Medical Complications in Pregnancy Flashcards
Name seven types of cardiac disease that can present in pregnant women
- Congenital heart disease
- Acquired heart disease
- Pulmonary hypertension
- Cardiomyopathy
- Artificial heart valves
- Ischaemic heart disease
- Arrhythmias
What cardiac diseases are classed as high risk?
Pulmonary Hypertension Presence of cyanosis TIA/arrhythmia Heart failure Left heart obstruction Aortic root >45mm Myocardial dysfunction
Describe the NYHA classification
I - no limitation
II - mild symptoms during activity
III - marked symptoms during daily life
IV - symptoms at rest
What cardiac symptoms are physiological in pregnancy?
Palpitations
Ectopic beats
Sinus tachycardia
What conditions can cause cardiac symptoms in pregnancy?
Hyperthyroidism
Phaeochromocytoma
What tests can investigate heart disease in pregnant women?
ECG FBC TFT Echo US
Describe the effect of hyperventilation in a pregnant woman
PaO2 increases and PaCO2 falls causes a higher arterial pH and alkalosis
Is breathlessness normal or abnormal in pregnancy?
Normal - improves on exertion
What percentage of women will have an acute asthma exacerbation during pregnancy?
10%
What can be given in asthmatic women to cover the stress of labour?
IV Hydrocortisone
Where do most DVTs occur in pregnant women?
Ilio-femoral area
State Virchow’s triad
Hypercoagulability
Venous stasis
Vascular damage
What are the signs/symptoms of a DVT?
Swelling, oedema, leg pain/discomfort, tenderness, increased temperature, lower abdominal pain, increased WCC
How is a suspected DVT investigated?
Compression duplex ultrasound
- normal - repeat in 7 days
- abnormal - MRI venography
What are the signs/symptoms of PTE?
Dyspnoea, chest pain, faintness, collapse, haemoptysis, raised JVP, focal signs in chest, signs of DVT, ECG and CXR abnormalities
Name two ways in which a PTE can be investigated
CTPA
V/Q scan
What blood thinner is highly teratogenic?
Warfarin - causes scoliosis, short limbs, short phalanges, chondral calcification
Dose dependent - >5mg/day
Describe post natal anticoagulation
Commence warfarin 5th post-natal day and continue for 6 weeks - 3 months post party
Name four connective tissue diseases that can cause problems in pregnancy
Lupus - renal and haematological
Rheumatoid
Scleroderma - renal and pulmonary hypertension
ASP
State the connective tissue treatments that are contraindicated in pregnancy
NSAID Cyclophosphamide Methotrexate Gold Penicillamine MMF Chlorambucil Leflunamide
What is APS?
Anti-phospholipid syndrome - acquired thrombophilia where anti-phospholipid antibodies react with the phospholipid part of the cell membrane
Name two antiphospholipid antibodies
Anticardiolipin
Lupus anticoagulant
What are the clinical features of APS?
Thrombosis Recurrent early pregnancy loss Late pregnancy loss Placental abruption Severe early onset pre-eclampsia Fetal growth restriction
How is APS diagnosed?
Clinical feature + laboratory testing
What clinical features are diagnostic of APS?
Pregnancy morbidity
>3 miscarriages, >1 foetal loss, >1 preterm birth
Vascular thrombosis
What is the laboratory testing for APS?
Positive antibodies on two occasions more than 6 weeks apart
How is APS managed?
No thrombosis - low dose aspirin + surveillance
Previous thrombosis - LDA, treatment dose LMWH
Recurrent early pregnancy loss - LDA + prophylaxis LMWH
Late foetal loss = LDA + prophylaxis LMWH
What is the risk to a baby if mum has a seizure?
Abdominal trauma - maternal fetal haemorrhage
Premature pre-rupture membranes
Preterm birth
Hypoxic acidosis
What is the risk to a baby if mum has epilepsy?
Malformations Adverse outcomes Developmental effects Haemorrhage disease Childhood epilepsy
How is a seizure during labour treated?
Left lateral tilt, benzodiazepines/phenytoin, may require C-section
Magnesium sulfate to cover eclamptic seizures
State some ways to ensure baby safety when mum is epileptic
Not in a side room, change baby on the floor, safe feeding position, avoid triggers, special pram, bathing support
What proportion of women are obese?
1/3
What are obese women at more risk of?
Miscarriage VTE Infection Macrosomia Diabetes C-section Hypertension Haemorrhage Congenital abnormality
How are obese women managed antenatally?
Low dose aspirin >12 weeks Thromboprophylaxis Detailed anomaly US OGTT Foetal growth scan Anaesthetic reveiw
