complications of pregnancy 2 Flashcards
what is defined as chronic hypertension in pregnancy ?
hypertension either pre-pregnancy or at booking < 20 weeks gestation
what is significant proteinuria ?
> 1+ on strip
creatinine ratio >30mg/mmol
24 hour urine >300mg
how do you treat hypertension in pregnant women ?
labetalol
nifedipine
what is pre-eclampsia ?
mild HT on 2 occasions more than 4 hours apart
proteinuria >300mgms/24 hours
what are risk factors for PET ?
first pregnancy extremes of maternal age previous pre-eclampsia pregnancy interval > 10 years BMI >35 family history of PET multiple pregnancy underlying medical disorders - renal, DM, SLE
what are maternal complications of PET ?
eclampsia severe hypertension HELLP - heamolysis, elevated liver enzymes, low platelets DIC renal failure pulmonary oedema
what are symptoms and signs of severe PET ?
headache blurred vision epigastric pain vomiting sudden swelling of hands/face brisk reflexes, papilloedema
what are biochemical abnormalities in severe PET ?
raised liver enzymes, bilirubin if HELLP
raised urea and creatinine, raised rate
low Hb
how do you manage PET ?
frequent BP checks and symptomology
CTG for fetus
labetolol, nifedipine, methyldopa
steroids
induction of labour
how do you treat seizures in PET ?
magnesium sulphate bolus IV
control BP - labetalol
low dose aspirin from 12 weeks in future pregnancy
what hormones in pregnancy have an anti-insulin action ?
human placental lactogen
progesterone
hCG
cortisol
what does maternal diabetes increase the risk of ?
congenital abnormalities - cardiac, sacral agenesis miscarriage fetal macrosomia shoulder dystocia stillbirth PET infection
what are risk factors for gestational diabetes ?
increased BMI previous macrocosmic baby previous GDM family history of diabetes race polyhydramnios recurrent glycosuria in current pregnancy
how do you screen for GDM ?
HbA1C if over 43
OGTT
how do you manage GDM ?
diet
metformin/insulin
