Medical disorders in pregnancy Flashcards
Maternal deaths
2/3 due to medical/mental health conditions
Pre-pregnancy
Optimise disease control
Pregnancy safe drugs
Risks and plan of care
contraception until ready to conceive
Delivery planning
Always safest mode for mother and baby
Neonat support, anaest expertise, HDU/ITU, post partum care
Hypertension
Increased risk of P-E (aspirin decreases this risk)
Risk of poor placental function - may need to deliver early
Pre-eclampsia
Symp - headache, liver pain, visual disturbance, vomiting
Signs - brisk reflexes, clonus, oedema
Complications - renal fail, pulm oedema, eclamp, HELLP
Treatment - antihypertensives (labetalol, nifedipine), fluid restriction, diuretics, MgSO4
Haematological conditions
Anaemia - preg need more iron
Thromboembolism - preg is prothrombotic - more at risk. Difficult to manage around birth as need anticoag but also can’t bleed out
Respiratory
Asthma - need preg safe med. Can cause FGR and prem delivery. Can have B2 agonists and inhaled steroids
Cardiac
Pre-preg counselling needed - leading cause of mat death. Assess risk and change meds if needed
Close monitoring during preg - timing/mode of delivery
Post preg - day 1-4 highest risk
Liver
Obstetric cholestasis - abnormal liver function. increased risk of PTB and still birth
Ursodeoxycolic acid - decrease biochem abnormalities
Hyperthyroidism
Uncommon
Mat risk - thyroid crisis with cardiac failure
Fetal risk - thyrotoxicosis due to TS antibodies
Antithyroid drugs - propylthiouracil (mat liver failure) and carbimazole (fetal abnorm)
Hypothyroidism
Untreated - miscarriage and impaired neuro dev
Adequate replacement with thyroxine
Diabetes
Preconcep - folic acid, stop ACE inhib and statins, screens/risk assesment
Mat risk - Hypogly, retinopathy, pre-eclamp, PTB
Fetal risk - miscarriage, macrosomaia, abnorm, still birth, neotnat hypo, resp distress
Need good glycaemic control from conception
Drugs: insulin, metformin, glibenclamide
Renal disease
Chronic renal disease - outcome dependent on renal dysfunction, BP, creatinine and proteinuria
Mat risk - hypertens, decrease renal func, P-E, c-sect
Fet risk - PTB, FGR, still birth, abnormalities (drugs)
Antenatal care - risk assess, multidis, monitor
Epilepsy
Mat risk - seiz f inc, sudden unexpected death (more common if not taking anti-conv meds)
Drugs are teratogenic (keppra, lamotrigine and cabemezipine - lowest. Sodium valproate - highest)
Increased risk of fetal hypoxia with seizures and injury from falling
Management of epilepsy
Pre-concep - high dose folic acid
Preg - screen for abnormalities and control seizures
Plan for delivery - pain relief, don’t want prolonged labour
Post partum support - change babies on floor, don’t bathe them alone
