Complications of pregnancy 2 Flashcards
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
What are the complications associated with diabetes in pregnancy?
- Macrosomia & polyhydramnios
- Miscarriage
- Shoulder dystocia
- Stillbirth
- Pre-eclampsia
When should thrombosis in pregnancy be suspected?
1) Older mothers
2) Increased BMI and a smoker
3) Pre-eclampsia
4) Decreased mobility
What is chronic hypertension in pregnancy?
Hypertension pre-pregnancy or at booking (<21 weeks gestation)
What is the systolic pressure for mild hypertension?
140-149
What is the systolic pressure for moderate hypertension?
150-159
What is the systolic pressure for severe hypertension?
> 160
How is gestational hypertension defined?
Hypertension which develops after 20 weeks gestation
What is the definition of pre-eclampsia?
New hypertension after 20 weeks associated with proteinuria
In which population of mothers is chronic hypertension most common?
Older mothers
If a pregnant woman is identified as having chronic hypertension what medication should she be started on?
Labetolol - 1st
Nifedipine - 2nd
Methyldopa
What is the target blood pressure for pregnant woman?
< 150/100
What antihypertensive medications should not be used during pregnancy?
ACE-inhibitors
ARB’s
What other steps can mothers take to lower their BP, apart from medication?
Lower dietary Sodium
How much protein must be detected in urine for pre-eclampsia to be diagnosed?
300mgs in 24 hours
Protein/creatinine ratio > 0.3
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
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
