Medical Conditions Flashcards
Risks of obesity
Bmi >25 overweight >30 obesity
Antenatal:
Mum: miscarriage, recurrent mc, pet, GDM, osa, vte, maternal death
Fetal anomalies (ntd), growth anomalies, still birth, PTB
IP: IoL, dystocia, monitoring issues, cs
Anaesthetic:local issues, ga issues, airway issues, icu admission
Postpartum: infection/dehis, vte, depression, bf issues, long term neonatal weight gain/body composition
PCKD
Autosomal dominant, usually doesnt impair renal function
Maternal risks: assoc with liver + subarachnoid disease, risk of UTI affecting longterm renal function, risk of HTN
disease
Fetus - miscarriage, PET, IUGR, PTB, polyhydramnios, stillbirth
Neonate - 50% chance of transmission
Start aspirin.
IF aneurysm, refer to neurosurg, consider MRI, may need clipping/endovascualr thing about valsalva/mode of delivery, tertiary centre
Aneurysm in pregnancy
PC: headache (thunderclap), vomiting, LOC, sudden collpase, neck stiffness, papilodema.
Can be AVM/SAH
CT shows acute bleed
MRI more delayed bleed
Refer to neurosurg, if >7-10mm, will likely clip or use endovascular techniques
ELCS or cautious epidural, short second stage, forceps
NOT for regional anaesthesia if recent SAH
Differential seizure in pregnancy
Ecclampsia Epilepsy Central venous thrombosis Stroke TTP Subarachnoid haemorrhage Drug + alcohol Metabolic derangement INfection (tuberculoma/toxoplasmosis) Psychosomatic
HIV
C-blood borne RNA virus, can be sexually transmitted
R-M: infection
F:transplacental infection, preterm birth
I - confirm with ELISA, other STI including syphilis, Hepb/c, Baseline LFTs
Monthly CD4 count, viral load, most important @ 36/40
T-HART, aim <50 copies, zidovudine may be needed. this is the PEP for newborn, must be within 4 hours
0-avoid amnio/ecv etc if >50 copies, if <50 copies essentially treat as normal, prefer formula feeding + dostinex, def not mixed feeding.
Determine mode @ 36/40
Full PPE for all staff
Paed review at delivery
Sickle cell disease
Autosomal recessive - glu-val
MDT - anaesthetics, haem, paed
Cold/nausea/pain/hypoxia
Perinatal mortality increased 4-6 fold
Risks - anaemia, dehydration, ACUTE CHEST SYNDROME, increase uti, gallstones, retinopathy, leg ulcers, pulm HTN
Transfusion if <80
Reduced life expectancy
Meds - 5mg folic acid throughout, aspirin (pet), prophylactic penicillin
Vaccinations - neisseria, strep, haemophilus
Growth scans
Von willebrand - pregnancy
Most common inherited bleeding disorder
Mostly autosomal dominant, severely deficient form autosomal recessive
Usually levels increase in pregnancy, but early gestation may still bleed lots with ectopic, miscarriage, cvs.
vWF and FVIII fall rapidly postpartum, increased risk PPH
DDAVP - may be given as IV infusion if type 1, more severe types need FFP
Avoid nsaids and aspirin
Hepatitis B
C- blood borne virus (sex, vertical, blood)
R - Mat: cirrhosis, HCC
- Fetal - transmission ,highest if e antigen present
- Neonatal - test at 9/12
Invx -
bloods: LFTs, e antigen, viral load (if >10^6 = need tenifovir), liver USS, coags,
T - tenofovir from 30/40, immunise household contacts and baby (baby immunoglobulin + vaccine within 24H)
If using tenofovir, dont breastfeed
O - 1st
2nd
3rd - no FBS/FSE
Fructosamine
Order in people with anaemia, thalassemia, sickle cell disease
Toxoplasmosis
C - usually asymptomatic, swollen lymph nodes, fever, muscle aches.Avoid raw/undercooked meat, wash hands after gardening
Risk of tranmission 10%, more likely to be transmistted early.
