Medical conditions In Pregnancy Flashcards
Risk factors for GDM?
Booking BMI >30, age > 40, fam history of DM, previous history of DM, previous macro sonic baby, previous perinatal loss, recurrent glycosuria, PCOS, ethnicity, multiple pregnancy, medications (CS, antipsychotics)
How often to monitor capillary BGL in labour?
Every 1-2 hours, keep between 4-7mmol/l
When to give Rh (D) Ig IM dose (not prophylaxis)
Within 72 hours of sensitizing event (but up to 9-10 d still ok)
At what point must start doing Kleihauer if there’s a sensitizing event
20 weeks onwards
Fetomaternal hemorrhage is large if 6ml and above
When and who to give Rh (D) Ig prophylactically
For women who have not formed alloimmune anti-D antibodies
625 IU at 28 weeks, and again at 32-34 weeks, Should take blood to screen beforehand.
If it was already given for sensitizing event, still need to give this.
Still need to give at birth even if it is still detectable
What to do if RH D negative mother who previously gave birth to Rh D positive baby comes for booking
Indirect antiglobulin (Coombs) test to detect antibodies in the blood
Investigations for preeclampsia
Urinalysis + MCS + spot urine ACR + 24 hr urine protein collection
PET: FBC, UEC, LFT, Uric acid, clotting
CTG if >28 weeks
Ultrasound for fetal biometry, AFI, Doppler, BPP
Outpatient:
- weekly PET and clinic
- repeat U/S every 2 weeks, surveillance as in BPP and Doppler weekly
Management of preeclampsia
Admit if severe HTN/s&s/abnormal lab tests
If SBP 160 and DBP 110
- target 140/90
- nifedipine, hydralazine, labetalol
If non-severe: methyldopa, nifedipine, labetalol (oral)
Betamethasone 2 IM doses of 11.4mg 24 hours apart
Fluid restriction 80ml/kg
MGSO4
- if <30 weeks and birth within 24 hours
- if n&v/blurred vision/headache
- 4g over 20mins, then 1g/hr IV
- continue for 24 hours post delivery
- monitor for SE
Delivery
- if gestation >37, HTN uncontrollable, severe pre-eclampsia, neuro complications, pulm edema, abruptio, non-reassuring fetus
- C-section if eclampsia/severe pre-eclampsia
- no emergency induce or augment labour
Postpartum
- monitor BP, may need anti-hypertensives
- follow-up in 6 weeks
MGSO4 SE and antidote
Hypotension, oliguria, respiratory depression, hyperreflexia, cardiac arrest
Calcium gluconate and stop Mg
Clinical features of preeclampsia
CNS: seizure, headache
Renal: proteinuria, edema, oliguria
CVS: chest pain, SOB, low oxygen sat
Vascular: abnormal HTN
Hepatic: abnormal LFTs, epigastric pain, N&V, HEELP
Ophthal: visual disturbance
Hemato: bleeding, coagulation abnormality, DIVC, stroke
Gestational hypertension investigations
Assess for proteinuria at each visit
Perform PET 4 weekly/as indicated
Ultrasound for fetal biometry/AFI/Doppler/BPP at time of diagnosis
- repeat every 3-4 weeks
Managing mild-mod gestational hypertension
Target BP 130-140/80-90 mmHg Avoid rapid fall Meds - methyldopa 250-750mg TDS - labetalol 100-400mg QID - nifedipine 20-60mg BD - hydralazine 25-50mg TDS
Managing severe gestational hypertension
Admit if >170 SBP Give IV fluid bolus Nifedipine oral 10-20mg (Max 40) Labetalol 20mg IV/200mg oral Hydralazine 20mg IV Continuous CTG till normal and BP controlled Indwelling urinary catheter for hourly output Half hourly maternal observation
Methyldopa SE and CI
Slow onset of action over 24 hours
May cause dry mouth, sedation, blurred vision.
Use w caution in history of depression, no in postpartum
Labetalol SE and CI
Bradycardia, bronchospasm, headache, nausea, scalp tingling which usually resolve within 24 hours
Asthma
