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Year 3 Repro (JK) > Complications of pregnancy 2 > Flashcards

Complications of pregnancy 2 Flashcards

1
Q

What is meant by chronic hypertension?

A

Hypertension pre-pregnancy or before 20 weeks gestation

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2
Q

Mild, moderate and severe chronic hypertension

A

mild - 140-49/90-99
moderate - 150-59/100-109
severe - >160/>110

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3
Q

What is meant by gestational diabetes?

A

new hypertension after 20 weeks

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4
Q

How to determine significant proteinuria - 3 ways

A

automated reagent strip >1
spot urinary protein:creatinine >30mg/mmol
24 hours urine protein collection >300mg/day

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5
Q

Important things to remember with chronic hypertension in pregnancy

A 
more common in older women 
may need to change anti-hypertensives
bp <150/100
super imposed PET
fetal growth 
placental abruption
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6
Q

Define PET

A

mild HT on 2 occasions 4 hours apart or moderate - sevre HT

PLUS proteinuria >300mgsms/24 hours

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7
Q

Pathophysiology of PET

A

genetic
- secondary invasion of maternal spiral arterioles by trophoblasts is impaired - decrease placental perfusion
- imbalance between vasodilators and vasoconstrictors
immunological

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8
Q

Risk factors for PET

A 
BMI>35
PET in previous pregnancy 
pregnancy interval >10 years 
family history of PET 
extremes of maternal age
chronic HT/renal disease/DM
first pregnancy 
multiple pregnancy
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9
Q

How is PET a multi-systemic multi-organ disorder?

A

renal, liver, vascular, cerebral, pulmonary

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10
Q

Maternal complications of PET

A 
eclampsia - seizures 
severe HT - cerebral haemorrhage and stroke
HELLP 
DIC 
renal failure 
pulmonary oedema and cardiac failure
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11
Q

HELLP

A

haemolysis, elevated liver enzymes, low platelets

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12
Q

Fetal complications of PET

A

impaired placental perfusion - IUGR, fetal distress, premature, mortality

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13
Q

List some symptoms/signs of PET

A 
headache, blurred vision, epigastric pain, pain below ribs, vomiting, sudden swelling of face/legs/hands
severe HT >3+ proteinuria 
clonus/brisk reflexes, papilloedema 
decreased urine output 
convulsions
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14
Q

Biochemical abnormalities in severe PET

A

raised liver enzymes, bilirubin if HELLP

raised urea, creatinine and urate

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15
Q

Haemotological abnormalities in severe PET

A

low platelets and hb

DIC

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16
Q

Only cure of PET

A

delivery

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17
Q

Managing PET

A

frequent bp and urine checks
check symptoms and signs eg clonus
bloods - FBC, LFT, renal, coagulation
fetal investigations - growth and CTG

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18
Q

Conservative management of PET

A 
Aim for fetal maturity
anti-hypertensives 
observe signs and investigations 
steroids for lung maturity <36 weeks 
IOL, CS
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19
Q

What % of women have PET?

A

5-8

20
Q

What % of PET is severe?

A

0.5

21
Q

What % of PET goes on to have eclamptic seizures?

A

0.05

22
Q

% of eclamptic seizures for ante, intra and post partum

A

ante - 38
intra - 18
post - 44

23
Q

3 treatments for seizures

A

IV magnesium sulphate infusion and bolus
avoid fluid overload - 80ml/hour
control bp - IV labetolol, hydralazine if >160/110

24
Q

Prophylaxis for PET

A

low dose aspirin from 12 weeks –> delivery

25
Q

Do women with PET have a higher risk of developing HT in later life?

A

yes

26
Q

2 signs of gestational diabetes

A

CHO intolerance with onset or first recognised in pregnancy

abnormal glucose that reverts to normal after pregnancy

27
Q

What are women with GDM more at risk of developing later in life?

A

Type 2 DM

28
Q

Why do women require more insulin in pregnancy?

A

human placental lactogen, hCG, cortisol and progesterone are anti-insulin

29
Q

Why does fetal hyperinsulinaemia occur in GDM and the consequence of this?

A

maternal glucose crosses placenta and induces more insulin production in baby - macrosomia

30
Q

In GDM what is there more risk of post-delivery?

A

neonatal hypoglycaemia

respiratory distress

31
Q

RISKs of diabetes on mother, fetus and neonate

A

infections - stillbirth - operative delivery/shoulder dystocia - macrosomia - neonatal hypos - fetal congenital abnormalities - miscarriage - PET - neonate jaundice and impaired lung maturity - worse nephropathy and retinopathy

32
Q

Preconception management of diabetes

A

better glycaemic control (4-7mmol/l and HbA1c <48mmol/mol)
folic acid high dose 5mg and diet
retinal and renal assessment

33
Q

During pregnancy management of diabetes

A

optimise glucose control - could continue metformin but may need to change to insulin
risk of hypos - glucagon injections/concentrated glucose solutions
watch for ketonuria and infections
repeat retinal assessment at 28 and 34 weeks
watch fetal growth

34
Q

Management of diabetes - labour and after

A

observe for PET
IOL early (38-40 weeks) or elective CS if macrosomia
dextrose insulin infusion in labour
CTG, fetal feeding early
resume pre pregnancy insulin regimen after delivery

35
Q

Risk factors for GDM

A 
high BMI 
previous baby >4.5kg
previous GDM 
FH of diabetes 
risk for diabetes eg Asian
polyhydramnios 
recurrent glycosuria
36
Q

Screening for GDM

A

if risk factor - offer HbA1c, >6% do OGTT

if OGTT negative repeat at 24-28 weeks

37
Q

Management of GDM

A

control blood sugars - metformin/insulin, diet
check OGTT 6-8 weeks PN
yearly HbA1c

38
Q

Virchow’s triad

A

stasis
vessel wall injury
hypercoaguability

39
Q

Why is pregnancy hypercoaguable and pathophysiology of this

A

to prevent bleeding post delivery
increased fibrinogen, clotting factors, platelets
decrease in natural anticoagulants - antithrombin 3
increase in fibrinolysis

40
Q

Why is there increased stasis in pregnancy ?

A

progesterone and enlarging uterus

41
Q

When may there be vascular damage in pregnancy?

A

delivery/CS

42
Q

Risks for VTE in pregnancy

A 
older, parity, BMI 
sickle cell disease, haemophilia 
smokers, IVDU
PET
dehydration/hyperemesis 
previous VTE, decreased mobility, operative delivery
infection, haemorrhage
43
Q

VTE prophylaxis in pregnancy

A

TED stockings
increase mobility and hydration
anti-coagulation

44
Q

signs/symptoms of VTE

A

sore, swollen, red leg
cough, SOB, hypoxia, pleural rub, chest pain on breathing
calf muscle tenderness
tachycardia

45
Q

Investigations of VTE

A

V/Q scan, ECG, doppler, blood gases

CTPA

Year 3 Repro (JK) (33 decks)

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