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O&G > Medical Disorders in Pregnancy > Flashcards

Medical Disorders in Pregnancy Flashcards

1
Q

Why is urinalysis for glycosuria not a reliable test for gestational diabetes?

A
  • In pregnancy, kidneys excrete slightly less glucose

- Glycosuria thus may occur at physiological blood glucose concentrations

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2
Q

Define gestational diabetes (NICE 2015)

A

Carbohydrate intolerance which is diagnosed in pregnancy and may or may not resolve after pregnancy

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3
Q

Define the fasting glucose and glucose tolerance test cut offs for gestational diabetes (NICE)

A

Fasting glucose level: ≥ 5.6 mmol/L

2 hour-OGTT (75g load): >7.8 mmol

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4
Q

What are the different types of diabetes present in pregnancy and describe how they relate to the incidence of complications

A
  • Pre-existing diabetes (type I or type II)
  • Gestational diabetes (glucose levels rising to diabetic levels during pregnancy)

Glucose levels rising are a physiological change in pregnancy
Complications are more present with pre-existing diabetes

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5
Q

Outline some foetal complications of diabetes in pregnancy

A

Congenital abnormalities

  • Neural tube defects
  • Cardiac defects

Preterm labour

Reduced foetal lung maturity

Increased birthweight (macrosomia)

  • Foetal islet cell hyperplasia –> hyperinsulinaemia –> fat deposition
  • This can lead to increased urine output and polyhydramnios (increased liquor) for the mother

Foetal distress in labour (due to increased size)

  • Dystocia
  • Birth trauma
  • Sudden foetal death
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6
Q

Outline some maternal complications of diabetes in pregnancy

A

Insulin requirements increase by up to 300%, ketoacidosis is rare, hypoglycaemia can occur from attempts to achieve optimum glucose control

  • UTIs, wound, endometrial infection following delivery
  • Pre-eclampsia is more common
  • Pre-existing HTN is more common
  • Worsening of pre-existing ischaemic heart disease
  • C-section/instrumental delivery more likely
  • Diabetic nephropathy
  • Diabetic retinopathy
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7
Q

Describe some planning steps for management of pre-existing diabetes in pregnancy

A
  • Consultant based antenatal care
  • MDT approach: obstetrician, midwife, GP, dietician
  • Education/counselling of glucose control
  • Blood glucose monitoring 7 times a day
  • Increase dose of metformin/insulin during 2nd half of pregnancy (as insulin resistance increases)
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8
Q

Outline some advice that can be given in pre-conceptual care in pre-existing diabetics

A

Optimise glucose levels

  • HbA1c should be <6.5% (48mmol/mol)
  • Pregnancy not advised if HbA1c >10%
  • Fasting glucose: 4-7mmol/L

Medication

  • Metformin and insulin are appropriate, stop other hypoglycaemic drugs
  • Folic acid given
  • No ACEi/statins/ARBs
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9
Q

Describe the management of pre-existing diabetes mellitus during pregnancy, with reference to glucose targets

A

Blood glucose monitoring:
- Morning, before meals, 1hr after meals and at bedtime

Blood glucose targets:

  • Pre-meal target < 5.3 mmol/L
  • 1-hour postprandial target < 7.8 mmol/L

Metformin/insulin used:
- Doses progressively increased as pregnancy increases

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10
Q

Describe maternal monitoring carried out during and treatment steps to prevent risks of complications during pregnancy for diabetics

A
  • Renal function
  • Retinal screening

Treating complications:

  • Aspirin, 75mg daily given from 12wks onwards: to reduce risk of pre-eclampsia
  • Be wary of diabetic ketoacidosis: medical emergency
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11
Q

Outline the additional foetal monitoring required for women with diabetes mellitus

A
  • Foetal echocardiography

- Ultrasound to monitor foetal growth & liquor volume: 32 and 36 weeks

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12
Q

Describe the management of labour and in the puerperium for women with diabetes mellitus

A

Delivery

  • 37-39 weeks is advised
  • Elective C-section when estimated foetal weight >4kg
  • During labour: sliding scale of insulin, dextrose

The neonate & puerperium

  • Commonly develops hypoglycaemia (as it has become used to a hyperglycaemic state, so its insulin levels are high)
  • Respiratory distress syndrome can occur
  • Mother’s insulin dose immediately changed to pre-pregnancy levels
  • Breastfeeding advised
  • Check neonatal blood glucose within 4hrs of birth
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13
Q