Congenital - stillbirth, intracranial anomalies, developmental delay, ocular inflammation, impaired hearing.
First trimester - low risk infection, high risk of damage
Third - high risk infection, low risk damage, usually asymptomatic.
Tests - USS +/- fetal MRI, amnio >4 weeks, to see if fetus infected, if fetus infected, offer TOP, or continue with pyrimethamine + folinic acid + test infant
Treat - spiramycin (treats Mum) or >18 weeks pyrimethamine + sulfadiazine
Risks of anti epileptic drugs
If taking 2 or more, risk = 10-15%
Ideally levitiracetam, lamotrigine, carbamazepine
MAJOR
- neural tube (valproate)
- orofacial
- cardiac
Minor - fetal anticonvulsant syndrome Dysmorphic features Hypertelorism (eyes far apart) Hypoplasitc nails and digits Hypoplastic midface
Valproate the worst, also assoc with impaired neurodevelopment, reduced IQ
Risks of overt hypothyroidism
Miscarriage Hypertensive disorders Placenetal abruption Anaemia PPH
Prematurity, LBW, increased perinatal morbidity + mortality
Hypothyroidism
Usually autoimmune - anti TPO antibodies, antithyroid peroxidase = Hashimoto’s disease
-post thyroidectomy/radiation
Aim TSH <2.5 first tri then <3.
If have anti TPO antibodies and subclinical, offer treatment
MDT, endocrinologist, anticipate increased dosing
Monthly TFT
Serial growth scans
Cystic Fibrosis
C - autosomal recessive, early repeated lung infections, respiratory failure, pancreatic insufficiency, early mortality
20% have diabetes, 15% have IGT
R - maternal: infective exacerbations, congestive heart failure, poor weight gain (preterm + stillbirth)
F-PTB, IUGR due to chronic hypoxia
Invx - Echo, FEV1/pulm function tests, nutrition, resp
T - MDT, control infection (prophyl abx if needed), grpwth scans, cs for obs only, avoid hypoxia, measure growth
O - avoid prolonged 2nd stage as incr risk pneumothoraces, encourage BF with nutritional support
High Risk MSS1
Screening test - incompatible w life or assoc with high morbidity + long term disability, treatment in utero or immediately postpartum
Non diagnostic
Only 3 conditions - tri 21 is down syndrome, brief explanation (intellectual impairment, congenital malformations w cardiac, leukemia, thyroid, alzheimers)
Further options
NIPT - still screening, not diagnostic
Diagnostic - CVS or amnio or wait till baby born and examine and test
Hep C
C - BBV
R
- mat: cirrhosis, HCC
- fetal: transplacental transmission
- newborn: monitor, for up to 12 months
I - LFTs, viral load, LFT + USS, check for HIV, full sexual health screen Hep b/c/hiv/syphilis consider trich/chlam/gono
T - minimise invasive procedures (check re amnio)
O - full PPE for all staff
- MDT w gastro, ID
- mode determined by obstetric, avoid FBS/FSE
- bathe baby before vit K
- post partum eradication (ribovarin - teratogenic)
- BF if dont have cracked nipples
Lupus
C - autoimmune condition, deposition immune complexes
Flare = fever, lymphadenopathy, skin + joint + renal, can rx w steroids/hydroxycholoroquine
R: wait until 6-12 month flare free, can stay on hydroxychloroquine (this also reduces heart block by 77%)
Preg on disease -
Disease on preg - PET, nephritis (PET, FGR, fetal loss, worsening renal), VTE, PPH
Fetal: IUGR, IUFD, PTB
Neonatal: heart block 2% (if prev baby 15-20%). cutaneous lupus 5% within 6 months
Invx FBC, UEC, urine, PCR APL: anticardio, B2 glyco, ANA anti ro/ssa and la/ssb c3/4 ds dna
Rx - heartbeat each visit
