Maternal Mortality in Pregnancy Flashcards
How does a peripartum cardiomyopathy present?
can’t lie flat
What % die if they have a MI in pregnancy?
1/3rd
What % of women get breathless in pregnancy?
75% - esp in 3rd trimester
What is a red flag to do with breathlessness?
if they cannot carry out normal activities
How should births be managed for those with asthma?
aim for vaginal birth
women should continue inhalers during pregnancy/labour
give IV hydrocortisone if on oral steroids
How much does the VTE risk increase in pregnancy?
4-6x increase
Why does VTE risk increase in pregnancy?
oestrogen promotes blood cotting and decreases activity of antithrombin 3
How do Virchows triad change during pregnancy?
hypercoagulability - increased Von Willibrand factor, increased factors VII, IX, X + XII, increased fibrogen
venous stasis - slowing of circulation
vascular damage - impaired fibrinolytic activity
What can cause VTEs?
thrombophillia - anti thrombin deficiency or protein C
How does a DVT present?
swelling oedema leg pain/discomfort tenderness increase in leg temperature lower abdo pain increased WCC
How are DVTs investigated?
duplex ultrasound
How do PEs present?
dyspnoea chest pain faintness haemoptysis focal signs in the chest chest pain collapse raised JVP similar symptoms/signs of DVT
How are PEs diagnosed?
V/Q perfusion scan
How are DVTs and PEs treated?
warfarin then LMWH by 6 weeks
How long should anticoagulant therapy be used?
6 weeks post natally and 3weeks post partum
Should warfarin be used in pregnancy?
not past week 6
it is tetarogenic - causes Warfarin embryopathy
How do autoimmune conditions react to pregnancy?
get better due to immuno suppression
What autoimmune drugs are contraindicated in pregnancy?
NSAIDS >32 weeks cyclophosphamide methotrexate chlorambucil gold penicillamine MMF leflumide
What is antiphospholipid syndrome?
antiphospholipid antibodies react with the phospholipid component of the cell membrane
causes recurrent and early miscarriages, pre ecclampsia, placental abruption and fetal growth retardation
How is APS managed?
LMWH and LDA
How do seizures change in epileptics with pregnancy?
stay the same or get better
What are the risks to the fetus with an epileptic mother?
2-3x increased risk of malformations for any single anti epileptic drug
long term developmental effects
haemorrhagic disease of the newborn
risk of childhood epilepsy
How is the risk reduced for epileptic mothers?
folic acid 5mg
lowest effective dose of anti epileptic drug
How is an intrapartum seizure managed?
left lateral tilt
IV lorazepam/diazepam
IV phenytoin
What should be given in an intrapartum seizure if there is no history of epilepsy?
magnesium sulphate
How are obese mothers managed in pregnancy?
red pathway folic acid 5mg from 12 weeks 10mg vitamin D from 12 weeks low dose aspirin from 12 weeks USS growth at 28 weeks OGTT 24-28 weeks
What should be given at the 3rd stage of labour in an obese mother?
IM syntometrine or IV oxytocin - prevents bleeding and increases contraction of the uterus
What should be given to obese mothers post partum?
fragmin for 6 weeks post natally