Outline some risk factors for gestational diabetes

A
  • Previous history of GDM
  • Previous large baby (>4.5kg)
  • Unexplained stillbirth
  • 1st degree relative with diabetes
  • BMI >30
  • Ethnicity: south asian, black Caribbean, middle eastern
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14
Q

Outline the indications for gestational diabetes mellitus screening

A

1 risk factor: OGTT at 24-28wks
Those with previous GDM: OGTT at booking

If the following are detected during pregnancy, OGTT is indicated:

  • Polyhydramnios
  • Persistent glycosuria
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15
Q

Outline the steps in management for gestational diabetes (from screening –> medical treatment)

A

Step 1

  • Screening, timing depends on presence of risk factors
  • If fasting >5.6 or 2h OGTT >7.8 go to step 2

Step 2

  • Check HbA1c to identify pre-existing diabetes
  • Advise re diet & exercise
  • Give home glucometer
  • If fasting >7 go to step 4
  • If fasting <7, but after 2wks, levels >5.3 before meals OR >7.8 1h after meals: go to step 3

Step 3

  • Metformin
  • If after 2 wks, levels >5.3 before meals OR >7.8 1hr after meals, go to step 4

Step 4
- Insulin

Rest of treatment same as for pre-existing diabetics

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16
Q

Describe antenatal care, delivery, neonatal and puerperal management for GDM

A
  • Antenatal care and delivery planning same as for pre-existing diabetics
  • Neonatal management same (risk of complications is lower than for pre-existing diabetics)

Puerperium:

  • Treatment can be discontinued
  • Fasting glucose MUST be measured at about 6 weeks post partum (risk of subsequent T2DM is higher)
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17
Q

What are the normal changes in CO in pregnancy, and as a result what is found on cardiovascular examination?

A

CO increases (by 40%)

  • Increased blood flow –> flow ejection systolic murmur
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18
Q

What are common ECG changes in pregnant women?

A
  • Left axis deviation

- Inverted T waves

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19
Q

What are the main cardiac conditions to be aware of in pregnant women?

A
  • Hypertension, valvular disease, ventricular failure (decompensation as a result of increased demands), peripartum cardiomyopathy
  • Mild abnormalities: PDA, VSD, ASD
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20
Q

Outline the clinical presentation of cardiac disease in pregnancy

A

• Assess new/deterioration of symptoms → SOB, palpitations, orthopnoea, paroxysmal nocturnal dyspnoea,
decreased exercise tolerance, chest pain

  • General → pulse (tachy, thread, collapsing), BP (high or low), JVP raised, oedema, cyanosis
  • Chest → ejection systolic murmur common in pregnancy
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21
Q

Outline the general preconceptual, antenatal and intrapartum management of cardiac disease

A

Pre-conceptual

  • Assess cardiac risk (cardiac assessment with echo): address relative risks and contraindications
  • Optimise medication: e.g the following are contraindicated: warfarin, ACEi

Antenatal

  • Monitor foetal well being (foetal cardiac abnormalities detected in 20 week USS)
  • Consider thromboprophylaxis (LMWH)

Intrapartum:

  • Pay attention to fluid balance (uterine involution squeezes fluid into circulation)
  • Consult with anaesthetists: epidurals reduce after load
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22
Q

Describe the management/outline the risks for the following:

pulmonary hypertension, cyanotic heart disease (without PHTN), valvular disease, peripartum cardiomyopathy

A

Pulmonary hypertension

  • Pregnancy contraindicated/termination offered
  • High maternal mortality

Cyanotic heart disease (without PHTN)

  • Risk of embolism
  • Anticoagulation required

Aortic stenosis/mitral valve disease

  • Severe AS: should be corrected before pregnancy (beta blockers)
  • Anticoagulation for metallic heart valves

Peripartum cardiomyopathy (HF specific to pregnancy)

  • Risk of maternal mortality and permanent LV dysfunction
  • Supportive treatment: diuretics, ACEi
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23
Q

Outline the prognosis of cardiac disease in pregnancy

A
  • Leading cause of maternal death in the UK

- Important to be managed appropriately during all points in pregnancy (pre-conception to postpartum)

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24
Q

Grade both severe and life threatening asthma with the following domains: PEFR (%), pulse (bpm), RR (bpm), clinical presentation

A

Severe attack:

  • PEFR <50%
  • Pulse >110bpm
  • RR > 25
  • Inability to complete sentences

Life threatening attack:

  • PEFR <33%
  • Silent chest, cyanosis, bradycardia, hypotension, confusion, coma
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25
Q

What is the standard medical management for asthma?

