Medical Complications in Pregnancy Flashcards

1
Q

Name seven types of cardiac disease that can present in pregnant women

A
  • Congenital heart disease
  • Acquired heart disease
  • Pulmonary hypertension
  • Cardiomyopathy
  • Artificial heart valves
  • Ischaemic heart disease
  • Arrhythmias
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2
Q

What cardiac diseases are classed as high risk?

A
Pulmonary Hypertension 
Presence of cyanosis 
TIA/arrhythmia
Heart failure 
Left heart obstruction 
Aortic root >45mm
Myocardial dysfunction
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3
Q

Describe the NYHA classification

A

I - no limitation
II - mild symptoms during activity
III - marked symptoms during daily life
IV - symptoms at rest

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4
Q

What cardiac symptoms are physiological in pregnancy?

A

Palpitations
Ectopic beats
Sinus tachycardia

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5
Q

What conditions can cause cardiac symptoms in pregnancy?

A

Hyperthyroidism

Phaeochromocytoma

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6
Q

What tests can investigate heart disease in pregnant women?

A
ECG
FBC
TFT
Echo
US
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7
Q

Describe the effect of hyperventilation in a pregnant woman

A

PaO2 increases and PaCO2 falls causes a higher arterial pH and alkalosis

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8
Q

Is breathlessness normal or abnormal in pregnancy?

A

Normal - improves on exertion

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9
Q

What percentage of women will have an acute asthma exacerbation during pregnancy?

A

10%

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10
Q

What can be given in asthmatic women to cover the stress of labour?

A

IV Hydrocortisone

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11
Q

Where do most DVTs occur in pregnant women?

A

Ilio-femoral area

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12
Q

State Virchow’s triad

A

Hypercoagulability
Venous stasis
Vascular damage

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13
Q

What are the signs/symptoms of a DVT?

A

Swelling, oedema, leg pain/discomfort, tenderness, increased temperature, lower abdominal pain, increased WCC

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14
Q

How is a suspected DVT investigated?

A

Compression duplex ultrasound

  • normal - repeat in 7 days
  • abnormal - MRI venography
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15
Q

What are the signs/symptoms of PTE?

A

Dyspnoea, chest pain, faintness, collapse, haemoptysis, raised JVP, focal signs in chest, signs of DVT, ECG and CXR abnormalities

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16
Q

Name two ways in which a PTE can be investigated

A

CTPA

V/Q scan

17
Q

What blood thinner is highly teratogenic?

A

Warfarin - causes scoliosis, short limbs, short phalanges, chondral calcification
Dose dependent - >5mg/day

18
Q

Describe post natal anticoagulation

A

Commence warfarin 5th post-natal day and continue for 6 weeks - 3 months post party

19
Q

Name four connective tissue diseases that can cause problems in pregnancy

A

Lupus - renal and haematological
Rheumatoid
Scleroderma - renal and pulmonary hypertension
ASP

20
Q

State the connective tissue treatments that are contraindicated in pregnancy

A
NSAID 
Cyclophosphamide 
Methotrexate 
Gold 
Penicillamine 
MMF 
Chlorambucil 
Leflunamide
21
Q

What is APS?

A

Anti-phospholipid syndrome - acquired thrombophilia where anti-phospholipid antibodies react with the phospholipid part of the cell membrane

22
Q

Name two antiphospholipid antibodies

A

Anticardiolipin

Lupus anticoagulant

23
Q

What are the clinical features of APS?

A
Thrombosis
Recurrent early pregnancy loss 
Late pregnancy loss 
Placental abruption 
Severe early onset pre-eclampsia 
Fetal growth restriction
24
Q

How is APS diagnosed?

A

Clinical feature + laboratory testing

25
Q

What clinical features are diagnostic of APS?

A

Pregnancy morbidity
>3 miscarriages, >1 foetal loss, >1 preterm birth
Vascular thrombosis

26
Q

What is the laboratory testing for APS?

A

Positive antibodies on two occasions more than 6 weeks apart

27
Q

How is APS managed?

A

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

28
Q

What is the risk to a baby if mum has a seizure?

A

Abdominal trauma - maternal fetal haemorrhage
Premature pre-rupture membranes
Preterm birth
Hypoxic acidosis

29
Q

What is the risk to a baby if mum has epilepsy?

A
Malformations 
Adverse outcomes 
Developmental effects 
Haemorrhage disease 
Childhood epilepsy
30
Q

How is a seizure during labour treated?

A

Left lateral tilt, benzodiazepines/phenytoin, may require C-section
Magnesium sulfate to cover eclamptic seizures

31
Q

State some ways to ensure baby safety when mum is epileptic

A

Not in a side room, change baby on the floor, safe feeding position, avoid triggers, special pram, bathing support

32
Q

What proportion of women are obese?

A

1/3

33
Q

What are obese women at more risk of?

A
Miscarriage 
VTE
Infection 
Macrosomia 
Diabetes 
C-section 
Hypertension 
Haemorrhage 
Congenital abnormality
34
Q

How are obese women managed antenatally?

A
Low dose aspirin >12 weeks 
Thromboprophylaxis 
Detailed anomaly US 
OGTT
Foetal growth scan 
Anaesthetic reveiw
35
Q
A