Maternal medicine - Medical disorders in pregnancy Flashcards
Structured framework in approach to medical disorder in pregnancy
effect of disease on pregnancy → maternal, fetal, post-natal
effect of pregnancy on disease → disease itself, medication
Each can be divided into pre-pregnancy, antepartum, intrapartum, postpartum periods
FDA classification of safety of medications in pregnancy
Contraception and sterilization in women with medical disease
Considerations
Considerations:
- Any increase risk due to pre-existing medical condition e.g. COCP increase risk of venous thromboembolism
- Future fertility wish? Completed family?
- Effectiveness of contraception: type, compliance, effect of medication on contraception…?
- Absolute contraindication to pregnancy e.g. Eisenmenger syndrome
GDM
Pathophysiology
GDM
High risk factors indicating early OGTT
GDM
Recommended screening time
Diagnosis of GDM
GDM
Maternal and fetal complications
GDM
Management plan at diagnosis
GDM
Antenatal care plan
GDM
Intrapartum and postnatal care plan
Effect of pregnancy on DM
Effect of DM on pregnancy
Pre-existing DM
Pre-pregnancy management
Pre-existing DM
Management at diagnosis
Pre-existing DM
Antenatal management
Pre-existing DM
Intrapartum management
Pre-existing DM
Postpartum management
Thyroid disorder
Physiological changes during pregnancy
Hypothyroidism
Effect of pregnancy on disease
Effect of disease on pregnancy
Management
Hyperthyroidism
Effect of pregnancy on disease
Effect of disease on pregnancy
Management
Autoimmune diseases during pregnancy
Usual disorders
Effect of pregnancy on autoimmune disorders
Effect of autoimmune disorders on pregnancy
Treatment of autoimmune disorders during pregnancy
SLE
Effect of pregnancy on SLE
Effect of SLE on pregnancy
Management
Differentiate SLE from pre-eclampsia
Cardiac disease in pregnancy
Effect of pregnancy on cardiac disease
Cardiac disease in pregnancy
Cardiac condition effect on pregnancy
Management of cardiac condition in pregnancy
- Contraindicated treatments
- Treatment considerations
Pre-pregnancy assessment of maternal cardiac conditions
Antenatal management of maternal cardiac condition
Intrapartum management of maternal cardiac conditions
Epilepsy
Effect of pregnancy on epilepsy
Effect of epilepsy on pregnancy
Epilepsy during pregnancy
Treatment considerations
Epilepsy during pregnancy
Pre-pregnancy management
Epilepsy during pregnancy
Antenatal, intrapartum and postpartum management
Thrombophilia and pregnancy
Effect of pregnancy on thrombophilia
Thrombophilia and pregnancy
Effect of thrombophilia on pregnancy
Thrombophilia and pregnancy
Treatment
Thrombophilia in pregnancy
Pre-pregnancy assessment
Thrombophilia in pregnancy
Management for low-risk patients
Thrombophilia in pregnancy
Management for high-risk patients
Renal disease in pregnancy
Effect of pregnancy on CKD
Effect of CKD on pregnancy
Renal disease in pregnancy
Pre-pregnancy management
Renal disease in pregnancy
Antenatal management
Renal disease in pregnancy
Considerations for renal transplant
Renal disease in pregnancy
Renal transplant timing and drug choice
Skin disease in pregnancy
Effect of pregnancy on eczema, acne, psoriasis
Pemphigoid gestationis
Prevalence
S/S
Dx
Mx
Impact on pregnancy
Polymorphic eruption of pregnancy (PEP)
Prevalence
S/S
Mx
Impact on pregnancy
Prurigo of pregnancy
Prevalence
S/S
Mx
Impact on pregnancy
Pruritic folliculitis of pregnancy
Cause
S/S
Mx
Substance abuse in pregnancy
Prevalence
Common drugs
Substance abuse in pregnancy
Obstetric and maternal complications
Alcohol use in pregnancy
Prevalence
Safe level
Associated disorders
FASD:
- Alcohol-related neurodevelopmental disorder (ARND)
- Alcohol-related birth defects (ARBD)
- Fetal alcohol syndrome (FAS)
Alcohol-related neurodevelopmental disorder (ARND)
Clinical features
Alcohol-related birth defects (ARBD)
Clinical features
Fetal alcohol syndrome (FAS)
Prevalence
Diagnostic criteria
Fetal alcohol syndrome (FAS)
Clinical features
Facial dysmorphism: short palpebral fissure, thin vermillion border, smooth philtrum
Growth retardation: prenatal or postnatal, ≤10th percentile at any time
Brain involvement: microcephaly, structural brain abnormalities, hard neurologic signs, recurrent seizure not due to postnatal insult or fever
Neurobehavioral impairment: global cognitive/intellectual deficits, developmental delay, functional deficits, impaired self-regulation
Other features:
- Cardiac defect: ASD, VSD, aberrant great vessels, ToF
- Skeletal defect: large joint flexion contracture, pectus excavatum or carinatum, scoliosis, shortened and clinodactyly of 5th finger
- Renal defect: aplastic / hypoplastic kidney, horseshoe kidney, duplex kidney, hydronephrosis
- Ocular defect
- Auditory defect
Cigarette smoking
Antenatal and intrapartum complications
Opioid abuse in pregnancy
Antenatal, neonatal complications
Ketamine and metamphetamine abuse
Antenatal and neonatal complications
Cocaine abuse
Antenatal complications
Substance abuse in pregnancy
Management