A

Step 1 – inhaled SABA PRN (salbutamol)

Step 2 – + regular inhaled ICS (400mcg/day)

Step 3 – + LABA/increase ICS to 800mcg/day

Step 4 – ICS 2000mcg/day and + LTRA, theophylline or beta 2 agonist

Step 5 – + oral steroids

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26
Q

Describe the management of asthma during pregnancy

A
  • Drugs shouldn’t be withheld, as they’re generally safe and severe asthma attacks could be lethal
  • Steroid increase during labour
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27
Q

What are potential complications of asthma attacks during pregnancy?

A
  • Prolonged hypoxia –> IUGR –> foetal brain injury• Oral • • • Corticosteroids use in first trimester increases cleft lip risk
  • Preterm birth
  • Perinatal mortality
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28
Q

Outline the acute management of an asthma attack

A
  • Resus, monitor O2, ABG and PEFR
  • High flow oxygen, neb salbutamol (5mg initially continuous, then 2-4hourly), ipratropium 0.5mg QDS
  • Steroid therapy (100-200 IV hydrocortisone, then 40mg PO prednisolone 5-7 days)
  • IV magnesium sulphate if not improvement, consider IV aminophylline or IV salbutamol
  • Summon anaesthetic help if pt getting exhausted PCO2 increasing

Discharge when PEFR >75% of pts best, diurnal variation <25%, stable on discharge meds for 24h

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29
Q

What are the main considerations for women with epilepsy who are pregnant?

A
  • Seizure control deteriorates in pregnancy
  • Anti-epileptic drugs should be continued (due to increased mortality risk of epilepsy)
  • However, risk of congenital abnormalities is increased with medication
    (Dose dependent, higher with multiple drug usage, higher with certain drugs, e.g sodium valproate)
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30
Q

Outline the antenatal management of epilepsy in pregnancy

A
  • Regular assessment for risk factors or triggers for seizures: sleep deprivation, stress, adherence to AEDs,
    seizure type and frequency
  • Growth scans
  • Anti-epileptics: fewest drugs possible at lowest therapeutic dose
  • Folic acid
  • Ideally avoid sodium valproate: carbamazepine, lamotrigine are safer
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31
Q

Pre-conceptually, outline contraceptive management in patients taking anti-epileptics

A

If pt taking enzyme inducing anti-epileptics (e.g phenytoin, carbamazepine, phenobarbitals):

  • Promote copper IUDs, Mirena and injections
  • Caution with OCP, patches, implants

If on non-enzyme inducing AED (e.g sodium valproate, levetiracetam, gabapentin, pregabalin):
- Offer any form of contraceptive

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32
Q

What needs to be considered if a woman is presenting with seizures for the first time during pregnancy?

A

Remember eclampsia:
- 1st seizures, 2nd half of pregnancy: follow protocol for eclampsia management until a full neurological assessment is done

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33
Q

Outline the complications of hypothyroidism in pregnancy

A
  • Increased risk of mortality
  • Miscarriage, preterm delivery
  • Intellectual impairment in the child
  • Slight increased risk of pre-eclampsia
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34
Q

Describe the management of hypothyroidism in pregnancy

A
  • Important to monitor during first 12 weeks due to dependency on maternal hormones – cretinism is risk
  • TFTs regulated: TSH kept in lower 1/2 of normal <2
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35
Q

Outline the complications of hyperthyroidism in pregnancy

A
  • Increased risk of mortality
  • Neonatal thyrotoxicosis and goitre (if antithyroid antibodies cross placenta)
  • Maternal risk of thyroid storm
  • Increased risk of: pre-eclampsia, placental abruption, miscarriage
36
Q

Describe the management of hyperthyroidism in pregnancy

A
  • Free T4 should be kept in upper 1/3 of pregnancy specific reference range
  • Propylthiouracil (PTU) in first trimester, carbimazole for rest
37
Q

Describe thyroiditis that occurs postnatally

A
  • Common (5-10%), can develop up to 12 months post partum
  • Initially subclinical hyperthyroidism
  • Then hypothyroidism: can be difficult to diagnose, as symptoms similar to post-pregnancy motherhood (can be a cause of PND)
38
Q

