high risk pregnancy - medical disorders Flashcards
what is the most common neurological condition in pregnancy ?
epilepsy
what advice should be given regarding folic acid with women who have epilepsy ?
5mg of folic acid should be taken daily preconception and for at least 12 weeks after
what advice should be given to epileptic women regarding vitamin K ?
prophylactic vitamin K should be taken orally everyday 20mg from 36 weeks until delivery
babies born to women who are taking anti convulsants are more prone to be born with a specific deficiency ..
increased risk of HDNB ( hemolytic disease of the newborn) due to vitamin K deficiency
what vitamin should the baby receive after birth ?
vitamin K
what medications are contraindicated for women taking anti epileptic drugs ?
combined oral contraceptives
progesterone only pills
depo-prova injections
what are the indications for the use of depo-prova injections in women using anti epileptic drugs ?
these injections must be taken every 10 weeks instead of every 12 weeks
what are the indications for steroid use inn pregnant women using anti-epileptic drugs ?
corticosteroid dosage must be doubled
what event constitutes an indication to take oral vitamin K supplements ?
risk of preterm delivery
where is the most appropriate place of delivery for women with epilepsy ?
consultant-led unit
should anti epileptic regimen be continued during pregnancy ?
yes
How can fits during labour be managed ?
intravenous diazepam ( 10 mg bolus followed by 2mg slow infusionn)
what analgesic is contraindicated in pregnant women with epilepsy ?
pethidine
What is the best next step inn management if diazepam doesn’t stop the fits ?
intravenous phenytoin
what is the problem with using carbamazepine in epileptic women and how is this problem treated ?
carbamazepine interferes with folate metabolism , so women who are on carbamazepine should be administered higher doses of folic acid
what risk do multiple seizures impose on the fetus ?
anoxia ( extreme form of hypoxia)
when is CS under GA indicated in epileptic women ?
in women who have multiple and repeated seizures
what must first be rules out if a pregnant women newly presents with seizures ?
eclamptic seizures must be ruled out
why is there an increased risk of thromboembolism during pregnancy ?
due to an increase in the level of coagulation factors increased fibrinogen levels increased platelete activation decreased protein s and antithrombin III venous stasis
what type of imaging can be used to detect VTE ?
compression venous ultrasound
MRI
what are the clinical manifestations of pulmonary embolisms ?
shortness of breath chest pain tachypnea tachycardia decreased oxygen saturation
what lab investigation would you ask for if you are suspecting pulmonary embolism ?
CBC - leukocytosis
ABG - hypoxia
what imaging can be used to detect pulmonary embolism ?
- ventilation/perfusion scanning
- CTPA
- chest x ray
in what order should imaging for pulmonary embolism be taken ?
first chest x ray if that is abnormal then
V/Q scan if that is abnormal then
CTPA
For a VTE score of 2 what is the management ?
prophylactic LMWH at least 10 days post partum
For a VTE score of 3 what is the management ?
prophylactic LMWH from 28 weeks and then 6 weeks postnatally
for a VTE score of 4 or more what is the management ?
prophylactic LMWH throughout the antenatal period and then 6 weeks postnatally
what is the most appropriate initial step in management in a case of suspected VTE ?
LMWH until the diagnosis is excluded by investigation
what additional investigation must be performed in ann obstreitics patient who has received unfractionated heparin ?
platelete count monitoring performed every 2-3 days from days 4-14 or until heparin is stopped
which anticoagulant is to be avoided during pregnancy ?
warfarin because it passes the placenta
what is the best line of management once pulmonary embolism is suspected ?
IV heparinization along with supportive oxygen therapy
what are the pregnancy complications associated with Antiphospholipid syndrome ?
pree eclampsia
placental abruption
fetal growth restriction
recurrent pregnancy loss
what are the criteria required to make a diagnosis of Antiphospholipid syndrome ?
need both clinical and laboratory criteria
What are the clinical criteria for the diagnosis of antiphospholipid syndrome ?
- thrombosis diagnosed by diagnostic imaging
- adverse pregnancy outcomes including fetal death at 10 weeks of gestation ( morphologically normal fetus)
- 3-1 or more preterm birth prior to 34 weeks due to preeclampsia or placental insufficiency
what are the laboratory criteria for the diagnosis of antiphospholipid syndrome ?
these results must be at least 12 weeks apart :
IgG or IgM anticardiolipin antibodies
antibodies to beta glycoprotein
Lupus anti-coagulant
what is the antepartum management required for APS ?
- 24 hour urine collection for creatinine clearance and total protein
- maternal echocardiogram ( to rule out endocarditis )
- liver function test
how is APS managed ?
low dose aspirin
low molecular weight heparin
if pre term delivery is expected should low molecular weight heparin be continued ?
recommended to switch to unfractionated heparin
when should an anomaly scan be performed ?
at 18 weeks
when shouyld we start monitoring fetal growth in women who are on annticoagulants ?
starting from week 20
what does the prognosis of a live birth in a patient with SLE depend on ?
- the activity of the disease at conception
- the occurence of subsequent flares
- co-existence of lupus nephritis
- development of APA
- presence of anti-SSA (Ro) antibodies
what is the association with the presence of Anti-Ro/Anti-La ?
congenital heart block
neonatal cutaneous lupus syndrome
how do we investigate for the assessment of disease activity in the pre-pregnancy consultation for patients with SLE ?
cardiac - ECG, echo
Respiratory - Chest Xray / CT
Renal - renal function test
Hematology/immunology - assessment of risk of thrombosis
what is the mainstream treatment used for active disease in pregnancy (SLE) ?
prednisone
if a pregnant woman with SLE is refractory to glucocorticoid use what should be used as an alternative ?
azathioprine
what is significant asymptomatic bacteriuria ?
presence of 100,00 or more bacteria per ml of urine in 2 freshly voided midstream specimens of urine
how should asymptomatic bacteriuria caused by e.coli be treated ?
use ampicillin antibiotic
what are the predisposing factors to pyelonephritis ?
- asymptomatic bacteruria
- urinary stasis
- atony of the ureter associated with the enlargement and compression of the uterus
what is the most common causative organism in pyelonephritis ?
e.coli
what are the routes of infection of E.coli ?
blood borne
lymphatic spread
ascending infection
what medication is used for daily prophylaxis of cystitis?
nitrofurantoin
what is the primary tool for evaluation of clinical symptoms of DVT ?
compression venous ultrasound
what effect does heparin have on APTT ?
prolongs APTT
what are the differential diagnosis of pyelonephritis in pregnancy ?
appendicitis
acute abdomen
other causes of fever and vomiting in pregnancy
what is the management of cystitis in pregnant women ?
nitrofurantoin for daily prophylaxis
