Maternal Flashcards
definition and etiology of maternal mortality
death while pregnant or within 42 days of TOP from a cause related to or aggravated by the pregnancy
CVD, suicide, ectopic, HTN disorders, haemorrhage, sepsis, DVT, PE, AFE
Mx of GORD
non pharm - don’t over eat, avoid acidic and spicy food, avoid caffeine, smoking and alcohol
pharm - antacids, PPI, histamine receptor antagonists
Mx of constipation
metamucil
movicol
coloxyl and senna
Mx of back pain
non pharm - light exercise, physiotherapy, hot and cold packs
pharm - paracetamol (avoid NSAIDs and aspirin)
Clinical features of obstetric cholestasis
pruritus of hands and feet without rash
rarely other biliary symptoms like jaundice, dark urine, pale stool
clinical features of acute fatty liver of pregnancy
malaise N&V abdominal pain jaundice acute liver failure
anaemia defintion in pregnancy
1st trimester <110
2nd and 3rd <105
postpartum <100
maternal anaemia - complications for foetus and mother
foetus - IUGR, prematurity, B12 deficiency causes neuro deficits
maternal - fatigue, SOB, dizziness, lack of reserve for PPH
Mx of anaemia in pregnancy
- how to correct ie meds and diet
- SE of medication
- F/U
iron supplementation 100mg/day
diet - leafy greens, red meat, vitamin C, avoid coffee and tea
SE PO iron - abdo discomfort, constipation, black stool, N&V
F/U: Hb 2/52 until corrected, continue supplements until 6 weeks postpartum
complications and management of varicella in pregnancy
complications
- maternal varicella pneumonia, neurological spread
- foetal congenital varicella syndrome
Mx in non immune mother
<96 hours from exposure, VZV Ig
>96 hours acyclovir PO
mother has varicella - acyclovir PO, USS monitoring, C/S if foetal or maternal compromise
Parvovirus B19 complications and management
foetus - miscarriage, anaemia, heart failure and death (hydrops fetalis)
no treatment available - supportive, USS monitoring
Hep B and C management in pregnancy
hep B - 3rd trimester medication to reduce viral load
Hep C - medication NOT recommended in pregnancy, wait until finished breast feeding
both - clean skin of neonate prior to injections, no scalp electrode, no foetal scalp sampling
pathophysiology of GDM
placenta secretes anti-insulin hormones ie glucagon, cortisol, lactose
maternal anti-insulin hormones increase ie thyroid hormone, cortisol
insulin resistance –> increased pancreatic production of insulin
not all women have enough reserve to increase insulin production –> GDM
pathophysiology of hypoglycaemia in the neonate born to mother with GDM
maternal glucose crosses placenta but insulin does not –> foetus increases insulin production
post partum - no maternal glucose, remaining increased insulins –> hypoglycaemia
risk factors for GDM
age >40 personal hx of GDM family hx of diabetes PCOS obesity multiple pregnancy ATSI steroids antipsychotics
diagnosing GDM
screen with OGTT at 24-28 weeks (earlier if RF present)
fast overnight, measure BGL, drink 75g glucose, measure 1 hr and 2 hrs after
diagnostic criteria for OGTT results:
fasting >5.1
1hr >10
2hrs >8.5
GDM complications for mum and baby
baby - PTL, premature, hypoglycaemia, macrosomia or LGA, IUGR, polyhydramnios, birth trauma
mum - birth trauma, PET, PTL, PPH, increased risk for DM later
glucose monitoring for mum with GDM and baby
- antenatal
- intrapartum
- postpartum
mum - BGL QID
intrapartum 2 hourly
postpartum over 24 hours
repeat OGTT 6 weeks
foetal
- USS from 24 weeks + doppler studies 4 weekly from 28/40
- CTG intrapartum
- postnatal BSL after 1st feed
glycemic control for GDM and indications for medication
also other medications to give
non pharm: educate importance of management, refer dietician, EP
pharm:
- indications: failed 2 week diet, macrosomia or AC >75th percentile
- metformin 1st line
- add insulin if required
stop medications immediately postpartum
also give 5mg folate + aspirin
metformin and insulin for delivery - when to stop them
metformin - cease once labour established or if elective CS stop 24hrs before
insulin - cease once labour established or if elective CS take night before but not morning of
GDM mode of delivery
VB - okay if no macrosomia or other complications
CS - macrosomia >4500g
MDT for GDM
dietician
diabetes educator
exercise physiologist
endocrinologist
causes of postpartum pyrexia
breast - mastitis womb - endometritis wind - atelectasis, pneumonia water - UTI wound infection - CS, episiotomy walking - DVT
treatment of endometritis
gentamicin + ampicillin + metronidazole
clinical features of endometritis
fever, lower abdo pain, foul discharge, secondary PPH, tachycardia
causes of maternal collapse
4Hs - hypoxia, hypovolemia, hyper/hypokalaemia, hypothermia
- hypoxia: cardiomyopathy, MI, aortic dissection, aneurysm
- hypovolemia: bleeding
4Ts - tension PTX, toxins (MgSO4), thromboembolism (DVT, PE, AFE), tamponade
what is the edinburgh postnatal depression scale, when is it used, how is it interpreted
used as routine screening tool in antenatal period to assess for PND
10 Qs
>/= 9 or suicidal –> psychiatric assessment
clinical features of PND
excessive guilt and feelings of worthlessness stop breastfeeding negative feelings towards infant denial somatic symptoms delayed attachment
management of PND
safety - suicide and violence risk assessment, safety plan, +/- admission
bio - SSRI only for severe PND
psycho - educate, give resources, refer to psychologist specialising in PND, CBT, IPT
social - DV, do they require additional support, PANDA (postnatal anxiety and depression australia)
antidepressant medications in pregnancy
SSRI - fluoxetine, sertraline, citalopram all safe
- should wean prior to birth if mild-mod depression
TCA - safe
SNRI - avoid
what are ‘baby blues’
depressive symptoms 3-10 days postpartum
depressed, angry, irritable, teary, sensitive, anxious
treatment of pre-existing bipolar or psychotic disorder in pregnancy
bipolar - stop lithium or anti-epileptic medications
- switch to antipsychotic
psychotic illness - typical and atypical medications are safe EXCEPT clozapine
clinical features of postpartum psychosis
abrupt onset first few days following delivery - deteriorate daily
early - mainly psychotic features ie delusions, hallucinations, fear, agitation
later - mainly bipolar illness with mix of mania and depression
drugs contraindicated in breastfeeding
anticancer drugs, lithium, oral retinoids, amiodarone and gold salts
