

A
  • Low platelets
  • Low haemoglobin, signs of haemolysis
  • Features of DIC
19
Q

Management of pre-eclampsia

A
  • Frequent BP checks + urine protein
  • Check symptomatology: headaches, epigastric pain, visual disturbances
  • Check for hyper-reflexia + tenderness over liver
  • Blood investigations
  • Foetal investigations
20
Q

What investigations would be carried in pre-eclampsia

A
  • Blood investigations: FBC (for haemolysis), LFT’s, Renal function tests (serum urea, creatinine, urate), coagulation test if indicated
  • Foetal investigation: Scan for growth + Cardiotocography (CTG)
21
Q

What would be considered if maternal or foetal condition deteriorates during pre-eclampsia and why

A

Induction of labour, regardless of gestation, as the only cure for pre-eclampsia is delivery

22
Q

When would steroids be given to mature foetal lungs for pre-term delivery

A

<36 weeks gestation

23
Q

Treatment of eclamptic seizures

A

Magnesium sulphate bolus + IV infusion

24
Q

Prophylaxis for pre-eclampsia in subsequent pregnancies

A

Low dose aspirin, from 12 weeks till delivery

25
Q

2 types of diabetes in pregnancy

A
  • Pre-existing diabetes (type 1 & less often type 2)

- Gestational diabetes

26
Q

3 characteristics of gestational diabetes

A
  • Carbohydrate intolerance with onset in pregnancy
  • Abnormal glucose tolerance that reverts to normal after delivery
  • More at risk of developing type 2 later in life
27
Q

Why does the insulin requirements of the mother increase in a healthy pregnancy

A
  • Human chorionic gonadotropin
  • Cortisol
  • Progesterone
  • Human placental lactogen

All have anti-insulin action

28
Q

What causes foetal hyperinsulinaemia and what’s the effect of it

A
  • Maternal glucose crosses the placenta, inducing increased insulin production in the foetus
  • The foetal hyperinsulinaemia cause Macrosomia (large baby)
  • Post delivery more risk of neonatal hypoglycaemia
29
Q

Having diabetes during pregnancy increases the risk of what

A
  • Miscarriage, stillbirth, perinatal mortality
  • Pre-eclampsia
  • Foetal macrosomia and polyhydramnios
  • Congenital abnormalities
  • Worsening of nephropathy, retinopathy, hypoglycaemia and reduced awareness of hypoglycaemia
  • Neonatal: impaired lung function, neonatal hypoglycaemia, jaundice
30
Q

What values for blood glucose and HbA1c are aimed for with diabetes during pregnancy

A

-Blood glucose: <5.3 mmol/L fasting
<7.8 mmol/L 1hr postprandial
<6.4 mmol/L 2hr postprandial
6mmol/L before bedtime

31
Q

Treatment for diabetes during pregnancy

A

Can continue with oral metformin but may need to change to insulin for tighter glucose control

32
Q

How does labour differ if diabetes is present during the pregnancy

A
  • Usually induced 38-40 weeks (earlier if foetal or maternal concerns)
  • Consider CS if significant macrosomia
  • Continuous CTG foetal monitoring during labour
  • Early feeding of baby to reduce neonatal hypoglycaemia
33
Q

Risk factors for gestational diabetes mellitus (GDM)

A
  • BMI >30
  • Previous macrosomic baby (>4.5 kg)
  • Previous GDM
  • FHx of diabetes
  • Polyhydramnios
34
Q

What is GDM associated with

A

-Some increase in maternal complications (chronic hypertension) and foetal complications (macrosomia)

35
Q

What is associated with a higher risk of maternal and foetal complications, GDM or type 1/2 diabetes

A

Type 1 or 2

36
Q

How to screen for GDM

A

If risk factors are present

  • Offer HbA1c at booking (first antenatal scan)
  • If HbA1c >43 mmol/L do OGTT
  • If OGTT normal repeat it at 24-28 weeks

-Can also offer a OGTT at 16 and repeat at 28 weeks is significant risk factor present (e.g. previous GDM)

37
Q

Management of GDM

A

Control blood sugars with;

  • Diet
  • Metformin/insulin if sugars remain high
  • 6-8 weeks post delivery check OGTT
  • Yearly check of HbA1c (due to higher risk of developing overt diabetes)

Reproduction (22 decks)

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