Drugs & diseases in pregnancy Flashcards
Effects of Benzodiazepines in pregnancy
Cleft palate, lip and shoulder
Effects of lithium in pregnancy
Heart defect e.g. Ebstein’s anomaly.
Thyroid defect
Floppy baby syndrome 😧
teratogenic anti-epileptics
Valproate, carbamazepine
Antidepressants often used in pregnancy
SSRI - sertraline, fluoxetine
Transmission of HIV from mum to babba
Vertical: via vaginal delivery and breast feeding
Antenatal care of HIV+ve pregnant mum
Treat any infections Can continue HAART 5mg of folic acid Plan delivery by 36weeks gestation. MDT care with HIV physician.
Safe drugs for DM in pregnancy
Insulin, metformin
Risks with hyperthyroidism in pregnancy
Malformations, prematurity, fetal death.
Good drug for hyperthyroidism in pregnancy
Propylthiouracil (less cross of placenta than carboimazole)
Effects of hyperthyroidism on fetus
High levels of TSH-R antibodies = fetal thyrotoxicosis.
Fetal TC, goitre, polyhydramnios, prematurity.
Causes of juandice in pregnancy
Obstetric cholestasis
Acute fatty liver of pregnancy
Viral hepatitis
HELLP
What to give an epileptic pregnancy woman in last 4 weeks of preg
Vitamin K if on hepatic ally excreted anti epileptic med.
And should be on 5mg of folic acid too!
2 drugs to give antiphospholipid syndrome woman
Aspirin and heparin
Rubella in pregnancy - affects, detection and treatment
Aetiology: airbourne.
S+S for mum: German measles, mild viral symptoms
Fetal effects: Eyes, hearing and cardiac malformations.
Mainly affected in first 16 weeks gestation. The earlier the infection the worse prognosis.
Rx: maternal IgM levels Offer antenatal screening to see if vaccinated (MMR). Offer termination in 1st trimester
CMV in pregnancy - affects and treatment
Aetiology: body fluids e.g. sexual contact.
S+S for mum: viral symptoms (fever, headache)
Effects for fetal: deafness, learning disability.
Toxoplasmosis in pregnancy
Aetiology: raw or undercooked meat, infected cat faeces.
S+S for mum: none, flu-like symptoms (fever, headache).
Fetal effects: only a risk if maternal infection within 3 months of conception. Epilepsy, hydrocephalus, neurological malformations, hepatosplenomegaly.
Rx = spiramycin to mother.
Herpes varicella zoster in pregnancy affects and treatment
If acute infection at term, avoid vaginal delivery - C/S.
Early pregnancy, no Hx of chickenpox with mum but contact with a chickenpox patient = give mum V.zoster antibodies as prophylaxis
Develop chickenpox in pregnancy = acyclovir.
Causes eye defects, microcephaly, low IQ, neuro problems.
Hepatitis B in pregnancy - detection, affect and treatment
Mum’s screening for antibodies in booking appt.
Neonatal hepatitis B, cirrhosis.
Rx = immunoglobulins and vaccinate mum and baby.
Complication of a UTI in pregnancy
Increase risk of preterm labour
Which GBS mum’s to treat with antibiotics
High risk factors: High vaginal swab positive. Bacteriuria culture positive. Premature labour Hx of previously GBS infected baby
ABx for GBS
Benzylpenicillin.
Effect on fetus of maternal Syphilis during pregnancy
Stillborn.
Who to give prophylactic LMWH to
Women who are at high risk of a VTE should be offered prophylactic LMWH throughout the antenatal period and will usually require prophylactic LMWH for 6
weeks postnatally.
Lower risk women should be offered LMWH postpartum only.
Risk factors for VTE in pregnancy
Thrombophilia e.g. Factor V Leiden, protein C or S deficiency. Pre-eclampsia Multiple pregnancy Obese Increased age (over 35) Smoker Parity >3 Hyperemesis IVF etc etc
Most common cause of hyperthyroidism in pregnancy
Graves disease. IgG antibodies involved in the patholphysiology of the disease can cross placenta and damage fetus (preterm, IUGR)
What receptors does labetalol act on
Combined alpha and beta blocker
Organism in Syphilis
Treponema pallidum
Women who has heart valve replacement and wants to get pregnant, what do you have to consider?
STOP WARFARIN!
Change to dalteparin/LMWH
Risks of anaemia in pregnancy
Low birth weight
Preterm
Management of obstetric cholestasis
Ursodeoxycholic acid
Piriton for itching
Common symptom in hyperthyroidism in pregnancy
Excessive vomiting
