Medical Complications Flashcards
What hypertensive disorders exist in pregnancy?
Chronic (essential ) hypertension
Gestational hypertension
Pre-eclampsia
What is gestational hypertension?
New hypertension after 20weeks gestation
What is pre-eclampsia?
New hypertension after 20 weeks and significant proteinuria
What other systems does hypertension in preganancy affect?
Renal
Liver
Placenta
Hypertensive Effects on renal disease?
Decrease GFR Proteinuria Increased serum Uric acid Increased creatinine/ potassium/ urea Oliguria Acute renal failure -> acute tubular necrosis , renal cortical necrosis
Hypertensive effects on liver disease?
Epigastric / RUQ pain
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome
What is HELLP syndrome?
Haemolysis
Elevated liver enzymes
Low platelets
Placental disease due to hypertension?
IUGR
Placental abruption
Intrauterine death
Investigations for hypertension?
U&Es Serum urate LFTs FBC Coagulation screen CTG USS
Hypertensive management?
BP monitoring
Meds- labetolol, methyldopa, nifedipine
What hypertensive medications are not ok in pregnancy?
ACEi
ARBs
What is the target BP for pregnancy?
Aim for <150/80-100 mmHg
What effects does pregnancy have on diabetes?
Poorer control
Deterioration of renal function
Deterioration of ophthalmic disease
What’s effects does diabetes have on pregnancy?
Miscarriage Fetal malformations - cardiac, neural tube defects, caudal regressions syndrome IUGR/ macrosomnia Unexplained IUD PET
What is the aim HbA1c in diabetes in pregnancy?
<6.0%
What is the leading cause of maternal death?
VTE in pregnancy
What investigation for DVT?
Duplex ultrasound of proximal leg
Is d dimmer useful in pregnancy?
No
Management of DVT in pregnancy?
LMWH
TEDs
Investigations of PE?
CTPA ABGs CXR ECG Duplex US of proximal leg V/Q scan
Can you continue heparin during labour?
No
Is warfarin safe during pregnancy?
Yes but stop 6-12 weeks
When do you stop warfarin before labour?
6 weeks before
Is warfarin safe during breastfeeding?
Yes
What is hypothyroidism associated with in pregnancy?
Increased rates of miscarriage
Still birth
PET
IUGR
Treatment for hypothyroidism?
Increase levothyroxine
What is hyperthyroidism associated with in pregnancy?
IUGR
Preterm
If hyperthyroid, labour delivery survey and anaesthesia can lead to what?
Thyroid storm
Management of hyperthyroidism?
PTU/ carbimazole
TFTs every trimester
Propranolol
Growth scans
Does Epilepsy worsen in pregnancy?
Not really, unless already poorly controlled then will deteriorate
When are risk of epileptic seizures highest?
In peripartum
Teratogenic risks of anticonvulsants?
Neural tube defects
Orofacial defects
Heart defects
fetal anticonvulsant syndrome
What is involved in fetal anticonvulsant syndrome?
Dystrophic features - v shaped eyebrows, low-set ears, broad nasal bridge, irregular teeth
Hypertelorism
Hypo plastic nails and distal digits
Are antiepileptic drugs safe during labour?
Yes
What should neonate be given after birth if mum epileptic?
1mg IM Vit K
Management of epilepsy in pregnancy?
Folic acid 5mg /day from 12 weeks prior to conception
Continue drugs if well controlled
What antiepileptic drug is not ok during pregnancy?
Phenobarbitone
