Conditions in Pregnancy Flashcards
What needs to happen to the dose of levothyroxine dueing pregnancy
Increased usually by around 30-50%
What can happen if hypothyroidism medication is not altered during pregnancy
Miscarriage, anaemia, small for gestation age, pre-eclampsia
Which hypertensive medications need to be stopped
ACEI, ARBs, thiazide and thiazide like diuretics
Which hypertensive medications are safe in pregnancy
Labetelol, calcium channel blockers and alpha blockers
What effects can pregnancy have on epilepsy
Worsen seizure control due to lack of sleep, stress, hormonal changes, altered medication regimes
Which drugs are safest in pregnancy for epilepsy
Levetiracetam, lamotrigine and carbamazepine
Which drugs are avoided in pregnancy
Sodium valproate and phenytoin
Which medications can be continued for rheumatoid arthritis during pregnancy
Hydroxychloroquine and sulfasalazine
What can happen to arthritis symptoms during pregnancy
Can improve due to release of increased amounts of steroids, then may flare up after delivery
Why is pregnancy considered a diabetogenic state
Due to the increased insulin resistance - insulin antagonists are produced by the placenta
What can happen in pregnancy of a patient who is a type 1 diabetic
Increased insulin requirements so tight control can lead to hypoglycaemia. Progression of diabetic neuropathy and diabetic ketoacidosis
Effects of diabetes on fetus and neonates
Congenital manformations, macrosomia, polyhydramnios, birth risks, risk of stillbirth and neonatal death, polycythaemia and jaundice, fetal hypoglycaemia
Effects of diabetes on pregnant mother
Miscarriage, pre-eclampsia, infection, caesarean, early induction of labour, poor progress in labour, macrosomia
When should pregnancy be advised against in T2DM
If HbA1c is above 86
What additional management is given to T2DM mothers
Aspirin 75mg from 12 weeks (pre-eclampsia), early dating and anomaly scan, regular BP and urinalysis, 4 weekly growth scans from 28 weeks
What is obstetric cholestasis associated with
Increased risk of stillbirth
Presentation of obstetric cholestasis
Pruritis, fatigue, dark urine, pale greasy stools, jaundice. Typically later in pregnancy - third trimester
Treatment of obstetric cholestasis
Ursodeoxycholic acid, water soluble Vit K if clotting is deranged
What happens in acute fatty liver of pregnancy
There is rapid accumulation of fat within the liver cells causing acute hepatitis. There is impaired processing of fatty acids in the placenta
Presentation of acute fatty liver disease of pregnancy
General malaise and fatigue, nausea and vomiting, jaundice, abdominal pain, anorexia, ascites. Normally in 3rd trimester
Investigation and results of acute fatty liver in preg
LFTs will show elevated ALT and AST, also may have raised bilirubin, WBC, derranged clotting and low platelets
Treatment of acute fatty liver of pregnancy
Delivery of baby and treatment of acute liver failure. Can lead to liver failure and mortality so needs promt treatment
What happens in rhesus incompatibility
Mothers anti-rhesus D antibodies cross the placenta into the fetus -> fetus then is rhesus D positive -> these autoantibodies attach themselves onto the RBCs of fetus and immune system attacks them -> haemolysis -> haemolytic disease of the newborn
Ways to manage rhesus incompatibility
Prevention of sensitisation using IM anti-rhesus D injections
When is anti-rhesus D antigen given
28 weeks gestation if babys blood group is found to be rhesus positive, in antepartum haemorrhage, amniocentesis procedures, abdominal trauma, and within 72 hours of sensitisation event
What does the Kleinhauer test measure
How much fetal blood has passed in to the mothers blodo to determin whether further doses of anti-D are required
Risk of UTIs during pregnancy
Preterm birth, low birth weight, pre-eclampsia
Which is most common cause of UTI in pregnancy
E.coli
Treatment of UTIs in 3rd trimester of pregnancy
Trimethroprim - in 1st trimester as it is a folate antagonist and causes congenital malformatoins
Treatment of UTIs in 1st trimester of pregnancy
Nitrofurantoin - avoided in 3rd trimester as risk of neonatal haemolysis
Management of anaemia in pregnancy
Iron replacement, supplementary iron, and if low B12 then IM hydroxocobalamin or oral cyanocobalamin
Risk factors for VTE in pregnancy
Smoking
Parity >3
Age >35
BMI >30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
FHx of VTE
thrombophilia
IVF pregnancy
Guidelines for starting VTE prophylaxis in pregnancy
From 28 weeks if there are 3 risk factors
First trimester if there are 4 or more risk factors
Which medications are given for VTE prophylaxis
LMWH unless contraindicated - enoxaparin
What circumstances is VTE prophylaxis stopped in pregnancy
Until 6 weeks postnatally
Temporarily stopped during labour
Not started if there is PPH, spinal anaesthesia or epidurals
What is hyperemesis gravidarum
Severe form of nausea and vomiting in pregnancy with 5% weight loss compared with before pregnancy. Dehydration and electrolyte imbalance
Score to assess severity of hyperemesis gravidarum
Pregnancy-unique quantification of emesis score (PUQE)
Management of hyperemesis gravidarum
Antiemetics, PPIs, acupressure on wrist, ginger
Anti emetics used in pregnancy
Prochlorperazine, cyclizine, ondansetron, metoclopramide
Presentation of nausea and vomiting in pregnancy
Start in the first trimester peaking at 8-12 weeks, often resolving by 16-20 weeks. More severe in molar pregnancies, multiple pregnancies, first pregnancy or overweight
Risks and complications of gestational diabetes
Macrosomia, birth trauma, shoulder distocia, increased induction, increased LSCS, pre-eclampsia, neonatal hypoglycaemia, polycythaemia, increased perinatal mortality rate
Risk factors for GDM
BMI >30, previous macrosomic baby, previous GDM, FHx of diabetes, ethnic origin of asian, middle eastern, southern europe, afro caribbean. Glycosuria
What classifies as gestational diabetes
Carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition in pregnancy.
How to test for gestational diabetes
2 oral 75g oral glucose tolerance test for women with risk factors at 26-28 weeks. If after 2 hours >7.8mmol/L or fasting >5.6mmol/L
Management of gestational diabetes
Diet and exercise advice, metformin or insulin, 4 weekly growth scans from 24 weeks, delivery by 40 + 6 weeks
