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Reproduction > Medical complications in pregnancy and post partum > Flashcards

Medical complications in pregnancy and post partum Flashcards

1
Q

when does a dating scan take place?

A

12 wks

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2
Q

name the “booking bloods” taken at first antenatal appt? (4)

A

FBC, blood group and antibodies
haemoglobinopthies
infection screen (Hep B, HIV, Rubella, VDRL)
Random Blood glucose

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3
Q

what appointments occur at the following gestation?

  • 8-12
  • 11-12
  • 20
  • 28
  • 28 & 34
  • 28-36
  • 37+
A
  • booking visit
  • dating USS
  • anomaly scan
  • monthly visits till 28
  • Anti D
  • fortnightly visits
  • weekly visits till delivery
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4
Q

what investigations are performed at each antenatal visit? (5)

A
  • Accurately document gestation
  • BP
  • Urinalysis
  • SFH (FSH)
  • foetal heart/kicks
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5
Q

name the 3 main hypertensive disorders in pregnancy and when (gestation) they occur

A

Chronic (essential) hypertension- present at booking or < 20 wks

Gestational hypertension- new, >20 wks without significant proteinuria

Pre-eclampsia
New, >20 weeks + significant proteinuria

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6
Q

maternal renal disease

  • symptoms?
  • signs (GFR, uric acid, creatinine, K, urea,
  • 2 kinds of acute renal failure most common
A

-oliguria/ anuria
proteinuria

-reduced GFR
inc serum uric acid
inc creatinine/K/urea

-acute tubular necrosis
renal cortical necrosis

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7
Q

Maternal Liver disease

  • presentation
  • what is HELLP syndrome?
  • presentation of HELLP?
A

-Epigastric/RUQ pain
abnormal liver enzymes
Hepatic capsule rupture

-Complication of pre-eclampsia
Haemolysis, Elevated liver enzymes, low platelets

-Headache
Nausea/vomiting/indigestion with pain after eating
Abdominal or chest tenderness and RUQ pain
Shoulder pain or pain when breathing deeply
Bleeding
Changes in vision
Swelling

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8
Q

Placental disease

name the 3 most common forms of placental disease

A

IUGR
Placental Abruption
Intrauterine death

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9
Q

Investigations needed in mother presenting with complication of pregnancy? (7)

A 
Us &amp; Es
Serum urate
LFTs
FBC
Coagulation screen
CTG
USS- biometry, AFI, Doppler
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10
Q

management of maternal hypertension?

-how is response to treatment monitored?

A

asses risk and the risk factors for pre-eclampsia
Give Aspirin

Scans
BP monitering
Urine testing
staff

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11
Q

Medications used in hypertension & pregnancy

  • mild/moderate(3)
  • what drugs should be stopped?
  • severe? (3)
  • target BP?
A

labetalol
Methyldopa
Nifedipine (in addition to monotherapy)

-Stop ACE & ARBs

-labetalol (oral/IV)
Hydrazine (IV)
Nifedipine (oral)

-aim <150/80-100mmHg
if target organ damage <140/90mmHg

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12
Q

Hypertensive disorders in pregnancy:

-Give a summary of these (6)

A 
gestational hypertension 
Preeclampsia (deliver 37 wks) 
eclampsia 
pregnancy causes vasoconstriction so inc
impacts on kidney, liver and eye function
IUGR, abruption, miscarriage
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13
Q

Pregnancy and DM

  • what are the effects of pregnancy on diabetes? (4)
  • what are the effects of Diabetes on pregnancy? (5)
  • time of delivery in diabetes?
A

-poorer control
deterioration of renal function and ophthalmic disease
gestational DM

-miscarriage 
foetal malformations 
IUGR/Macrosomia 
unexplained IUD
PET (Pre-eclamptic toxaemia)

-37-38 wks

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14
Q

Describe the physiological effect that diabetes has on the developing foetus?

A

maternal diabetes causes hyperglycaemia
this causes foetal hyperinsulinaemia and increased foetal growth.
This has 4 consequences:
-Foetal macrosomia
(risk of birth injury, shoulder dystocia)
-Polyuria & polyhydramnios
(risk preterm labour, malpresentation, cord prolapse)
-Increased O2 demands polycythaemia
(risk of unexplained term stillbirth)
-neonatal hypoglycaemia
(risk of CP)

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15
Q

Describe the risk factors for gestational DM? (9)

A 
prev GDM
fam hx
poor obstetric hx
significant glycosuria
polyhydramnios
Macrosomic infant in this pregnancy
PCOS
BMI > 30
south Asian, middle eastern or african origin
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16
Q

Management of DM in pregnancy:

  • medications?
  • what investigations should be done throughout? (7)
  • after birth?
A

-Diet first
Metformin
Insulin

-detailed USS including cardiac views
Blood glucose 
HbA1C < 6.0%
retinal screening 
serial growth scans 
monitor for PET
elective delivery

-ensure no neonatal hypoglycaemia
pre-existing DM- return mother to prev dose
GDM- stop treatment and monitor

17
Q

Summarise the effects on the foetus of maternal DM? (6)

