Medical disorders in pregnancy Flashcards
what are the booking bloods
FBC and blood group and ABs
harm-globulins
infection screen - hep B, HIV, rubella, VDRL
RBG
when is the booking visit dating USS anomaly scan monthly visits are till when anti D (2) fortnightly visits when weekly visits till when
8-12 weeks 11-12 weeks 20 weeks till 28 weeks 28 and 34 weeks 28-36 weeks 37 weeks - delivery
what should be checked/asked at every antenatal visit
document gestation BP urinalysis SFH (FSH) fetal kicks/heart
incidence of hypertension in pregnancy
PET
severe PET
eclampsia
10-15%
3-5%
5/1000
5/10000
what is chronic (essential) ht
what is gestational ht
what is pre eclampsia
HTN present at booking or <20 weeks
new HTN> 20 weeks with proteinuria
new htn >20 weeks and significant proteinuria
what can lead to an increased risk inPET
chronic hypertension in mothers
or gestational hypertension
hypertension has what effects on the kidneys during pregnancy
increased GFR proteinuria serum uric acid cr/k/urea oliguria/anuria acute renal failure
hypertension has what effect on liver
epigastric/RUQ pain
abnormal liver enxymes
hepatic capsule rupture
HELP
what is HELP synd
type of pre eclampsia - haemolytic, elevated liver enzymes, low platelets
placental and hypertension
IUGR
placental abruption
intra uterine death
investigations for htn
u&es serum urate LFTs FBC coag screen CTG US
management at booking
if there are risk factors for pre eclampsia -> put on aspirin
management of htn
labetalol
methyldopa
nifedipine (if the other two fail)
what should be stopped in preg
ACE and ARBs
what should be used in severe hypertension
labetalol PO/IV
hydralzaine IV
nifedipine PO
target BP
<150/80-100
organ damage <140-90
if <140/90 consider reducing dose
if <130/90 reduce dose
effects of hypertension on pregnancy and management of that
gestational htn
PET
eclampsia
monster BP, bloods, protein
planning of delivery in htn
vaginal
deliver at 37 weeks if PET
effects of pregnancy on DM
poorer control
deterioration of renal function
deterioration of ophthalmic disease
gestational DM
effects of medical condition on pregnancy
miscarriage fetal malformations cardiac/NTD/caudal regression syndrome IUGR/macrosomia unexplained IUD PET
medications in DM
diet
metaformin
insulin
planning of delivery in DM
vaginal
induce labour at 37-38 weeks
what does having diabetes lead to in the baby
fetal hyperinsulinaemia which leads to increased fetal growth
what 4 things does increased fetal growth lead to and whats a risk for each one
fetal macrosomia - risk of birth injury/shoulder dystonia
polyuria/polyhydramnios - risk of preterm labour/malpresentation/cord prolapse
increased oxygen demands/polycytheamia - risk of unexplained term stillbirth
neonatal hypoglycaemia - risk of cerebral palsy
risk factors for gestations DM
previous GDM FH - one first degree relative or two second degree relatives poor obstetric history significant glycosuria polyhydramnios macrocosmic infant in this pregnancy PCOS weight>100kn or BMI >30 south asian, muddle eastern or african origin
BM target
HBA1C target
retinal screening when
4-6
<5%
every trimester
growth scans in DM
monitoring for what
elective delivery
serial growth scans at 28, 32, 36 weeks
PET
37-38 weeks in pre existing DM
38 weeks in GDM on insulin, may be 41 weeks if GDM on diet with normal Bfs and fetal growth
neonatal in DM
surveillance at delivery monitor BMs to ensure no neonatal hypoglycaemia
post natal management for mum in DM
return to pre pregnancy insulin/oral HG regime
GDM: stop treatment and monitor BM for 48 hours to ensure return to normal and no persistence
macrosmonia can lead to what
increased risk of birth injury/shoulder dystocia
obstetric litigation major cause
LSCS recommended in DM where macrosomia and EFW>4000g
polycythaemia effects on baby
thrombotic effects
jaundice
effects of pregnancy on VTE/PE
medications
increased risk of it
