Medical disorders of pregnancy Flashcards
What is the leading cause of maternal mortality of pregnant women in the UK?
Cardiac disorders
What cardiac drugs are contraindicated in pregnancy
Warfarin, statins, Ace inhibitors
How do you manage maternal hyperthyroidism during pregnancy (uncommon)?
Propylthiouracil
not carbimazole because contraindicated
Why is urine MC+S carried out on the booking visit?
To screen for asymptomatic bacteruria because leads to pyelonephritis
How is obstetric cholestasis characterised?
- Raised LFT’s ALT, AST
- Raised bile acids
- Pruiritis without rash, on palms and soles of feet- worse in night and third trimester
What is obstetric cholestasis associated with in the newborn?
Still born
Meconium passage
PPH
How often should LFTs and serum bile acids be measured in someone diagnosed with obstetric cholestasis?
Every 2 weeks
How do you manage obstetric cholestasis?
How later after delivery do you monitor patient
- UDCA: pruiritis
- Vitamin K 10mg oral from 36 weeks every day
6 weeks following delivery
How does obstetric cholestasis resolve and what is recurrence rate?
- resolves after delivery
- 50% recurrence
How do you screen for gestational diabetes and what is management protocol?
- If 1 risk factor then do HB1ac and OGTT at 24-28 weeks- positive: OGTT >7.8 then…
- Diet and exercise, glucometer tell to measure pre & postprandial
- Review in two weeks, if pre >6 and postprandial >7 then start on oral metformin
- See again in 2 weeks, if same readings then short acting inuslin
In diabetics how often do you see them to measure bloods, and growth ultrasounds and AFI?
- Every two weeks
- From 28 weeks to 36 weeks, do serial surveillance every 4 weeks
In pre-existing diabetics what is it important to do? (macrovascular and microvascular complications)
- Folic acid 5mg
- pre-conception check retina health because diabetic retinopathy deteriorates during pregnancy
- Do PCR, creatinine clearance to screen for nephropathy
- Baseline BP because at risk of preeclampsia
- Neuro exam- neuropathy
If macrosomic fetus then do elective C-section but if labour what do you use?
Sliding scale of insulin and dextrose infusion
Fetal complications of diabetes?
Shoulder dystocia- Erbs palsy Neonatal hypoglycaemia Hypomagnesia, hypocalcaemia Increased risk of congenital abnormalities- especially if mother type 1 Macrosomia Stillbirth increased risk Pre-term labour Poor lung maturity- tachypnoea of new born Jaundice due to birth trauma
Maternal complications of diabetes?
- pre-eclampsia, increased risk of venous thromboembolism, deterioration of diabetic retinopathy
- glycosuria- UTI’s, candida
- C-section, instrumental delivery
- ketoacidosis and hypoglycaemia (common, insulin requirements increase during pregnancy)
- wounds, and endometrial infection following delivery
