Maternal Medicine Flashcards
What are the maternal risks of obesity in pregnancy?
Thromboembolism Pre-eclampsia Diabetes C-section Wound infections Difficult surgery PPH Maternal death
What are the risks to the fetus caused by obesity?
Congenital abnormalities
Perinatal mortality increased (due to diabetes and pre eclampsia)
What modifications to drug treatment need to be made in obese women?
Preconceptual weight advice
High dose (5mg) preconceptual folic acid supplementation recommended
Vitamin D
Weight best maintained – loss impractical + can cause malnutrition
Consider high risk pregnancy (esp. if BMI >35)
Screen for gestational diabetes + closer BP surveillance required
Formal anaesthetic risk assessment is recommended if BMI >40
Thromboprophylaxis often used
What are the consequences of HIV on pregnancy?
Main concern is high risk of vertical transmission to baby
<1% if best prophylaxis, 15% with none, up to 40% if breast feeding + under resourced
Increased by early and late disease, high CD4 or low viral load, prematurity, other infection, labour, long rupture of membranes
Increased risk of miscarriage Fetal growth restriction Prematurity Stillbirth Pre-eclampsia
How is HIV in pregnancy managed?
combination therapy elective C-section avoid breastfeeding treat neonate for 6 weeks screen for other infections
What are the main types of thrombophilia?
antiphospholipid syndrome protein S and C deficiency Activated protein C resistance and factor V Leyden Prothrombin gene mutation Antithrombin III deficiency Hyperhomocysteinaemia
What are the effects of thrombophilia in pregnancy?
VTE Miscarriage Preterm delivery Pre-eclampsia Placental abruption IUGR Fetal death
What modifications to drug treatment need to be made in thrombophilia?
high risk pregnancy care
aspirin and LMWH usually only if adverse previous obs history
postnatal LMWH to prevent VTE
What are the risks of epilepsy in pregnancy?
Congenital abnormalities (e.g. neural tube defects) increased – risk dose dependent, higher with multiple drugs + with sodium valproate
Newborn has 3% risk of developing epilepsy
How does pregnancy effect epilepsy?
seizure control deteriorates in pregnancy and labour
antiepileptic treatment is continued
How is drug treatment of epilepsy modified in pregnancy?
Preconceptual assessment preferred – seizure control with as few drugs as possible at lowest dose 5mg/day folic acid throughout pregnancy + 10mg vit K from 36 weeks
Avoid sodium valproate
Carbamazepine + lamotrigine safest
Doses may need to be increased but benefits of routine drug level monitoring
remain debated
20 week scan + fetal echocardiography to exclude fetal abnormalities
What effect does pregnancy have on the CV system?
40% increase in cardiac output, due to increase in stroke volume + HR, 40% increase in blood volume
50% reduction in systemic vascular resistance, BP drops in second trimester but normal by term
Ejection systolic murmur in 90% pregnanct woman
Left axis shit + inverted T waves on ECG
What are the risks of cardiac disease in pregnancy?
depends on cardiac status
most encounter no problems
if acquired and uncorrected then can cause cardiac failure and maternal mortality
How should cardiac disease be managed?
assess before pregnancy
warfarin and ACEI contraindicated
cardiac assessment required
Fetal USS at 20 weeks to exclude abnormalities
Treat HTN
elective forceps to avoid pushing in labour, abx if replacement valves, elective epidural
How is asthma/ resp disease managed in pregnancy?
drugs should be continued
if on long term steroids then increase dose in labour
