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Obs & Gynae > Conditions in Pregnancy > Flashcards

Conditions in Pregnancy Flashcards

1
Q

Why is epilepsy affected in pregnancy

A 
Enhanced metabolism of drugs
Increased volume of distribution
Increased protein so drugs bound
Decreased compliance with meds 
Hormone changes = more seizure
N+V
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2
Q

Why are AED teratogenic

A

Anti-folate

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3
Q

AED and contraception

A

Induce p450 so will affect OCP / POP

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4
Q

What do you do pre-conception

A

Change drugs
Best control on lowest dose
Aim monotherapy
Folic acid 5mg

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5
Q

What drugs safest

A

Lamotrigine

Carbamazepine

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6
Q

What do you not give

A

No sodium valproate

Phenytoin

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7
Q

What do you do antenatal

A

Consultant clinic
May need to increase doe
Vit K as risk of clotting issues in newborn

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8
Q

What do you do intrapartum

A

Aim vaginal
CS if status
Continue AED
Treat seizure

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9
Q

What do you do post partum

A

Vitamin K to baby
Reduce AED to pre-preg dose
Contraception

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10
Q

What are complications

A 
Infant epilepsy
IUGR
Microcephaly
Perinatal mortality 
Congenital malformation
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11
Q

What are the DDx

A 
Eclampsia = much more common 
Migraine
Panic attack
Phaeochromocytoma
HYpoglycaemia
Hyponatraemia
Intracranial mass 
Stroke
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12
Q

What is major cause of hyperthyroid

A

Graves

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13
Q

What is the relevance of thyroid and pregnancy

A

T4/T3/TBG increased to maintain free T4
TSH falls in 1st
HCG increases as mimics
bHCG similar action as TSH so if bHCG increases so does TSH
TSH = hyperemesis
Iodine deficiency as given to foetus and increased excretion in urine

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14
Q

What are the symptoms of hyperthyroid

A 
Tremor 
Weight loss
Irritable
Exophthalmos
Tachycardia
Restless
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15
Q

Why does normal pregnancy mimc hyperthyroid

A

Tachy
Warm moist skin
Goitre
Anxiety

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16
Q

What is show on bloods

A

Raised T3/4
Suppressed tSH
Growth scans
Look for Ab as fatal

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17
Q

How do you treat

A

PTU
Carbimazole
BB for Sx

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18
Q

What do you do for pre-pregnancy

A

Anti-thyroid

Surgery for goitre / dysphagia / stridor

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19
Q

What are the complications

A

Miscarriage
IUGR
Pre-mature
Fertility reduced

20
Q

What should you beware of

A

TSH receptor stimulating Ab
Can cause fatal thyrotoxicosis if cross placenta
Test in newborn

21
Q

What is CI in preg

A

Radioactive iodine

22
Q

What is post-partum thyroiditis

A

Hyperthyroid
Followed by hypothyroid
Normal thyroid

23
Q

How do you Dx post partum

A

Clinica Sx
TFT
Monitor for hypo

24
Q

What do majority have

A

Thyroid peroxidase Ab

25
Q

How do you treat

A

Hyperthyroid = self-liming
BB
Treat hypothyroid
Withdraw Rx after 6-12 months to see if need long term

26
Q

Why does anti-thyroid not work

A

Doesn’t work due to gland destruction

27
Q

What causes hypothyroid

A

Primary due to underactive
Thyroiditis
Removal of thyroid due to hyperthyroid
Thyroid peroxidase Ab in Graves cross placenta

28
Q

What are symptoms of hypothyroid

A

Tiredness
Heat intolerance
Hair loss
Dry skin

29
Q

How do you treat

A

Increase thyroxin

Optimise t4 pre-conception

30
Q

What are risks of hypothyroid

A 
Miscariage
IUGR 
Infertility 
Oligomenorrhoea
Menorrhagia
Fertility
Post partum depression
31
Q

Thrombocytopenia

A

Physiological OR

ITP

32
Q

How do you treat

A

Steroid if very severe

Transfusion in newborn

33
Q

What caues thrombocytopenia in newborn

A

Polycythaemia

ITP Ab cross placenta

34
Q

What are the symptoms of obstetric cholestasis

A 
Intense pruritus - due to build up
No rash
Jaundice
Raised bilirubin 
Cholestatic picture on LFT
35
Q

When is cholestasis / fatty liver common

A

3rd trimester

36
Q

How do you treat

A

UDCA for itch and improve outcome
Vit K as deficient due to cholestasis
Anti-histamine / topical emollient for Sx
Chlorophenamine - sleep and itch
Close monitoring of LFT
Exclude other causes - gall stone, acute fatty liver, hepatitis

37
Q

What do you do with reagards to delivery and why

A

IOL at 37 to reduce risk of still birth / PPH and premature
Baby’s liver immature an can’t deal with bile salts
Also bile salts can constrict veins = hypoxia
Follow up to make sure LFT back to normal

38
Q

What are the symptoms of acute fatty liver (rapid accumulation of fat leading to hepatitis)

A 
Abdo pain
N+V
Headache
Jaundice
HYpoglycaemia
PET if severe
39
Q

How do you Dx acute fatty liver and how do you Rx

A

ALT elevated
Raised WBC
Coagulopathy
Stenosis on USS

Rx = prompt delivery of baby as high risk of liver failure and mortality

40
Q

What do you do when treating RA but want to get pregnant

A

Defer conception until stable

41
Q

What is not safe

A

Methotrexate

Stop 6 months prior (men and women)

42
Q

What is safe

A

Sulfalasine
Hydroxychloroquine
Low dose steroid
NSAID until 32 weeks

43
Q

What is risk of RA during delivery

A

Atalntoaxial subluxation

44
Q

What causes amniotic fluid embolism

A

Amniotic fluid passes into mothers blood which contains fatal cells leading to immune reaction

45
Q

What are main RF

A

Maternal age

Induction of labour

46
Q

How does it present

A 
Usually around time of labour / delivery but can occur post partum
SOB
Cough
Resp failure
Tachy
Hypotension
Fever
Haemorrhage
47
Q

How do you Rx

A

Supportive

Critical care

Obs & Gynae (23 decks)

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