A

Macrosomia
inc risk of birth injury- shoulder dystocia

Polyhdramnios
foetal malpresentation and inc risk preterm labour

hyperinsulinaemia
severe hypoglycaemia and risk of CP

polycythamia
thrombotic effects & jaundice

hypocalcaemia

HOCM

18
Q

Thromboembolic disease in pregnancy

  • explain the underlying physiology? (3)
  • what are the risk factors? (14)
  • management (low, intermediate, high risk ante and postnatal)?
A 
-prgnancy pro-thrombotic state 
Virchow's triad 
stasis- venous compression by uterus
Hypercoagulability- effects of pregnancy
Vascular damage- varicose veins 
-prev VTE
thrombophilia
medical comorbidities 
fam Hx
inc age
obesity parity >3
smoker 
current pre-eclampsia
IVF
C section in labour
prolonged labour
PPH
preterm/stillbirth
OHSS
-Antenatal
Lower risk
(mobilise and avoid dehydration)
intermediate risk
(consider prophylaxis with LMWH)
high risk
(defo LMWH prophylaxis)
Postnatal
intermediate risk
(10 days LMWH)
high risk
(6 wks LMWH)
19
Q

Describe the coagulation changes that occur in pregnancy?

A

Increased factor 7,8,9,10,12, inc fibrinogen, inc platelets

decreased levels of factor 11 and antithrombin \so effects on intrinsic and extrinsic pathways

20
Q

DVT in pregnancy

  • investigations?
  • management?
A

-Duplex US on lower limb
FBC, clotting, Us & Es, LFTs
platelet levels & thrombophilia screen

-compression stockings
LMWH e.g. Dalta-parin
(1mg/kg twice a day)
continue till 3 months after delivery

21
Q

Why is LMWH suitable in pregnancy?

A

does not cross the placenta so has no anticoagulant effect on the foetus

22
Q

Pulmonary Embolism in pregnancy

  • investigations?
  • management?
  • labour and delivery?
  • postnatal management?
A 
-ABGs
ECG
Chest X ray 
Duplex US of lower limbs 
V/Q scan
CTPA (check hx for breast cancer)

-LMWH

-stop heparin when in labour
anaesthesia:
if therapeutic then stop 24 hrs prior
If prophylactic then stop 12 hrs before

-at least 3 months anticoagulation with either LMWH or Warfarin

23
Q

Warfarin

  • when should it be avoided in pregnancy and why?
  • is it safe to breastfeed?
  • monitored using?
A

-6-12 wks as teratogenic
stop 6 weeks before labour

  • yes
  • INR
24
Q

Thyroid in pregnancy

  • hypothyroid management?
  • hyperthyroid (effects on condition, effect no pregnancy, medication used?)
A

-increase levothyroxine by 25-50mcg in first trimester and repeat TFTs every trimester

-gets worse due to HCG in 1st trimester
improves 2nd and 3rd
IUGR, preterm labour, thyroid storm 
Carbimazole/PTU
propranolol
25
Q

describe the respiratory changes in pregnancy

  • RR?
  • tidal vol?
  • inspiratory capacity?
  • residual vol?
  • expiratory reserve?
  • functional residual capacity?
A

-RR increases
this causes inc pH, decreased pCO2 and decreased HCO3

  • increases
  • increases
  • decreases
  • decreases
  • markedly reduced due to diaphragmatic elevation and increase in subcostal angle
26
Q

Asthma in pregnancy

  • effects of preg on asthma?
  • effects of asthma on preg?
  • management?
A

-greater risk of deterioration in severe disease in the 3rd trimester
normally due to reduction of meds due to safety fears

-if very severe and poorly controlled then can cause PIH/PET, PTL, LBW, IUGR, neonatal morbidity

-prevention rather than treatment
optimise control prior to preg
use of B2 agonists +/- inhaled corticosteriods

27
Q

Epilepsy in pregnancy

  • effect of pregnancy on epilepsy? (3)
  • effects of epilepsy on pregnancy? (5)
  • management (pre conceptually, pregnancy, postpartum)?
A

-increase in seizure frequency, if poorly controlled then likely to deteriorate (poor compliance due to fear of teratogenicity & reduced drug levels due to nausea etc)
risk of seizures highest in peripartum period

-feotus resistant to short term hypoxia & no increased risk of miscarriage or obstetric complications
Major risk is the teratogenicity of drugs
20% risk child will develop epilepsy if both parents diagnosed

-Preconceptually
take folic acid 5mg/day at lest 12 wks prior to conception

Pregnancy
folic acid
continue current drugs BUT wean off phenobarbitone due to risks of neonatal withdraw convulsions
detailed scan at 18-20 wks
Vit K 10-20mg orally from 34-36 wks (risk of haemorrhage disease of the newborn)

Postpartum
1mg IM Vit K for baby
encourage breastfeeding 
shallow baths and showers
increased risk of SUDEP

NB: most have normal births but fits may increase around delivery period

28
Q

Describe the teratogenic risks of anticonvulsants?

  • major malformations & causative drugs? (3)
  • minor malformations? (3)
  • overall risk of malformation?
  • what is the risk to feotus if taking phenytoin, valproate and carbamazepine
  • what is the mechanism for this teratogenicity?
A 
-neural tube defects (valproate &amp; carbamazepine)
orofacial clefts (phenytoin)
cardiac defects (phenytoin &amp; valproate)

-dysmorphic features
hypertelorism
hypoplastic nails & distal digits

  • 6-7%, risk increases with no. of drugs
  • 50%
  • thought to be folate deficiency

Reproduction (48 decks)

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