Complications of pregnancy 2 Flashcards by Martin Beattie

What are the complications of hypertensive disorders during pregnancy?

Maternal:

Eclampsia seizures
Cerebral haemorrhage or stroke
Haemolysis
Elevated liver enzymes
Low platelets
Renal failure
Pulmonary oedema

Fetal:

Impaired placental perfusion leading to fetal distress or prematurity

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What are the complications associated with diabetes in pregnancy?

Macrosomia & polyhydramnios
Miscarriage
Shoulder dystocia
Stillbirth
Pre-eclampsia

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When should thrombosis in pregnancy be suspected?

1) Older mothers
2) Increased BMI and a smoker
3) Pre-eclampsia
4) Decreased mobility

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What is chronic hypertension in pregnancy?

Hypertension pre-pregnancy or at booking (<21 weeks gestation)

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What is the systolic pressure for mild hypertension?

140-149

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What is the systolic pressure for moderate hypertension?

150-159

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What is the systolic pressure for severe hypertension?

> 160

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How is gestational hypertension defined?

Hypertension which develops after 20 weeks gestation

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What is the definition of pre-eclampsia?

New hypertension after 20 weeks associated with proteinuria

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In which population of mothers is chronic hypertension most common?

Older mothers

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If a pregnant woman is identified as having chronic hypertension what medication should she be started on?

Labetolol - 1st

Nifedipine - 2nd

Methyldopa

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What is the target blood pressure for pregnant woman?

< 150/100

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What antihypertensive medications should not be used during pregnancy?

ACE-inhibitors

ARB’s

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What other steps can mothers take to lower their BP, apart from medication?

Lower dietary Sodium

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How much protein must be detected in urine for pre-eclampsia to be diagnosed?

300mgs in 24 hours

Protein/creatinine ratio > 0.3

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What is the pathophysiological process involved in pre-eclampsia?

1 - Secondary invasion of maternal spiral arterioles by trophoblasts resulting in reduced placental perfusion

2 - Imbalance between vasodilators and vasoconstrictors

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What are the risk factors for pre-eclampsia?

1 - 1st pregnancy

2 - Extremes of maternal age

3 - >10 years between pregnancies

4 - BMI > 35

5 - +ve FH for pre-eclampsia

Which organs are affected by pre-eclampsia?

Kidneys

Liver

Brain

Eyes

Vascular

What are the complications of pre-eclampsia in the mother?

1 - Seizures

2 - Stroke

3 - HELLP

4 - DIC

5 - Renal failure

What does HELLP stand for in terms of complications of pre-eclampsia?

H - Haemolysis

EL - Elevated Liver enzymes

LP - Low platelets

What are the complications of pre-eclampsia for the fetus?

Intra-uterine growth restriction (IUGR)

Prematurity

Fetal distress

What are the symptoms of severe PET?

1 - Heache

2 - Blurred vision

3 - Pain below ribs

4 - Oedema of hands, face and legs

5 - Seizures

How is pre-eclmapsia seizures treated?

Magneisum sulphate bolus + IV infusion

What is the prophylactic treatment for pre-eclampsia?

Low dose aspirin

What happens to insulin requirements of mother during pregnancy?

Increase

Why do insulin requirements of the mother increase throughout pregnancy?

Pregnancy hormones (hCG, progesterone etc.) have an anti-insulin effect

What are the implications for the fetus when a mother has poorly controlled blood glucose?

Macrosomia

Increases in which hormones cause macrosomia in the fetus?

Glucose Insulin

What are the effects of diabetes on the mother and fetus?

- Fetal congenital abnormalities - Miscarriage - Macrosomia - Shoulder dystocia - Increased risk of pre-eclampsia

How is diabetes managed during pregnancy?

1 - Optimise glucose control 2 - Retinal & renal assessment 3 - Observe for pre-eclampsia 4 - Labour induced 38-40 weeks

What are the risk factors for gestational diabetes?

1 - BMI \> 30 2 - FH of diabetes 3 - Previous macrosomic baby

How is gestational diabetes screened for during pregnancy?

1 - Risk factor present 2 - HbA1C levels checked 3 - If HbA1C \> 6% then OGTT

How is gestational diabetes managed during pregnancy?

1) Control blood sugars via diet

What are the components of Virchows triad?

Stasis Hypercoaguability Damage to vessel wall

How are each of the components of Virchows triad affected by pregnancy?

Stasis - Progesterone & growing fetus Hypercoaguability - Increased levels of fibrinogen, Factor VIII, VW Factor, platelets Vessel wall damage - Can occur during delivery or C-section

As a result of significant changes to the components of Virchow's triad, what is the mother at increased risk of?

Venous-thrombo embolism

What are the risk factors for venous-thromboembolism during and after pregnancy?

- Older mothers - Increased BMI - Smokers - Pre-eclampsia - Sickle cell disease

What are prophylactic measures that can be taken to reduce the risk of VTE's during pregnancy?

1 - TED stockings 2 - Increase mobility 3 - Stay hydrated

What are the signs of VTE?

1 -Pain in calf 2 - Swollen leg 3 - Breathless

What investigations can be performed to diagnose a VTE?

Doppler of leg V/Q scan