Management of Pre-Existing Medical Conditions in Pregnancy Flashcards
Which Anti-Hypertensives are Teratogenic?
Warfarin
ACEi
HTN –> Use Beta-Blockers
Management of Asthma in Pregnancy
Continue inhaler therapies as they are generally safe
Asthma attack can be life threatening
Women on long-term steroids require increased dose during labour
Suppressed adrenals can’t increase production for demands of labour
Management of Epilepsy in Pregnancy
Carbamezepine and Lamotrigine safest in pregnancy
0.5% of pregnant women Seizure control can worsen in pregnancy Increased risk (4% overall) of anomaly with anti-seizure meds --> NTDs 5mg Folic Acid/day 3% risk of newborn developing epilepsy 10mg Vit K from 36 weeks onwards
Sodium valporate should be avoided –> congenital abnormalities and lower intelligence
20 Week USS and Fetal Echocardiography to detect anomalies
Thyroid Disease in Pregnancy
Hypothyroidism –> Hashimotos or previous thyroid surgery
Replace Thyroxine, measure every 6 weeks
Hyperthyroidism –> Grave’s
Propylthiouracil to block thyroid
Propylthiouracil crosses placenta, can causes neonatal hypothyroidism so use lowest dose possible and monitor thyroid function
(NOT carbimazole)
Postpartum Thyroiditis 5-10% Can cause postnatal depression 3m of hyper followed by 4m hypo 20% permanent hypo
Management of Obesity
20% of pregnant women have BMI >30
Risks to Mother VTE PET DM C-section Difficult surgery Wound Infections PPH Death
Risks to Fetus Increased risk of congenital abnormality PET complications GDM complications Increased perinatal mortality
Mx preconception weight loss High dose folate Vitamin D Weight maintenance during pregnancy Screen for GDM and BP High risk if BMI >35 Formal anaesthetic assessment if BMI >40
Sickle Cell Disease
HbS or HBSC
Sickle cell crisis Pregnancy --> more sickle cell crisis PET Thrombosis Infection
Fetal Complications Miscarriage IUGR PTL Death
Hb Electrophoresis performed on all pregnant women
Partners of heterzygotes screened
Amniocentesis offered if both carriers
Thalassaemias
Offer CVS diagnostic if both parents carriers
