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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > Medical disorders in pregnancy > Flashcards

Medical disorders in pregnancy Flashcards

1
Q

What are common conditions seen in women of reproductive age?

A
  • Asthma
  • Diabetes
  • Epilepsy
  • Cardiac Disease
  • UTI
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2
Q

What medications should not be started in a pregnant woman for treatment of asthma?

A

Leukotriene receptor antagonists

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3
Q

What measures should be taken pre-conception in a woman with epilepsy?

A
  • Folic acid 5mg for >3 months prior
  • Optimise treatment - avoid ppolypharmacy
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4
Q

What are other causes of seizures during pregnancy beside epilepsy?

A
  • Pre-eclampsia
  • Cerebral venous thrombosis
  • Intracranial mass
  • Stroke
  • Hypoglycaemia
  • Migraine
  • Hyponatraemia
  • Drugs/Withdrawal
  • Infection
  • Postdural puncture
  • Pseudoseizures
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5
Q

What epileptic medication has highest risk of foetal abnormality associated with it?

A

Sodium valproate

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6
Q

When should a pregnant woman with epilepsy be started on Vit K in the last 4 weeks of pregnancy, and why?

A

If on following antiepileptic drugs - All enzyme inducers - clotting factors may be reduced in the newborn

  • Carbemazepine
  • Phenytoin
  • Primidone
  • Phenobarbitol
  • Ethosuximide
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7
Q

When is fitting in labour indicative for a C-section?

A

Only if in status epilepticus - otherwise

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8
Q

Should you continue anti-epileptic drugs during labour?

A

Yes

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9
Q

Are epidurals safe in epileptic women going through labour?

A

Yes

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10
Q

How would you manage seizures during labour that were not self-limiting?

A

Benzodiazepines - lorazepam, diazepam

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11
Q

Why are seizures in epilptic pregnant women common intrapartum and postpartum?

A
  • Sleep deprivation
  • Reduced drug efficacy - increased volume of distribution, increased serum binding
  • Hyperventilation
  • Hormonal changes
  • Nausea and vomiting
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12
Q

Why would you give vitamin K to a child post birth?

A

To reduce risk of haemorrhagic disease of the newborn

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13
Q

What might you have to do with the dose of oral contraception in post natal epileptic women if they are on enzyme inducing drugs?

A

Increase dose of oral contraceptive

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14
Q

What cardiopulmonary disease carries a high risk of mortality in pregnant women?

A

Pulmonary hypertension

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15
Q

What might you think of if you saw sinus tachycardia in a pregnant woman?

A
  • Anxiety
  • Anaemia
  • Hyperthyroidism
  • Infection
  • Hypovolaemia
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16
Q

What psychiatric medication should be avoided in pregnany?

A
  • Valproate
  • Carbemazepine
  • Paroxetine - 1st trimester
  • Lithium
  • Benzodiazepines
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17
Q

What is gestational diabetes?

A

Diabetes which develops during pregnancy which reverts to normal after pregnancy

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18
Q

What are risk factors for gestational diabetes?

A
  • BMI > 30
  • Previous macrosomic baby
  • Previous GDM
  • FH of diabetes
  • High risk groups - asian origin
  • Previous polyhydramnios
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19
Q

Why can insulin requirements of pregnant type I/type II diabetics increase?

A

Increase in:

  • Human plcaental lactogen
  • Progesterone
  • B-HCG
  • Cortisol
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20
Q

Why can foetal hyperinsulinaemia occur in pregnancy of diabetic women?

A

Maternal glucose crosses the placenta and induces increased insulin production in the foetus -> Causes macrosomia

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21
Q

What complications are those who have type I/II diabetes at risk of during pregnancy?

A
  • Foetal congenital abnormalities - especially if blood sugars high peri-conception
  • Miscarriage
  • Pre-eclampsia
  • Macrosomia
  • Polyhydramios
  • Operative delivery
  • Shoulder dystocia
  • Worsening maternal nephropathy, retinopathy, hypoglycaemia, reduced awareness of hypoglycaemia
  • Infections
  • Stillbirth
  • Neonatal - impaired maturity, neonatal hypoglycaemia, jaundice
22
Q

Complications of diabetes in pregnancy

A
  • Shoulder dystocia
  • Macrosoma
  • Amniotic fluid excess
  • Stillbirth
  • Hypertension and neonatal hypoglycaemia
23
Q

What measures would you take preconception when managing someone who wants to get pregnant and has diabetes?

