Complications of pregnancy and labour Flashcards
What is the definition of anaemia during the first trimester of pregnancy?
Hb<110g/L
What is the definition of anaemia during the second/third trimester of pregnancy?
Hb<105g/L
What is the definition of anaemia postpartum?
Hb<100g/L
What are the symptoms of anaemia?
- Fatigue
- Pallor
- Weakness
- Headache
- Palpitations
- Dizziness
- Dyspnoea
- Irritability
- Pica
- Impairment fo temperature regulation
What are the consequences of anaemia on pregnancy?
- Decreased immune function
- Poor work capacity
- Disturbance of postpartum cognition/emotions
- Pre-term delivery
- LBW
- Placental abruption
What additional precautions may be necessary for women with anaemia during delivery?
- Delivery in hospital setting
- Available IV access
- Group & save
- Active management of third stage of labour
- Plans for excessive bleeding
How should a woman with pre-existing anaemia be managed?
Women with established iron deficiency anaemia should be given 100- 200mg elemental iron daily. Supplementation should be continued for 3 months
What are the main concerns with regard to a neonate born to a DM (esp. uncontrolled) mother?
- Neonatal hypoglycaemia
- Congenital heart defects
- Sacral agenesis
- Neonatal jaundice (due to polycythaemia)
- Macrosomia
What risks do DM present to a pregnancy?
- Miscarriage
- Congenital malformation
- Stillbirth
- Neonatal death
What is the preconception target for HbA1c?
<6.5% - women should be advised to continue with contraception until this target is met
What dose of folic acid should a DM mother take?
5mg/dy until 12/40
What is the first choice for long acting insulin in pregnancy?
Isophane insulin
How many times per day should a DM woman test her blood glucose?
4 - fasting, pre-meal, 1-hour post-meal and bedtime
What should the fasting blood glucose reading of a DM pregnant woman be?
5.3mmol/L
What should the 1-hour post-meal blood glucose reading of a DM pregnant woman be?
7.8mmol/L
From 28-36wks, how often should DM women be offered USS screening?
Every 4wks
What are the maternal complications of HTN in pregnancy?
- Placental abruption
- DIC
- Cerebrovascular accident
What are the foetal complications of HTN in pregnancy?
- IUGR
- Intrauterine death
- Prematurity
What defines mild gestational HTN?
BP 140/90-149/99
How is mild gestational HTN treated?
As an OP
Check BP weekly
Check for proteinuria at each antenatal visit
No additional blood tests required
What defines moderate gestational HTN?
BP 150/100-159/109
How is moderate gestational HTN treated?
As an OP
Treat with labetalol to 150/80-100
Check BP 2x per wk
Check for proteinuria at each antenatal visit
U&Es, FBC, LFTs in first instance. Do not repeat if there is no proteinuria at subsequent visits
What defines severe gestational HTN?
BP ≥160/110
How is severe gestational HTN treated?
Admit as an inpatient until BP ≤159/109 Treat with labetalol to 150/80-100 BP 4x daily Check for proteinuria daily Weekly U&Es, FBC, LFTs
When is proteinuria considered significant in pregnancy?
When proteinuria exceeds 300 mg/24 hours at any gestation
What is antepartum haemorrhage (APH)?
Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby
What are the most important causes of APH?
- Placental abruption
2. Placenta praevia
