conditions in pregnancy Flashcards
supplement for women with epilepsy
5mg folic acid prior to pregnancy
mx for epilepsy in pregnancy
mono therapy with levetiracetam, or lamotrigine, or carbamazepine
which AEDs can be taken in breastfeeding
all EXCEPT barbiturates
congenital problem with phenytion
cleft lip
if a mother is taking phenytion what else should be given
vit K in last month to prevent clotting disorder
risk with valproate
neural tube
consequence of cholestasis in pregnancy
preterm birth
symptoms cholestasis in pregnancy
itch (esp palms, soles, abdomen) // raised bilirubin // jaundice (20%)
when should labour be aimed for in cholestasis in pregnancy
37-38 weeks
mx cholestasis in pregnancy
ursodeoxycholic acid + vit K
when is biggest DVT/PE risk pregnancy
last trimester
why does pregnancy increase risk of DVT
hypercoagulable
invx DVT in pregnancy
USS (d dimer not helpful as usually raised in pregnancy)
invx PE pregnancy
ECG + CXR –> CTPA or V/Q
CTPA risks pregnancy
maternal breast cancer
V/Q risk pregnancy
childhood cancer
mx DVT/PE pregnancy
LWMH (also given prophylactically to high risk patietns)
what is contraindicated for DVT/PE mx in pregnancy
warfarin (+ DOAC)
APS assoc
SLE, other autoimmune conditions
features APS
recurrent feotal loss // venous or arterial thrombosis // livedo reticularis // pre-eclampsia, pulm HTN
invx APS
antibodies - antiocardiolipin, anti B2 // thrombocytopenia (low platelets) // raised APTT
primary thromboprophylaxis APS (NOT pregnant)
low dose aspirin
secondary thromboprophylaxis APS (NOT pregnant)
lifelong warfarin (INR 2-3 if first, 3-4 if second)
medications given to women with APS when pregnant
aspirin + LMWH
advice when getting pregnant RA
good control prior to pregnancy
which DMARDs are not safe in pregnancy
methotrexate or leflunomide // NSAIDs after week 32
what Hb indicates iron therapy in 1st trimester
<110
what Hb indicates iron therapy in 2nd/3rd trimester
<105
what Hb indicates iron therapy postpartum
<100
at what BMI is obesity a problem in pregnancy
30
mx obese pregnant women
5mg folic acid // OGTT at 24-28 weeks // BMI >35 = consultant
symptoms acute fatty liver of pregnancy
abdo pain // N+V // headache // jaundice // hypoglycaemia
invx acute fatty liver pregnancy
ALT >500
what happens to thyroid hormones in pregnancy
raised TBG, raised total thyroixine but not free thyroxine
Mx hyperthyroid in pregnancy
propythyiouracil in first trimester –> carbimazole 2nd semester
mx hypothyroid pregnancy
measure TSH each trimester and post partum / increase thyroxine by 50% ASAP
what is Gestational thrombocytopenia
low platelets as pregnancy progresses
ITP vs Gestational thrombocytopenia
ITP is dangerously low platelets // test for serum antiplatelet antibodies
mx ITP pregnancy
steroids
HTN in pregnancy
> 140 or ?90
pre-existing hypertension
> 140/90 before pregnancy or 20 weeks // no proteinuria or oedema
which Anti hypertensives are not allowed in pregnancy
STOP ACEi or ARBs
features pregnancy induced hypertension
high BP after 20 weeks - no proteinuria or oedema // resolves after pregnancy
mx HTN in pregnancy
oral labetolol or nifedipine (if asthmatic)
RG GDM
BMI > 30 // previous macrosmic baby // previous GDM // FH first degree with diabetes
screening for GDM
OGTT asap and again at 24-28 weeks
diagnosis GDM
fasting >5.6 // 2 hour >7.8
mx GDM if fasting glucose <7
trial of diet and exercise –> metformin –> short acting insulin
mx GDM if fasting glucose >7
start insulin
mx pre-existing diabetes in pregnancy
weight loss // stop meds except metformin + insulin // folic caid 5mg
