medical conditions in pregnancy Flashcards
hypertentsion possible has a _______cause
placental, causing vasocinstriction
medications used in hypertension in pregnancy?
labetalol, methyl dopa, nifedipine
in severe hypertension in pregnancy?
hydralazine
ACE inhibitors and arbs?
not to be used in pregnancy
vasoconstriction in pregnancy, leads to decreased blood flow to ?
organs
htn in pregnancy, target blood pressure?
AIM FOR
if
reducing dose
if
reduce dose
what is chronic hypertension?
HTN at booking/less than 20 weeks
what is gestational hypertension?
new htn at 20 weeks WITHOUT significant proteinuria
pre eclampsia?
new hypertension after 20 weeks with significant proteinuria
hypertension can cause damage to?
brain, kidneys, liver, eyes, fetus, placenta
what causes decrease in GFR in pregnancy?
damage to blood vessels in the kidney, dropping flow rate
pathway of renal disease in pregnancy?
decreased grr, proteinuria, increased serum uric acid, increased creatinine, oliguria, acute renal failure
what causes RUQ pain in pregnancy?
abnormal liver enzymes, hepatic capsule rutpture
HELLP syndrome?
haemolysis, elevated liver enzymes, low platelets
risk factor for placental abruption?
HTN (high pressure)
risk factors for pre eclampsia?
1st pregnancy, over 40, obesity, history, hypertension, diabetes, kidney disease
if they have risk factors, prescribe?
aspirin
if pregnant woman has pre eclampsia, deliver?
deliver at 37 weeks
pre 123 ac7ampsia
37 weeks
effects of diabetes on pregnancy
miscarriage, fetal metabolic reprogramming, cardiac problems, neual tube defects, caudal regression synrome,
what is PET?
complication in late pregnancy HIGH BLOOD PRESSURE
PET can be a complication of GD
.
complications of GD?
IUGR, macrosomia, PET, dead, malformed, DELIVER 37 -38 WEEKS
management of GD?
diet, metformin, insulin
what is macrosomia due to?
hyperinsulinaemia, insulin acts as growth factor on insulin sensitive tissues
why do babies get shoulder dystocia?
macrosomia
what can polyhydramnios cause
pre term labour, cord prolapse, malpresentation
what is the risk factor for unexplained stillbirth
polycythaemia
what does neonatal hypoglycaemia predispose?
risk of cerebral palsy
risk factors for GDM?
poor obstetric history (especially death of previous macrocosmic baby), family history, polyhydramnios, significant glycosuria, PCOS. BMI >30
eyes - what do all pregnant women with diabetes get?
retina screening every trimester
delivery?
37-38 weeks in pre existing DM, 38 weeks GDM on insulin
GDM - after birth?
stop treatment, monitor BMs for 48 hours to ensure return to normal and no persistence of IGT
VTE and pregnancy, why is pregnancy pro thrombotic?
increased blood viscosity, increased plasma, decreased haemoglobin concentration. move less. venous compression by uterus.
what factors do you get an increase in?
7, 8, 10 and fibrinogen
decreased?(2)
factor II and ATIII
dont do d dimer in pregnancy, why?
it increases throughout gestation, not an accurate test
how would you diagnose DVT?
duplex ultrasound on lower limb
which anti coagulant is safe in pregnancy i.e. doesn’t cross the placenta?
heparin
how do you manage a DVT in pregnancy
treat with heparin then see
side effects of heparin?
osteopaenia, haemorhage, hypersensitivity, heparin induced thromboctopaenia, allergy at injection site OHHHA
Investigations for PTE?
heparin, ABG, CXR
why can CXR be misleading?
normal in 50 % of PTE
what 4 things could be seen on a CXR in PTE?
effusion, focal opacities (white), atelectasis (partial collapse of lung), oligaemia (reduced vascularity)
term for partial collapse of lug?
atelectasis
reduced vascularity in lung?
oligaemia
CTPA - decreased chance of? but increased chance of?
child getting cancer than doing a VQ, but increased risk of breast cancer
when do you stop heparin? epidural anaesthetic?
before delivery, 24 hours before delivery
warfarin and LMWH when do you start them after birth?
6 weeks
how long on them?
3 months
when do you avoid warfarin in pregnancy?
6 - 12 weeks
can you breast feed with warfarin?
yes
bad effects on fetes - warfarin?
teratogenic, muscarriage, still birth
hypothyroid…what do you increase levothyroxin by in first trimester?
25-50mcg
what do you repeat every trimester?
thyroid function tests
minimal effects of hypothyroid on pregnancy
.
why is hyperthyroid made worse in pregnancy (first trimester)?
HCG acts like thyroid hormones
what happens second and third trimester?
gets better
preferred treatment of hyperthyroid?
PTU
what is given to reduce blood pressure in hyperthyroid?
propranolol
asthma in pregnancy - what does an increased RR cause?
resp alkalosis
what happens to pH? pCO2? HCO3?
ph goes up, picot goes down, hco3 goes down
02 demand is increased by?
20%
2 main changes in breathing in pregnancy?
increased rr, increased tidal volume
what is tidal volume?
normal volume inhaled/exhailed with no added effort
in pregnancy, what happens to residual volume?
decreased
what happens to FEV1 and Peak Expiratory Flow rate?
they remain unchanged
asthma has minimal effect on pregnancy, however in severe disease, when is the greatest risk of complication?
3rd trimester
treatment of asthma in pregnancy?
no difference
risk of maternal death in epilepsy due to aspiration?
yes
why is there an increased risk of seizures in first trimester?
hyperemesis and haemodilution
what is risk of malformation of foetus in maternal epilepsy due to?
anti epileptics
what is given to stop this?
5mg folic acid/day
when is vitamin k given if taking hepatic enzyme inducing anti convulsants
36 weeks
poorly controlled epilepsy likely to deteriorate in pregnancy
.
when is risk of seizures highest?
peri part period (last month of gestation)
increased risk in first trimester due to hyperemeseis and haemodilution, highest risk in last month of pregnancy
.
reasons for deterioration of control?
poor complicane (fear of teratogenesis)
decreased drug level due to nausea and vomiting
decreased drug level due to increased volume of distribution and increased drug clearance, lack of sleep, lack of absorption of drugs during labour
if mother has a seizure, how does baby cope?qrelatively resistant to short term hypoxia
no increased risk of miscarriage or obstetric complications
major risk is drugs!
ALL ANTI CONVULSANTS ARE TERATOGENIC
what is the mechanism thought to be?
foalate deficiency
major malformations? (3)
NTD, cardiac defects, orofacial defects
are benzos teratogenic?
no
women should be on folic acid pre conceptually and thought pregnancy (5mg per day)
wean off/change phenylbarbitone due to risks of neonatal withdrawal symptoms
vitamin k should be given orally from _______weeks (6am) if on enzyme inducers (anti convulsants) due to risk of vitamin k deficiency and hemorrhagic disease of the newborn
.
what are the two things epileptic women should be given when pregnant?
continue anti convulsants. 5mg folic acid per day. vitamin k from 34-36 weeks
anti epileptic drugs in labour?
continue them
neonate should receive?
1mg IM vit k. (hemorrhagic disease of newborn)
SUDEP?
risk of SUDEP increased in pregnancy
