Major disorders of pregnancy Flashcards
Which women are more at risk of hyperemesis gravidarum?
NB peak onset = 8-12 weeks
-First pregnancy
-Obesity
-Hyperthyroidism
-Trophoblastic disease
-Multiple pregnancy (large placental site)
-Hormone administration eg fertility treatment
How does HG present?
-N+V
-Excessive salivation
-Weight loss (5% of pre-pregnancy weight)
-Reduced urine output
-Epigastric pain
-Ketonuria
DIAGNOSTIC CRITERIA =
-5% pre-pregnancy weight loss
-Dehydration
-Electrolyte imbalance
How should you investigate HG?
-PUQE (Pregnancy-Unique Quantification of Emesis)
–<6 = mild, 7-12 = moderate, 13-15 = severe
-Exclude other causes eg UTI, thyrotoxicosis
How should HG be managed?
-Can often be managed with reassurance and self-help
-If dehydrated and not tolerating oral fluids –> admission (IV fluids + promethazine / ondansetron)
-In prolonged disease
–Vitamin supplements especially thiamine
What are the potential complications for the foetus and mother in HG?
FOETUS
-Growth restriction + pre-term birth
MOTHER
-Wernicke’s encephalopathy
-Mallory-Weiss tear
-Ventral pontine myelysis
-Acute tubular necrosis
What are the definitions of IUGR + SGA for the newborn + foetus?
IUGR = foetus that has failed to achieve its growth potential by a specific gestational age
SGA (foetus) = estimated foetal weight <10th percentile for gestational age
SGA (newborn) = birth weight <10th percentile for gestational age
What causes the different categories of SGA?
WRONG SMALL
-?Wrong dates
ABNORMAL SMALL
-Chromosomal / structural anomalies
-Infection eg rubella, CMV, toxoplasmosis, syphilis
-Genetic syndromes
NORMAL SMALL
-Genetic / constitutional
-Multiple pregnancy
STARVED SMALL (asymmetrical)
-Placental infarction / abruption / malposition
-HTN, anaemia, chronic disease
-Pre-eclampsia
-Drug / alcohol abuse
What pregnancies are considered high risk for IUGR?
-Multiple pregnancy
-Previous IUGR (20% recurrence)
-Pre-eclampsia (40%)
-Maternal medical disorders eg HTN, renal disease, APLS
-Drug abuse, smoking
How should IUGR be screened for?
-Dating scan (repeat in 2 weeks if concerned)
-Identify high risk pregnancies
-Low threshold if growth scan suspicious of SGA even in low-risk mothers
How should SGA pregnancies be monitored and managed?
-Growth scans + fundal height every 2-3 weeks
-If umbilical artery dopplers are normal –> aim for IOL at 37 weeks
-If umbilical artery dopplers abnormal and baby pre-term –> consider delivery + steroids
-Close monitoring of foetal movements, ?amniocentesis, weight checks for mother
What complications can arise from IUGR in pregnancy?
PREGNANCY
-Oligohydramnios
-Preterm birth
-Birth asphyxia –> brain damage
NEONATE
-Poor stress tolerance of vaginal delivery
-Hypothermia
-Hypoglycaemia
-Polycythaemia (chronic hypoxia)
-Infection risk
-Complications of prematurity eg intraventricular haemorrhage, respiratory distress, necrotising enterocolitis
What sign is seen on ultrasound to distinguish between normal small and IUGR?
-Head sparing effect
-Placental insufficiency means the limited blood supply is directed to the head as a matter of prioritising the brain
What are the main complications arising from LGA newborns?
-Increased risk of shoulder dystocia
-Prone to hypoglycaemia, hypocalcaemia and polycythaemia
In a woman with reduced foetal movements, what is important to ask for in the history>
-Duration - how long since last foetal movement felt?
–Ask about pattern as may be subjective eg more aware when lying down in bed
-Any vaginal loss, pain, systemic symptoms?
-Is baby SGA?
-Any problems with pregnancy so far?
What is the main priority when assessing reduced foetal movements and how should it be monitored?
-Rule out intra-uterine death
-Doppler if <28 weeks
-If >28 weeks doppler and:
–If no heartbeat –> USS
–If heartbeat –> CTG