Describe the clinical presentation of acute fatty liver in pregnancy

A
  • Normally third trimester: nausea, vomiting, abdominal pain, jaundice, bleeding
  • Liver tenderness, jaundice, ascites, manifestations of coagulopathy
  • 50% have proteinuric hypertension
39
Q

Outline the investigations for acute fatty liver in pregnancy

A
  • Urine: proteinuria

Bloods:

  • FBC – Hb, haemoconcentration, thrombocytopenia, clotting factors
  • LFT – raised transaminases, mild hyperbilirubinemia
  • U&Es, glucose – hypo common
40
Q

Outline the complications of acute fatty liver in pregnancy

A

Maternal

  • Death (10-20%)
  • Haemorrhage (secondary to DIC), renal failure, hypoglycaemia, hepatic encephalopathy

Foetal – death (20-30%)

41
Q

Describe the management for acute fatty liver in pregnancy

A
  • Delivery necessary to halt deterioration

Supportive (treat complications):
- Fluid, correct hypoglycaemia, blood transfusion, correct coagulopathy with platelets/FFP/cryoprecipitate

42
Q

Define intrahepatic cholestasis of pregnancy

A

Cholestasis (decrease in bile flow, reduction in excretion of substances into bile) occurring in pregnancy

  • Likely genetic
  • Likely hormonal also (abnormal sensitivity to the cholestatic effects of oestrogen)
43
Q

Describe the clinical presentation of cholestasis in pregnancy

A
  • Generalised pruritus in absence of rash

- Excoriations

44
Q

Outline the investigations for cholestasis in pregnancy

A

Bloods – LFTs
- Raised transaminases/GCT,
- Occasional mild hyperbilirubinaemia may be preceded by
symptoms therefore consider fortnightly repeat if normal
- Bile acids (raised)
- Clotting (may be abnormal due to reduced vitamin K absorption

Exclude other causes (liver USS, EBM, CMV serology, liver autoantibodies)

45
Q

Describe the management of cholestasis in pregnancy

A
  • Monitor: weekly LFTs, clotting, serial USS for foetal and intermittent CTG monitoring
  • Medication: ursodeoxycholic (reduce pruritis), vitamin K (reduce foetal haemorrhage - given from 36/40)
  • Delivery: induce at 37/40 due to increased risk of foetal death
  • Postpartum: 6 week follow up to ensure resolution of LFTs
46
Q

Outline complications of UTIs in pregnancy

A
  • Pyelonephritis
  • Preterm labour
  • Increased perinatal morbidity and mortality
47
Q

Outline the clinical presentation for UTIs and pyelonephritis in pregnancy

A
  • Dysuria
  • Frequency/urgency
  • Foul smelling urine
  • Dyspareunia
  • Lower abdominal pain

Pyelonephritis:

  • Loin pain
  • Rigors, vomiting, fever
48
Q

Describe the management for UTIs and pyelonephritis in pregnancy

A

• Prevention
- Drink water, eliminate refined foods, fruit juices, caffeine, alcohol, sugar
• Antibiotics – ampicillin, cephalosporins
- Often due to E.coli which is resistant to amoxicillin

49
Q

Describe the diagnostic criteria for antiphospholipid syndrome

A

Clinical criteria AND laboratory criteria

Clinical (1+ required):

  • Vascular thrombosis
  • 1+ death of foetus >10 weeks
  • Pre-eclampsia or IUGR requiring delivery <34 weeks
  • 3+ foetal losses <10 weeks, otherwise unexplained

Laboratory:
- Lupus anticoagulant and/or high ACAs (anticardiolipin antibodies): measured twice >3 months apart

50
Q

Outline the complications of antiphospholipid syndrome (APS)

A

Due to placental thrombosis:

  • Recurrent miscarriage
  • IUGR
  • Pre-eclampsia
51
Q

Describe the management of APS in pregnancy

A
  • Aspirin, LMWH
  • High risk pregnancy management: serial USS, elective induction at least by term
  • Postnatal anticoagulation
52
Q

Explain the aetiology of thromboembolism in pregnancy

A

Pregnancy is a pro-thrombotic state, as per Virchow’s triad (hyper coagulability, stasis, endothelial integrity):

  • Increased clotting factors
  • Reduced fibrinolysis
  • Altered blood flow: mechanical obstruction, immobility

Thromboembolism in pregnancy commonly consists of:

  • DVT
  • Embolism: PE
53
Q

Give some risk factors for thromboembolism in pregnancy.