A

Better glycaemic control

  • 4-7mmol/l pre-conception
  • HbA1c <6.1% (<43 mmol/mol)
  • Folic acid 5mg
  • Dietary advice/Weight reduction
  • Retinal assessment
  • Renal assessment
24
Q

What antenatal measures would you want to take during pregnancy when managing a diabetic woman?

A
  • Aim to stay normoglycaemic
  • Increase BM monitoring - Provide kits for hypo’s
  • Detailed scan at 18-20 weeks - look for foetal abnormality
  • Insulin increase - can be 50-100%, but may need to decrease towards end
  • Monitor foetal growth
  • Regular U+E’s, MSSU, HbA1c, Eye exam
  • Aim for tight control
25
Q

What are the cut-offs for the following in diabetic control in pregnancy:

  • Fasting glucose
  • Post - Prandial glucose
  • Before bedtime
A
  • Fasting - <5.3 mmol/L
  • Post-prandial - < 7.8mmol/L
  • Before bedtime - < 6mmol/L
26
Q

Can metformin be used in pregnancy?

A

Yes

27
Q

When is labour usually induced in diabetes?

A

38-40 weeks

28
Q

How would you control blood sugar in gestational diabetes?

A
  • Diet
  • Metformin/insulin
29
Q

Is a new onset Ejection systolic murmur normal in pregnancy?

A

Yes - 96% of women develop it

30
Q

What post-natal measures should you take with someone with GDM?

A

Do OGTT 6 weeks post-delivery

31
Q

What CNS problem can sodium valproate cause?

A

Neural tube defect

32
Q

What ENT problem can phenytoin cause?

A

Cleft lip/palate

33
Q

What cardiovascular problem can phenytoin/sodium valproate cause?

A

VSD

34
Q

How would you manage someone who is epileptic who wanted to get pregnant (e.g. pre-conception advice etc.)?

A
  • Assess epilepsy
  • Change from poly to monotherapy
  • Smallest possible dose
  • High dose folate
  • Advise strongly against stopping AED without medical advise
35
Q

What are the most commonly recommended forms of contraception in someone with epilepsy?

A
  • Barrier
  • IUD
36
Q

Why might oral contraceptives be less effective in someone with epilepsy?

A

Many AEDs induce liver enzymes, leading to rapid clearence of steroid hormones and allow ovulation in women taking OCP or other hormonal forms of birth control

37
Q

What epileptic drugs drugs have an anti-folate effect on the foetus?

A
  • Phenytoins
  • Carbemazepines
  • Barbituates
38
Q

What endocrine disorder can normal pregnancy mimic?

A

Hyperthyroidism

39
Q

What changes occur in thyroid physiology during pregnancy?

A
  • Thyroid binding globulin + T4 output rise to maintain free t4 levels
  • High levels of HCG mimic TSH
  • Redued iodine availibility - increased urinary excretion and active transport to feto-placental unit
  • T3/T4 increased
40
Q

Why might TSH fall below normal in first trimester?

A

Suppressed by BHCG

41
Q

What might happen to symptoms of hyperthyroidism in someone who is pregnant?

A

May improve as it can be autoimmune cause - autoimmune disorder tend to improve in pregnancy as it is an immunosuppressed state

42
Q

What problems can hyperthyroidism cause in pregnancy?

A
  • Risk of miscarriage
  • IUGR
  • Thyroid storm
  • Preterm labour
43
Q

How would you manage hyperthyroidism in pregnancy?

A
  • Propylthiouracil
  • Carbimazole
  • Beta blockers - symptom control
44
Q

What problems can severe hypothyroidism cause?

A
  • Misscarriage
  • Foetal loss
  • IUGR
45
Q

What foetal congenital abnormalities can occur in diabetes?

A
  • Sacral agenesis
  • Congenital heart disease
  • Neural tube defects
46
Q

What is important in terms of manage the neonate following delivery of a baby with diabetes?

A

Early feeding and regular BMs - risk of hypoglycaemia

47
Q

Why does polyhydramnios occur in pregnant women with diabetes?

A

Causes fetal hyperglycemia and resulting polyuria (fetal urine is a major source of amniotic fluid).

48
Q

How would you manage blood sugars during labour?

A

Sliding scale of insulin

49
Q

What scans would you do in someone who had type I/II diabetes?

A
  • First visit
  • Detailed
  • Cardiac Scan
  • Growth scan
50
Q

What complications can occur as a result of polyhydramnios?

A
  • Cord prolapse
  • Placental abruption
  • Malpresentation of baby
  • Preterm birth
51
Q

If a pregnant woman was found to be on sodium valproate at 12 weeks, what advise would you give them?

A

Delicately say there is no point in changing meds, as most important period is within first 12 weeks, and risks of complications from changing meds then outweigh risks to the baby

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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