Conditions Associated with Pregnancy Flashcards
Acute Fatty Liver
Extensive fatty change in the liver
Acute hepatorenal failure (spectrum of PET), DIC and hypoglycaemia
High maternal and fetal mortality
Malaise, vomiting, jaundice, vague epigastric pain and THIRST (1st symptom)
Mx Early diagnosis Prompt delivery Correction of clotting factors and hypoglycaemia Supprotive: Dextrose, fluid balance, Dialysis
Associated with defect in mitochondrial fatty acid oxidation
Intrahepatic Cholestasis of Pregnancy
Itching without skin rash and abnormal LFTs
Abnormal sensitivity to cholestatic effect of oestrogen
Associated with sudden stillbirth due to toxic effects of bile salts –> fetal arrhythmia
Increased tendency of haemorrhage –> Vit K 10mg/day from 36 weeks
Serum Bile acids raised
Key diagnostic test is a fasting serum bile acid concentration of greater than 10 mmol/L.
Mx UDCA (ursodeoxycholic acid) helps to relieve itching IOL at 38 weeks CTG bad at predicting poor outcome 6 week follow up of LFTs
Causes of Jaundice specific to Pregnancy
HELLP
Hyperemesis Gravidarum
Acute Fatty Liver
Intrahepatic Cholestasis of Pregnancy
Antiphospholipid syndrome
Antiphospholipid syndrome is an autoimmune disorder characterised by:
Arterial and venous thrombosis
Adverse pregnancy outcomes (for mother and fetus)
Raised levels of antiphospholipid (aPL) antibodies
Placental thrombosis –> recurrent miscarriage, IUGR, early PET
Managed as high risk pregnancy –> serial USS and IOL by term
Dx 1+ clinical criteria Vascular thrombosis 1+ death of fetus >10 weeks PET or IUGR requiring delivery <34 weeks 3+ fetal loss <10 weeks with no medical explanation
With laboratory criteria measured twice >3 months apart
Lupus anticoagulant
High anticardiolipin antibodies
Anti-B2 Glp I antibody
Pro-Thrombotic Disorders
HAPPF
Hyperhomocystienaemia
Antiphospholipid Syndrome
Protein C and S deficiency
Prothrombin gene mutation
Factor V Leiden Heterozygosity
Manage the same as APLS
Venous Thromboembolic Disease
Pregnancy = pro-thrombotic state
Increased clotting factors
Decreased fibrinolytic activity
Altered blood flow form mechanical obstruction and immobility
Diagnosis: CXR, ABG, CTPA, V/Q Scan
ECG changes of normal pregnancy can mimic PE
1% of pregnant women have DVT
Thrombosis normally ileofemoral
Thromboprophylaxis
Compression stockings
LMWH (antenatal and postnatal)
Sensitising Events in Pregnancy
TOP or ERPC Ectopic Vaginal bleeding <12 weeks or if heavy External Cephalic Version Invasive uterine procedure e.g. amniocentesis or CVS Intrauterine death Delivery Trauma
At which times should Anti-D be given?
1500IU
Given at 28 weeks to all Rh neg women
Decreased rate of isoimmunisation from 1.5% to 0.2%
Given within 72hr of any sensitising event
Some benefit gained even within 10 days
Includes threatened or actual miscarriage after 12 weeks or before if the uterus is instrumented
Postnatal within 72 hours of delivery if baby Rh positive
Kleihauer test = assess number of fetal cells in maternal circulation –> detect larger fetomaternal haemorrhages that will require larger doses of Anti-D
Complications of Rhesus Haemolytic Disease
Mild –> neonatal jaundice
Neonatal anaemia (haemolytic disease of the newborn)
More severe –> in utero anaemia –> cardiac failure, ascites and anaemia
usually worsens with subsequent pregnancies as matenral antibodies increase
Identification of Rhesus Disease
Screening for antibodies in maternal blood
Maternal sampling for fetal cells –> assess rhesus status when father is heterzygote (i.e. a significant chance of rhesus disease occurring)
Amniocentesis may be used but is risky as sensitising event
Anti-D Levels
<10IU/ml –> unlikely to be a problem, check every 2-4 weeks
> 10IU/ml –> further investigation indicated
Anti-kell antibodies are less predictive of severity therefore USS is utilized earlier
Assessing Severity of Haemolytic Anaemia
Assessed using USS
Doppler of MCA, measuring peak systolic velocity very sensitive identifying fetal anemia before 36 weeks
Used fortnightly in at-risk women
Very severe anaemia detected as fetal hydrops (Hb <5g)
If anaemia suspected –> USS guided fetal blood sampling
Insertion of needle into umbilical or intrahepatic vein
1% risk of loss
Neonatal checks for neonate born to Rh neg women
FBC
Blood film
Bilirubin
In Utero Transfusion
If anaemia confirmed, Rh neg, high haematocrit, CMV neg blood
Transfusion injected into umbilical vein
Repeat often until 36 weeks –> then deliver