Echo + ro/la around 20 weeks, repeat at 28
Monthly platelet
Repeat apL, complement, DNA, UEC every trimester
Rheumatoid arthritis
Systemic disorder, assoc w fatigue, haematological, resp issues, cardiac involvement (pericarditis/amyloiditis)
Assoc w lupus/Sjorgens syndrome
Ensure no issues with NECK (rare), hip abduction
If anti-Ro +ve = risk of neonatal lupus
50% improve during pregnancy, 90% get exac within first 4 months
Lower risk than SLE but can still have growth restriction, PTB
MTX - need to be off it ideally 12 weeks
NSAIDs - avoid 3rd trimester, pref is pred over NSAID for flare
meds that are okay: hydroxycholoroquine, sulfasalazine, prednisone
Fetal varicella syndrome
Highest risk 2nd trimester
<12 weeks, 0.55%
12-28 weeks 1.4%
>28 weeks, no cases of FVS
Abnormalities: Skin, eye, limb, prematurity, cortical atrophy, poor sphincter control, early death
Recommend
-MFM
Detailed anomalie scan FIVE WEEKS after primary
Repeat USS until delivery, consdier MRI
Amnio not routinely advised if uss normal
Maternal exposure to varicella
If IgG negative
< 96 hours, VZIG
If >96, no vzig, consider antiviral if high risk (late preg, lung disease, immunocompromised, smoker)
Refer to MFM
-detailed scan 5/52
amnio not that useful, altho can be reassuring if pcr -ve.
Ess HTN differentials
Renal disease Cardiac disease Hyperparathyroidism Cushing syndrome Conn syndrome Phaeochromocytoma
Examine: femoral pulses (radiofem delay), renal bruits, urinalysis m serum electrolytes incl calcium, urinary catecholamines
ESS HTN superimposed PET 25% Preterm 28% IUGR 17% Placental abruption + death
Thyrotoxicosis
Radioactive iodine contracindicaed
Surgery rarely required, only if cancer/obstructing ariway/cant take meds
Medical therapy
- PTU
- Propanolol to control HR
Recheck TFT every month and adjust to keep T4 in apprporiate range
Risks to baby - IUGR, PTB, neonatal hypothyroidism
Neonatal graves - tachycardia, LBW
T1DM
Maternal
-hypoglycaemia, retinopathy, nephropathy, autonomic dysfunction/gastroparesis
Fetal
-miscarriage, fetal anomalie (cardiac, situs, inversus, sacral agenesis), growth MACROSOMIA, hypertensive, PTB, shoulder dystocia
Neonatal - stillbirth, perinatal mortality, hypoglycaemia, NICU admit
MANAGEMENT
-optimise meds, Folic 5mg, iodine, aspirin, vit D
-dating scan, mSS1, genetic carrier, vaccines
-mdt: dietician, endocrine, combined clinic
Baseline PET
Early anatomy, detailed fetal echo, uterine artery
Growth scans
Retinal screening/renal management
IOL by 38 weeks depending on complications
CS if >4.5kg
Hourly BSL in labour
CEFM
PN - rapid change in insulin requirements, BF support, DM nurse FU, wound care, contraception
B thalassemia
Chronic anaemia
- splenomegaly, infections, bone marrow expansion
Test partner
-consider CVS/amnio/FBS
Genetic counselling
PGID
5mg folic acid, po iron only, may need RBC transfusions
Major = survivable
Minor - baby might inherit it and be major, if partner positive
End organ iron overload
- Heart (echo)
- Liver (liver uss)
- Endocrine (assoc with hypothyroidism)
- Consider DEXA scan
Do fructosamine instead of Hba1c for booking GDM etc
CVS
Chorionic villus sampling
Aspiration of biopsy of placental villi
11-13+6
Transvaginal or transabdo
Failure to obtain sample Blood stained sample Contaminated Risk of miscarriage 1-2% Chorioamnionintis Haemorrhage/haematoma Rhesus senstizan
Oromandibular limb hypoplasia (if <10 weeks)
