health conditions Flashcards
what causes hypothyroidism?
an under or over consumption of iodine in the diet
how much iodine do pregnant women require in their diet?
250ug/day
what is the care pathway for hypothyroidism?
Bloods taken at first appt and then every 4 weeks to test the thyroid function
how much does thyroxine need to increase by in pregnancy?
30-50% by 4-6 weeks gestation
What drug is used to control hyperthyroidism?
Propylthiouracil in place of carbimazole- still kepton lowest dose possible
Pathway for hyperthyroidism in pregnancy?
Take bloods 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
implications of epilepsy in pregnancy?
neural tube defects in the baby,
physical and emotional stress
injury during seizures,
birth defects from AEDs
What percentage of babies acquired developmental issues from the use of sodium valporate?
40%
what is the pathway of care for epilepsy in pregnancy?
consultant lead care,
continue AED’s
5mg folic acid priorto pregnancy and continued unto the 13th week
regular scans
FBC- if Hb reduced increase AEDs
enter onto UK epilepsy in pregnancy register
What is PCOS caused by?
a hormone imbalance
high testosterone levels 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,interrupted menstrual cycle, pelvic pain, obesity, anxiety and depression supressed ovulation
risk factors of PCOS in pregnancy?
30-50% chance of misscarriage pre-eclampsia gestational diabetes macrosomia premature birth 50%chance of female fetus developing PCOS C Section increased insulin by 200-250% Delay in lactation
Is the care for PCOS women consultant lead or mw lead?
mw lead but may have referrals made to dietician if BMI 35+
what causes cholestasis?
bile stoppage in the ducts of the liver, which leads to increased concentration of bile acids in the blood.
when does cholestasis typically develop?
post 30 weeks
what are the symptoms of cholestasis?
itching of the hands and the feet, severe body itching, jaundice, dark urine
what should happen next for women who are suspected to have cholestasis?
Blood tests should be taken and Liver function tests and bile acids weekly.
what are the complications that can come from cholestasis?
if bile acid conc is 40umol/L 1-2% misscarriate rate
if 80umol/L 4-5%
so IOL is offered if bile acids are above 40
What is the management for cholestasis?
weekly lfts
IOL offered if BA 40+ umol/L
Offered anyway at 37-38 weeks even if BA normal
to manage bile acid levels aswell as itching- give ursodeoxycholic medication
in addition supplement vitamin K, as absorption is affected.
Why does anaemia occur?
haemodilution due to increased volume not being matched by the increase in plasma or RBC decrease in Hb and plasma protein conc= physiological anaemia.
normal ferritin range?
12-150ng/ml
what is the pathway for treating anaemia?
If Hb <105g/dl for iron supplementation ie ferrous fumarate, ferrous sulphate citron.
if under 90g/dl- obstetric referral
for iv/im iron supplement
FBC to monitor Hb.
In late pregnancy how much does the cardiac output increase by late pregnancy?
From 5 to 7 litres.
How many pregnancies in western countries are are affected by cardiovascular disease?
0.2-4%
Complications of cardiac conditions
misscarriage stillbirth, maternal cardiovascular compromise reduced placental perfusion causing fetal growth restriction. Inheritance, maternal death, cyanosis.
Care type for cardiac conditions
consultant with pre pregnancy counselling and multidisciplinary care, combined clinic cardiologist.
What if the woman has a severe cardiac condition?
Offer TOP before 16/40. commence anticoagulant therapy.
How to manage a woman who’s having a heart attack
In community call 999 ask for paramedics with a defib, sit upright, reassure
In hospital, sit upright, reassure, trolley, facial oxygen, document times, events and drugs administered.
Emergency team will insert cannula, obtain blood specimens, provide pain relief and stabilise woman, possible transfer to coronary care.