Split into: major, intermediate, minor

A

Major

  • Previous VTE
  • High risk thrombophilia
  • Low risk thrombophilia with family history

Intermediate

  • Major medical co-morbidities (heart/lung disease, cancer, SLE, sickle cell etc)
  • Surgical procedure
  • C-section in labour

Minor

  • Age >35yrs
  • Obesity (BMI >30)
  • Parity ≥3
54
Q

Describe the clinical presentation of DVT

A

Red, hot, swollen tender calf

  • O/E: unilateral lower limb oedema, erythema, tenderness, low grade pyrexia
  • Occurs more commonly in deep veins to the left
55
Q

Describe the clinical presentation of PE

A

Pleuritic chest pain, dyspnoea, cough, haemoptysis

  • O/E General: tachycardia, tachypnoea, low-grade pyrexia, reduced O2 sats
  • O/E Chest: reduced air entry, crepitations
  • Cardiovascular – loud P2
56
Q

Outline the main investigations for DVT and PE

A

DVT

  • Duplex USS
  • Venogram (invasive - injection of dye followed by X-ray)

PE

  • General: ABG (hypoxia or hypercapnia), ECG (sinus tachycardia, S1Q3T3)
  • Imaging: CXR, duplex USS, CTPA
  • Bloods (prior to commencing anticoagulation): FBC, U&E, LFT, clotting
57
Q

Describe the medical management of thrombembolism both antenatally and post-natally

A

Thrombophrophylaxis screen undertaken (based on RFs), and duration of LMWH dependent on severity

Major (high risk)

  • Antenatal: requires LMWH
  • Postnatal: 6 weeks of LMWH

Intermediate (intermediate risk)

  • Antenatal: Consider LMWH prophylaxis
  • Postnatal: 10 days of LMWH

Minor:
- Intermediate management if 3 or more risk factors (antenatal) or 2 or more risk factors (postnatal)

Continue LMWH for pregnancy, stopping at start of labour or 24hr prior to planned delivery

Warfarin is teratogenic and can’t be used antenatally, but both warfarin and LMWH can be used during breastfeeding

58
Q

What are the general non-medical measures of management for thromboembolism in pregnancy?

A
  • Mobilisation, maintenance of hydration

- Compression stocking

59
Q

Define the BMI cut offs for; moderate, severe and morbid obesity

A

Obesity: BMI > 30kg/m2

Moderate: 30-34.9
Severe: 35-39.9
Morbid: 40+

60
Q

Describe the aetiology of obesity in pregnancy

A

Pre-existing obesity
▪ Poor diet
▪ Lack of exercise

Fluid retention
▪ Polyhydramnios
▪ Heart, kidney, liver failure

61
Q

Outline some complications of obesity in pregnancy

A

Increased risk of:

Maternal

  • Thrombembolism
  • Pre-eclampsia
  • GDM
  • Infections

Foetal

  • Congenital abnormalities (NTDs)
  • Diabetes & pre-eclampsia: perinatal mortality
62
Q

Describe the clinical presentation of obesity in pregnancy

A

Usually asymptomatic, symptoms of diseases associated with obesity:
o GDM
o Pre-eclampsia
o Infections

63
Q

Outline the management for obesity in pregnancy

A
  • Pre-conceptual weight advise
  • Folic acid, vitamin D
  • Weight is best maintained (to avoid malnutrition)

High risk pregnancy management

  • Screening for GDM
  • Close BP monitoring
  • Thromboprophylaxis based on risk factor profile
  • Anaesthetic risk assessment
  • Labour planning: potential C-section, induction

Postnatal follow up
- T2DM testing

64
Q

Outline risk factors for the development of depression in pregnancy

A

Normal RF for depression +

Triggers:

  • Difficult relationship
  • FHx or MHx
  • Infertility treatments, previous pregnancy loss, stressful life events
  • Complications in pregnancy
  • History of abuse of trauma
65
Q

Outline the management for depression in pregnancy

A

As for normal depression management:

  • Biological – medication (SSRIs are safe)
  • Psychological – CBT (1st line for mild-moderate)
  • Social – support groups (e.g PANDAS)
66
Q

Outline the mood stabilisers that are contraindicated in pregnancy

A
  • Sodium valproate & carbamazepine (teratogenic)

- Lithium (associated with cardiac defects)

67
Q

Give some risk factors for substance use disorder in pregnancy

A
  • Environmental stressors
  • Psychiatric comorbidities
  • Social problems: relationships, housing
68
Q

