Health conditions Flashcards
how many women get eclampsia?
1-2%
What is the incidence of fits in different stages of the natal period
AN- 38%
PN-44%
IP- 18%
How is eclampsia managed?
To lower the blood pressure labetelol iv or oral- nifedipine in asthatics with a prompt onset of 5 minutes,
magnesium sulphate for the management of seizuires
How is eclampsia managed in labour?
Regular bp monitoring, continued anti-hypertensives, magnesium sulphate, continous CTG, strict fluid balance, IV access, Active management in the 3rd stage however, syntometrine or ergometrine avoided as increase BP.
What is the cause of hypothyroidism?
In 90% of cases hashimotos thyroiditis.
Under of over consumption of iodine in the diet
How much ion do pregnant women require each day?
250ug/day
what is the pathway for managing hypothyroidism?
bloods taken at booking, then every 4 weeks, testing tft.
How much is thyroxine increased by?
30-50% from 4-6 weeks gestation
what drugs are used to control hyperthyroid in pregnancy?
Propylthiouracil in place or carbimazole- kept at lowest dose
What is the pathway for hyperthyroidism in pregnancy?
Blood taken at booking to measure TFT then every 4 weeks to stabilise TSH and T4.
What are the symptoms of epilepsy?
Jerking and shaking, losing awareness and staring into space. Becoming stiff, strange sensations
What implications can epilepsy have on pregnancy?
Neural tube defects in the fetus, physical and emotional stress, injury during seizures, birth defects from AEMs
What percentage of babies acquired developmental issues from the use of sodium valporate?
40%
what is the pathway for managing epilepsy in pregnancy?
Consultant lead care, continue AEDs, 5mg folic acid prior to pregnancy up until the 13th week, regular scans, FBC checks if hb is reduced then AEDs are increased.
Enter onto uk epilepsy register
What is the cause of PCOS?
a hormone imbalance, high testosterone which antagonises the effect of oestrogen
What percentage of women are affected by PCOS?
6-15% BUT 50% remain undiagnosed
symptoms of PCOS?
Excessive hair growth, acne, cysts on ovaries pelvic pain obesity anxiety and depression suppressed ovulation
Risk factors of PCOS in pregnancy?
30-50% chance of stillbirth, preeclampsia, gestatioal diabetes, macrosomia, premature birth, 50% chance of female fetus developing PCOS. Higher C section rates, delay in lactation, increased insulin
How much does insulin levels increase by in pregnancy for PCOS women?
200-250%
What is the cause of cholestasis?
Bile stoppage in the bile ducts of the liver, which leads to increased conc of bile salts in the blood.
When does cholestasis typically develop?
post 30 weeks
Symptoms of cholestasis?
itching of hands and feet, severe body itching, jaundice, dark urine.
Management of cholestasis in pregnancy?
Blood tests and bile acids taken weekly.
IOL if BA 40+ umol/L
offered IOL at 37-38 weeks even with stabilised BA levels.
Supplemented vit K, and ursodeoxycholic medication to reduce BA and itching.
Complications of increased BA on pregnancy?
40umol/L or above 1-2% misscarriage rate
80umol/L 4-5% rate. IOL offered to all women if bile acids are above 40.
What is the physiological cause for anaemia in pregnancy?
Haemodilution due to increase in blood volume not being matched by increase in plasma and HB.
Pathway to manage anaemia?
if hb <105g/dl for iron supplementation
ie ferrous sulphate, citon or ferrous fumarate.
Of under 90g/dl make obstetric referral for iv/im iron supplementation FBC to monitor hb.
In late pregnancy, how much does the cardiac output increase by
from 5 to 7 litres
how many pregnancies in western countries are affected by cardiovascular disease?
0.2-4%
Complications of cardiac conditions in pregnancy?
Misscarriage, stillbirth, reduced placental perfusion, fetal growth restriction, inheritance, maternal death, cyanosis
Care pathway for cardiac issues
Consultant care with pre pregnancy counselling and multidisciplinary care combine clinic with cardiologist
What is offered to women if they are affected by a serious cardiac condition in pregnancy?
they are offered at TOP before 16/40, if the decide against they will be advised to take anticoagulant therapy.
How to manage a heart attack in pregnancy?
in community- call 999 ask paramedics for a defibrillator, sit woman upright, reassure
in hospital- sit the woman upright, apply facial oxygen,. document the times events and drugs administered.
Emergency team to insert cannula, obtain blood samples, provide pain relief, stabilise woman and possibly transfer to coronary care.
