Medical Conditions in Pregnancy (OLD NOTES) Flashcards
What things are done at a normal ANC booking visit?
- General pregnancy advice is given.
- Identify if low/high risk.
- Information on choices for place of delivery.
- Discuss screening.
- Check height and weight (BMI).
- Check BP.
- Arrange dating USS at 12 weeks.
- Arrange ‘booking’ bloods.
What bloods are taken at booking, and what is screened for via blood testing?
- FBC and Blood Group and Antibodies (Rh status)
- Haemaglobinopathies
- Infection Screen - Hep B, HIVm rubella, VDRL
- Random Blood Glucose - screen for diabetes
When is the first USS done?
11-12 weeks
When is the anomaly scan done?
20 weeks
Up to how many weeks are monthly visits done?
28 weeks
When is anti D checked?
28 weeks + 34 weeks
When are weekly visits done?
37 weeks until delivery
What is done at every antenatal visit?
- Accurately document gestation.
- BP.
- Urinalysis.
- SFH (FSH).
- Referral of any problems to Consultant Unit.
What is the commonest medical problem in pregnancy?
HYPERTENSION
What is defined as chronic essential hypertension in pregnancy?
HTN present at booking or <20weeks
What is gestational hypertension defined as?
New HTN >20weeks without significant proteinuria.
What is pre-eclampsia defined as?
New HTN >20weeks + significant proteinuria.
What 5 factors do you need to consider in someone with suspected hypertension?
- Effect on pregnancy.
- Pregnancy effect.
- Medications.
- Delivery.
- Post-partum.
Outline 3 factors which contribute to decreased blood flow to organs.
- Vasoconstriction
- Pro-coagulation
- Intravascular thrombosis
What happens to GFR? (in pregnancy-induced renal disease)?
It decreases
What happens to serum uric acid? What may be associated with this? (in renal disease in pregnancy)
It increases
There is also placental ischaemia
What 3 things increase in renal disease in pregnancy?
- Creatinine
- Potassium
- Urea
What happens to urine output in a pregnancy lady with renal disease?
There is oliguria/anuria (small amounts of urine or no urine)
What 2 categories can acute renal failure be divided into?
- Acute tubular necrosis.
2. Renal cortical necrosis.
What symptoms may a pregnant woman with liver disease experinece?
Epigastric/RUQ pain
What – on investigation – may be abnormal, in a pregnant lady with liver disease?
Liver enzymes
What serious condition can arise from liver disease in pregnancy?
HEPATIC CAPSULE RUPTURE
What may hepatic capsule rupture/ liver disease in pregnancy lead to?
HELLP Syndrome – haemolysis, elevated liver enzymes, low platelets.
Give 3 problems associated with placental disease.
- IUGR.
- Placental abruption.
- Intrauterine death.
What investigations should be done for hypertension in pregnancy?
- Urea and electrolytes.
- Serum urate.
- LFT’s.
- FBC.
- Coagulation screen.
- CTG.
- Ultrasound – biometry, AFI, Doppler.
At what points in the pregnancy journey should the mx of HT be considered?
- Pre-conception.
- Booking.
- Antenatal.
- Intrapartum.
- Postpartum.
If, on assessment at booking or at any other point antenatally, there are risk factors for pre-eclampsia, what should be done?
GIVE ASPIRIN
If, on assessment at booking or at any other point antenatally, there are risk factors for pre-eclampsia, what should be done?
Surveillance
- Scans.
- BP monitoring.
- Urine testing.
- Staff: medical, midwives, community
If a woman has hypertension at < 20 weeks, what should you do?
Check for a secondary cause - it is VERY likely that she already had hypertension
What medications are used to treat HT in pregnancy? (list these in order of 1st, 2nd line etc)
- Labetalol.
- Methyldopa.
- Nifedipine (usually if monotherapy fails ie. top up).
What anti-hypertensive medication should be stopped in pregnancy?
ACEI’s and ARB’s
What can be used for severe hypertension in pregnancy?
- Labetalol (oral or IV).
- Hydralazine (IV).
- Nifedipine (oral).
165/110 would be classified as ______ hypertension in pregnancy
severe
What is the target BP in pregnancy?
150/80-100mmHg
If there is target organ damage, e.g. renal damage, causing proteinuria or retinal damage, what BP should you aim for?
<140/90mmHg.
If BP is i) <140/90 ii) <130/90mmHg, what should you do?
i) Consider reducing dose.
ii) Reduce dose.
What are the effects of pregnancy on diabetes?
Pregnancy is DIABETOGENIC
- poorer control
- deterioration of renal function
- deterioration of ophthalmic disease
- GDM
What are the effects of diabetes on pregnancy?
- Miscarriage.
- Foetal malformations: cardiac, neural tube defects, caudal regressions syndrome.
- IUGR/Macrosomia.
- Unexplained IUD.
- PET.
How can diabetes in pregnancy be managed?
Diet, metformin or insulin
What type of delivery should be aimed for in diabetes?
Vaginal delivery – induce labour at 37-38 weeks
What type of diabetes can present in pregnancy?
- Pre-existing Type 1.
- Pre-existing Type 2. (increasing)
- Gestational Diabetes. (increasing).
Outline the effects of diabetes on the foetus.
- Maternal diabetes – hyperglycaemia
- Foetal hyperinsulinaemia
- Increased foetal growth foetal macrosomia shoulder dystocia
- Polyuria + Polyhydramnios, Increased O2 demands risk of preterm labour, malpresentation and cord prolapse
- neonatal hypoglycaemia risk of cerebral palsy
Outline risk factors for GDM.
- Previous GDM.
- FHx: one first degree, or two second degree relatives.
- Poor obstetric history, esp. death of previous macrosomic baby.
- Significant glycosuria.
- Polyhydramnios.
- Macrosomic infant in this pregnancy.
- Polycystic ovary syndrome.
- Weight >100kg or BMI>30.
- South Asian, Middle Eastern or African origin.
HbA1C should be kept below what?
6%
What should be done every trimester in a woman with hypertension?
Retinal screening
When should serial growth scans be done in a pregnancy lady with hypertension?
At 28, 32 and 36 weeks.
What should be monitored for in pregnant ladies with hypertension?
PET
