medical disorders of pregnancy Flashcards
What is the general approach to medical disorders?
Always think what of the effect of pregnancy on the disease and what is the effect of the disease on pregnancy
If someone presents with fatigue in pregnancy what should you check for?
Anaemia- do FBC and haemitinics
What is anaemia’s affect on the fetus?
low birth weight and prematurity
Are the values for anaemia the same as in non-pregnancy?
No
There are lower values as the blood is more “diluted” due to increased plasma volume –Hb <105
What kind of anameias are iron deficient and folate deficient anaemias?
Remember iron deficient is microcytic with serum ferritin low and B12/folate deficient is macrocytic.
What respiratory changes happen in pregnancy?
Increased metabolic rate so there is more oxygen consumption
Increased ventilation due to increase in tidal volume
Arterial pO2 increases and pCO2 decreases
RR stays the same
What risks are associated with asthma in pregnancy?
Risk of prematurity and FGR due to inadequate placental perfusion
Does asthma get worse in pregnancy?
no
What high-risk cardiac problems in pregnancy?
aortic stenosis, coarction of the aorta, prosthetic valves and those with disease severe enough to be cyanosed
Why do cardiac problems generally get worse in pregnancy?
Cardiac output rises due to increased SV (CO=HRxSV)
What is the most common abdo complication in pregnancy?
Obstetric cholestasis
How does obstetrics cholestasis present in pregnancy?
presents with an itch without rash,
jaundice 20% pts
abnormal LFTs and high bilirubin
can lead to complications in fetus due to high bile acids
What is the management of obstetric cholestasis?
Management with ursodeoxycolic acid early delivery (37-38 weeks)
What should you rule out in abdo pain during pregnancy?
Think risk factors for hepatitis
HELLP
Gallstones or acute fatty liver
appendicitis
How does appendicitis present in pregnancy?
Remmeber due to large uterus other organs move around so appendicitis can present outside its ormal quadrant
What must you consider with hyperthyroidism in pregnancy?
can have a thyroid crisis –> cardiac failure
Risk of thyrotoxicosis in fetus due to transfer of thyroid stimulating Ab
what do you need to consider with hypothyroidism in pregnancy?
If left untreated can lead to poor neurodevelopment
Increase thyroxine dose
What is the diagnostic levels for gestational DM?
Fasting glucose of over 5.6 and random of over 7.8
How do you manage gestational DM?
Can use insulin, metformin and glipalamide NO other hypoglycaemics
Stop ACE-I and statins
screening for retinopathy or renal impairment
Why are you more likely to get a UTI in pregnancy?
Pelvicalyceal system dilates so is more likely to get infection
Why do seizures occur more in pregnancy?
There is a lower seizure threshold due to lack of sleep and pain caused by pregnancy
What needs to be considered in management of epilepsy in pregnancy?
All anti-convulsant are associated with fetal abnormalities- worst is sodium valproate eg ASD, spina bifida, cleft palate
but
During a tonic clonic seizure baby is hypoxic so need to weigh up
What is the management of epilpesy in pregnancy
Management: folic acid (spina bifida decreases), is medication required, screen fetal abnormalities, avoid prolonged labour and pain relief important
don’t forget to exclude pre-eclampsia
why are women in pregnancy more likely to get VTEs?
haematological changes in pregnancy pre-dispose as there is increased thrombus formation due to higher levels of fibrinogen and prothrombin
Where do the VTEs tend to develop?
Are more iliofemoral than femoral popliteal then in non-pregnant population
What else increases the risk of VTEs?
BMI, age, c-section
What are the investigations for VTE?
DVT- do doppler U/s
PE- do VQ scan or CTPA
What is the management for VTEs?
LMWH is management choice as warfarin can cross placenta and cause fetal abnormalities and intracranial bleeding
What is a Bartholins cyst?
Bartholin’s glands are a pair of glands located next to the entrance to the vagina. These are normally about the size of a pea, but can become infected and enlarge - forming a Bartholin’s abscess.
This can be treated by antibiotics, by the insertion of a word catheter or by a surgical procedure known as marsupialization.