LMWH
what is the main cause of maternal death
VTE
pregnancy is a what state in terms of coagulability
pro coagulable
what are there increased levels of and decreased levels of in terms of clotting factors
increased factor 7,8,9,10,12 and increase in fibrinogen and number of platelets
decrease in factors 11 and antithrombin 3
what are the risk factors for VTE and what should be done if there are < or 3 or 4 present
obesity age >35 parity 3 smoker gross varicose veins current PET immobility FH of unprovoked or oestrogen provoked VTE in first degree relative low risk thrombophillia multiple preg
<3 - mobilisation and avoidance of dehydration
3 - prophylaxis from 28 weeks
4 or more - prophylaxis from first trimester
any previous VTE is managed how
antenatal prophylaxiss with LMWH
how many DVTs are asymp
which leg more common
50%
L>R
ix of DVT
D dimer not done in preg
duplex US
therapeutic heparin
management of DVT
FBC, clotting factos, Uns, LFTs
antixa levels
platelet levels
thrombophilia screen - not routine and controversial
TEDs
LMWH in DVT preg
once daily
outside preg 1.5mg/kg
therapeutic dose 1mg/kg twice or once daily
continue till 3 months after delivery or 6 months after treatment
SE of heparin
haemorrhage hypersensitivity allergy at injection site HIT - heparin induced thrombocytopenia osteopenia - osteoperosis on prolonged use
HIT
1-30%
early in 5 days, usually mild
late >5 days
with unfractionated heparin
PE ix
ABGs CXR ECG duplex US ventilation/perfusion scans CTPA
CXR - who should it be done on
of negative what should be done
all women
bilateral compression duplex dopplers
duplex of lower limbs - useful or no
indirect way
limits further tests
if negative - doesn’t help much
CTPA
less childhood cancer risk compared to VQ
increased breast cancer risk
labour and delivery in VTE/PE
stop heparin in labour in vaginal delivery
stop therapeutic anaesthesia 24 hours before planned surgery
stop prophylactic 12 hours before
what should be given post natally in VTE/PE
6 weeks or for a total of 3 months warfarin or LMWH
what should warfarin be avoided in
avoided in pregnancy 6-12 weeks - teratogenic, miscarriage, neurological problems, stillbirth
stop 6 weeks before labour
effects of pregnancy on hypothyroid women
increase levy by 25-5-mcg in first trimester and repeat TFTs every trimester
effects of pregnancy on hyperthyroid women
gets worse due to HCG in first trimester
improves in second and third trimester
effects of hyperthyroid on pregnancy
IUGR
preterm labour
thyroid storm
medications in hyperthyroid
carbimazole/PTU
propanolol for IUGR
growth scans
respiratory changes in pregnancy
increase resp rate which can cause respiratory alkalosis
changes in PFTs
what happens to the tidal volume the inspiratory capacity FEV1 and PEFR residual volume expiratory reserve functional residual capacity
increases increases stay the same decreases decreases reduction in it
effects of pregnancy on asthma
can improve, deteriorate or stay the same
management of asthma
same
how many women of child bearing age have epilepsy
0.5%
what seizure types may be affected by pregnancy
all
what is epilepsy associated with
risks for maternal death due to aspiration
epilepsy in preg management
5mg folic acid
vit k from 36 weeks if taking hepatic enzyme inducing anti convulsants
effects of pregnancy on epilepsy
increase seizure frequency in some
effects of epilepsy on pregnancy
fetus resistant to short term hypoxia during seizures
no increased risk of miscarriage or obstetric cx
teratogenicity of drugs
pre conceptually in seizures
take folic acid 5mg/day at least 12 weeks prior to conception
epilepsy during pregnancy
continue folic acid
continue current drugs if well controlled - unless phenobarbitone
detailed fetal scan at 18-20 weeks with fetal cardiac scan at 22 weeks
vit k 10-20 mg orally from 34-36 weeks
post partum management in epilepsy
neonate should have 1mg IM vit K
