Haematology + AID in pregnancy

Question 1

Sickle cell disease in pregnancy

Answer 1

Crises
Prophylaxis Abx and heparin
Extra antenatal considerations
Post-natal anti-coag
Progesterone contraception recommended

Question 2

Sickle cell crisis in pregnancy

Answer 2

Prompt Mx
Hydration
O2
Analgesia
Screen for infection
Blood transfusion
Exchange transfusion

Question 3

Antenatal care in sickle cell disease in pregancy

Answer 3

do NOT use hydroxyurea (stop 3mo before pregnancy)
Low dose aspirin from 12w
Serial growth 4-24wks
Induction at 38w
Regional anaesthesia recommended

Question 4

Postnatal care in sickle cell disease in pregancy

Answer 4

LMWH - in hospital and 7d after discharge, 6w after C-sec

Question 5

Autoimmune thrombocytopaenic purpura in pregnancy

Answer 5

Serial monitoring on platetlets
Rx if <50x10^9 appracohing 37wk
Corticosteroids to supress auto-Ab
IVIG causes more rapid rise in platelet count
Vaginal delivery facilitated AVOID regional anaesthesia (80x10^9)
Cord blood sample for plt. count

Question 6

Rheumatoid Arthritis in pregnancy

Answer 6

If poorly controlled defer conception
Disease improves in pregnancy
Refer to obstetric anesthetist bc risk of atlanto-axial sublaxation

Question 7

Unsafe RA drugs in pregnancy

Answer 7

MTX NOT SAFE (stop 3m before conception)

Leflunomide not safe

Question 8

Safe RA drugs in pregnancy

Answer 8

Sulfasalazine, hydroxychlorquine
Low dose steriod for Sx
NSAIDs up to 32 wks (after risks PDA early closure)

Question 9

Coeliac Dx in pregnancy

Answer 9

Untreated a/w: spontaneous miscarriage, IUGR

Once gluten free diet established normal outcomes

Question 10

Inflammatory bowel disease in pregnancy

Answer 10

Uncontrolled Dx activity at conception a/w poorer outcomes
Flares in T1 and PP most commom
High dose (5mg) folate (+other vitamin supplementation)

Question 11

Risks of IBD in pregnancy

Answer 11

Increased c-sec rate (indicated in active perianal disease)
PTL
SGA

Question 12

IBD drugs in pregnancy

Answer 12

MTX CI

others: 5-ASA, azothioprine, ciclosporin, infliximab and CS are low risk

Question 13

IBD relapse Mx in pregnancy

Answer 13

Steroids (PO, IM, enema)

Question 14

Anaemia in pregnacy

Answer 14

Normal
110g/L T1
105 T2
100 T3
<70 urgent referral
Screened and booking and 28w
If low offer 100-200 PO iron recheck in 2-3w
Intrapartum:
Mx by consultant led unit
IV access and G+S
Active Mx of 3rd stage and PPH