Conditions in Pregnancy Flashcards
Why is epilepsy affected in pregnancy
Enhanced metabolism of drugs Increased volume of distribution Increased protein so drugs bound Decreased compliance with meds Hormone changes = more seizure N+V
Why are AED teratogenic
Anti-folate
AED and contraception
Induce p450 so will affect OCP / POP
What do you do pre-conception
Change drugs
Best control on lowest dose
Aim monotherapy
Folic acid 5mg
What drugs safest
Lamotrigine
Carbamazepine
What do you not give
No sodium valproate
Phenytoin
What do you do antenatal
Consultant clinic
May need to increase doe
Vit K as risk of clotting issues in newborn
What do you do intrapartum
Aim vaginal
CS if status
Continue AED
Treat seizure
What do you do post partum
Vitamin K to baby
Reduce AED to pre-preg dose
Contraception
What are complications
Infant epilepsy IUGR Microcephaly Perinatal mortality Congenital malformation
What are the DDx
Eclampsia = much more common Migraine Panic attack Phaeochromocytoma HYpoglycaemia Hyponatraemia Intracranial mass Stroke
What is major cause of hyperthyroid
Graves
What is the relevance of thyroid and pregnancy
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
What are the symptoms of hyperthyroid
Tremor Weight loss Irritable Exophthalmos Tachycardia Restless
Why does normal pregnancy mimc hyperthyroid
Tachy
Warm moist skin
Goitre
Anxiety
What is show on bloods
Raised T3/4
Suppressed tSH
Growth scans
Look for Ab as fatal
How do you treat
PTU
Carbimazole
BB for Sx
What do you do for pre-pregnancy
Anti-thyroid
Surgery for goitre / dysphagia / stridor
What are the complications
Miscarriage
IUGR
Pre-mature
Fertility reduced
What should you beware of
TSH receptor stimulating Ab
Can cause fatal thyrotoxicosis if cross placenta
Test in newborn
What is CI in preg
Radioactive iodine
What is post-partum thyroiditis
Hyperthyroid
Followed by hypothyroid
Normal thyroid
How do you Dx post partum
Clinica Sx
TFT
Monitor for hypo
What do majority have
Thyroid peroxidase Ab
How do you treat
Hyperthyroid = self-liming
BB
Treat hypothyroid
Withdraw Rx after 6-12 months to see if need long term
Why does anti-thyroid not work
Doesn’t work due to gland destruction
What causes hypothyroid
Primary due to underactive
Thyroiditis
Removal of thyroid due to hyperthyroid
Thyroid peroxidase Ab in Graves cross placenta
What are symptoms of hypothyroid
Tiredness
Heat intolerance
Hair loss
Dry skin
How do you treat
Increase thyroxin
Optimise t4 pre-conception
What are risks of hypothyroid
Miscariage IUGR Infertility Oligomenorrhoea Menorrhagia Fertility Post partum depression
Thrombocytopenia
Physiological OR
ITP
How do you treat
Steroid if very severe
Transfusion in newborn
What caues thrombocytopenia in newborn
Polycythaemia
ITP Ab cross placenta
What are the symptoms of obstetric cholestasis
Intense pruritus - due to build up No rash Jaundice Raised bilirubin Cholestatic picture on LFT
When is cholestasis / fatty liver common
3rd trimester
How do you treat
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
What do you do with reagards to delivery and why
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
What are the symptoms of acute fatty liver (rapid accumulation of fat leading to hepatitis)
Abdo pain N+V Headache Jaundice HYpoglycaemia PET if severe
How do you Dx acute fatty liver and how do you Rx
ALT elevated
Raised WBC
Coagulopathy
Stenosis on USS
Rx = prompt delivery of baby as high risk of liver failure and mortality
What do you do when treating RA but want to get pregnant
Defer conception until stable
What is not safe
Methotrexate
Stop 6 months prior (men and women)
What is safe
Sulfalasine
Hydroxychloroquine
Low dose steroid
NSAID until 32 weeks
What is risk of RA during delivery
Atalntoaxial subluxation
What causes amniotic fluid embolism
Amniotic fluid passes into mothers blood which contains fatal cells leading to immune reaction
What are main RF
Maternal age
Induction of labour
How does it present
Usually around time of labour / delivery but can occur post partum SOB Cough Resp failure Tachy Hypotension Fever Haemorrhage
How do you Rx
Supportive
Critical care
