Medical disorders in pregnancy Flashcards
What chart should be used for observations in pregnant women and when should they stop being used?
MEWS
until 6 weeks post-partum
Risk factors for gestational diabetes
age
FH
ethnicity/race
BMI
How is gestational diabetes diagnosed?
OGTT
Risks of diabetes in pregnancy
macrosomia
shoulder dystocia
congenital malformation
increased risk of pre-eclampsia
What anti-diabetic medications can continue in pregnancy?
insulin
metformin
When should retinal screening be done for diabetics in pregnancy?
at booking
if retinopathy - assess again at 16-20 weeks and 28 weeks
What extra growth scans should a pregnant woman with diabetes have?
28, 32 and 36 weeks
What HbA1C would it be recommended for a woman not to become pregnant?
> 86 mmol/L
Can you use eGFR in pregnancy?
no
What can be used to measure renal function in pregnancy?
creatinine
>77 needs investigating
What anti-epileptic drugs are considered safe in pregnancy?
levetiracetam
lamotrigine
Anti-epileptic drugs which carry higher risks of malformations if used in pregnancy
carbamazepine
phenytoin
phenobarbital
topiramate
sodium valproate
What congenital malformations are associated with use of anti-epileptic drugs in pregnancy?
neural tube defects
facial cleft
hypospadia
Reasons for loss of control of epilepsy during pregnancy
poor compliance - stopping medication over concerns for baby
altered drug levels - altered protein binding, increased metabolism/excretion, increased plasma volume
What condition can rotavirus cause?
intussusception
If IBD is active at time of conception, what is there higher risk of in the pregnancy?
miscarriage
preterm birth
low birthweight
if flaring at conception, more likely to flare throughout pregnancy
What should happen if a patient is on a biologic during pregnancy?
no live vaccines for baby for 6-12 months (eg. rotavirus, BCG)
What IBD medications are safe in pregnancy?
azathioprine
mesalazine
sulfasalazine
steroids
What IBD medications are not safe in pregnancy?
methotrexate
mycophenolate mofetil
What ECG changes are normal in pregnancy?
HR increases by 10-20 bpm
axis shifts superiorly - 15 degree LAD
small Q waves and T wave inversion in precordial leads (V1-V6)
atrial and ventricular ectopics
Concerning breathlessness-related symptoms in pregnancy
sudden onset SOB
pleuritic chest pain
collapse
haemoptysis
PND
orthopnoea
Features of physiological breathlessness of pregnancy
worse at rest
better with exercise
unremarkable examination
exertional saturations normal
respiratory rate should not be increased