Outline the main risks of alcohol use in pregnancy

A

Increased risk of

  • IUGR
  • Stillbirth
  • Miscarriage
  • Preterm delivery, small for gestational age

Foetal alcohol syndrome

  • Facial abnormalities
  • Growth restriction
  • Small/abnormal brain
  • Developmental delay
69
Q

Outline the management for alcohol use in pregnancy

A

Advice/social support

  • Avoid drinking, particularly in first 12 weeks
  • No drinking is best, but no consistent evidence of harm if <3 units per week
  • Referral to psychiatry if major problem: therapy

Ultrasound to monitor foetal growth

70
Q

Outline the main risks of tobacco use in pregnancy

A

Increased risk of

  • IUGR
  • Stillbirth
  • Miscarriage
  • Preterm birth
  • Placental abruption
  • SIDS (sudden infant death syndrome)

Pre-eclampsia is less common, but more severe if it does occur

71
Q

Outline the management for tobacco use in pregnancy

A
  • Encouragement to stop/cut down
  • Nicotine replacement therapy
  • Pregnancy should be considered higher risk

MDT approach is necessary to provide a non-judgemental + supportive environment

72
Q

Outline the main risks of cannabis use in pregnancy

A
  • IUGR
  • Preterm labour
  • Small for gestational age
  • Affects childhood development: academic achievement, behavioural problems
73
Q

Outline the main risks of cocaine use in pregnancy

A
  • Teratogenic
  • IUGR
  • Preterm delivery
  • Stillbirth
  • SIDS
  • Placental abruption

Methamphetamine also has similar risks

74
Q

Outline the main risks of opioid misuse in pregnancy

A
  • IUGR
  • Preterm delivery
  • Stillbirth
  • SIDS
  • 3rd trimester bleeding

Neonatal abstinence syndrome (NAS): postnatal withdrawal

  • Neonatal morbidity
  • Irritability, feeding problems, tremors, emesis, loose stools, seizures, respiratory distress
75
Q

Outline the management for opiate misuse in pregnancy

A
  • Avoid use of street drugs
  • Methadone maintenance
  • Withdrawal not advised: due to risk of NAS
76
Q

Describe the general principles of management of substance misuse in pregnancy

A

MDT approach is necessary to provide a non-judgemental + supportive environment

  • Consultant led antenatal care
  • Leaflets detailing support + effects of drugs on pregnancy
  • Urine drug screens
  • Infectious disease screening: STIs, HIV, Hep C

Referral to social services if (inform mother first), if:

  • Concerns about child care provision/safety
  • Concerns about lifestyle issues (e.g fixed abode)
  • Non-compliance substance misuse services, community drug teams or antenatal care
77
Q

What is the Hb diagnostic cut off for anaemia in pregnancy?

A

Hb <11.0g/dL

78
Q

What is the blood film appearance of iron deficiency?

A

Hypochromic, microcytic

79
Q

What is the MCV change in folic acid/B12 deficiency anaemia?

A

Increased MCV

80
Q

Outline risk factors for developing anaemia in pregnancy

A
  • Multiple pregnancy
  • 2 pregnancies close together
  • Excessive vomiting due to morning sickness
  • Anaemia before becoming pregnant
  • Inadequate intake/poor absorption
  • Vaginal loss/preexisting haemorrhage
81
Q

Describe the clinical presentation of anaemia in pregnancy

A
  • Tired or weak
  • Dizziness
  • SOB
  • Tachycardic, tachypnoea
  • Pale skin, lips, nails, conjunctiva
82
Q

Outline the investigations for anaemia in pregnancy

A
  • FBC, haematinics, blood film, haematocrit

Hb checked at booking, 28/40, 34/40

83
Q

Describe the medical management of anaemia in pregnancy

A
  • Iron supplements, folic acid (0.4mg daily)
    If pt has epilepsy, diabetes, obesity or previous history of NTD, give 5mg folic acid

Given when:

  • Hb <11.0g/dL (1st and 3rd trimesters)
  • Hb <10.5g/dL (2nd trimester)
84
Q

Outline dietary advice given to pregnant women to avoid anaemia

A

Food rich in iron

  • Meat (kidney, liver)
  • Eggs
  • Green vegetables

Food rich in folic acid

  • Lightly cooked/raw green leafy vegetables
  • Fish
85
Q

Outline some complications of anaemia in pregnancy

A
  • Preterm or low birth weight baby
  • Postpartum depression
  • Child with developmental delays
  • Spina bifida

O&G (6 decks)

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