Maternal medicine Flashcards
What is the definition of maternal death?
Death WHILST PREGNANT
OR
WITHIN 42 DAYS OF END OF PREGNANCY
Cause: related to or aggravated by pregnancy or management
*includes birth, ectopic pregnancy, miscarriage or termination of pregnancy
What is the definition of ‘direct’ maternal death?
death resulting from obstetric complications, interventions, omissions or incorrect treatment
What is the definition of ‘indirect’ maternal death?
deaths resulting from previous EXISTING DISEASE or DISEASE DEVELOPED DURING PREGNANCY
not the results of obstetric cause but AGGRAVATED BY BEING PREGNANT
What is a late maternal death?
Deaths occurring between 42 DAYS and 1 YEAR after the end of pregnancy*
direct or indirect maternal causes
*inclused ectopic pregnancy, miscarriage or termination
What is ‘coincidental’ maternal death?
Death from UNRELATED causes which happen to occur in pregnancy or puerperium
What cardiac problems would we be concerned about in a pregnant woman?
congenital or acquired CHD
What are some symptoms women may experience whilst pregnant, that could indicate cardiac problems?
Fatigue Fainting Chest pain Shortness of breath Difficulty breathing while sleeping Palpitations
Have a low threshold to investigate
What would you keep in mind for the monitoring and management of a pregnant woman with cardiac health problems?
MDT - obstetrician led care
Consider early delivery (time of delivery is more important than mode of delivery)
What would you keep in mind for the monitoring and management of a pregnant woman with epilepsy?
MDT - obstetrician led care?
Patient may/may not require medication
Folic acid 5 mg/day
Postnatal liaison with patient carer
What are the risks associated with being on anti-epileptics during pregnancy?
Fetal abnormalities (NTD,cardiac, facial )
Frequent seizures
Status epilepticus
What does essential hypertension during pregnancy increase the risk of?
Maternal pre-eclampsia/eclampsia and placental abruption
Maternal morbidity and mortality, especially with very high systolic blood pressure
Intrauterine fetal growth restriction and preterm delivery
Neonatal morbidity and mortality
What drugs should ideally be given for HTN in pregnancy (instead of ACEi)?
labetalol
nifedipine
methyldopa
(consider aspirin)
What is worth noting about ACEi (ie. why do they need changing to labetalol, nifedipine and methyldopa)?
teratogenic
How would you manage a pregnant woman with essential hypertension?
frequent monitoring of both mother and foetus
change teratogenic drugs to labetalol, nifedipine and methyldopa
consider low-dose aspirin from 12 weeks
How does maternal drug abuse effect the mother, pregnancy process and the foetus?
Maternal death from overdose
Blood-borne diseases (HBV,HCV,HIV)
Fetal growth restriction and stillbirth
Abruption placenta
Preterm delivery
Difficulty to establish venous access
Neonatal withdrawal syndrome
- Patients at higher risk of violence
How would you manage a pregnant mother with drug abuse problems?
Obstetrician-led care
More frequent monitoring eg. growth scan
encourage mothers to participate in methadone programme
think re. safeguarding issues