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Fetus > Medical disorders of pregnancy > Flashcards

Medical disorders of pregnancy Flashcards

1
Q

What are the general principles of medical disorders in pregnancy

A

Pregnant women more predisposed to acute medical problems

Chronic medical problems can worsen/flare in pregnancy

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2
Q

What are the causes of maternal deaths

A

Direct, indirect, late, coincidental

2/3 indirect, 1/3 direct

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3
Q

What pre-existing conditions are worsened by pregnancy

A

Asthma, epilepsy, hypertension, diabetes, thyroid, renal, lupus, arthritis

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4
Q

What are pregnancy specific medical conditions

A

Pre-eclampsia, thromboembolism, gestational diabetes, obstetric cholestasis, acute fatty liver

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5
Q

How are medical disorders managed in pregnancy

A

Be aware of normal physiological changes
Preconceptual counselling
Pregnancy-safe medication or contraception until ready to conceive
Assess effects of pregnancy on medial condition + effects of medical condition on pregnancy
Decide safest mode of delivery

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6
Q

How is essential hypertension managed in pregnancy

A

Pregnancy-safe medication
Risk of superimposed preeclampsia- aspirin to reduce risk
Serial growth scans to monitor risk of poor placental function
Possible early delivery

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7
Q

What are the pathophysiological processes underlying preeclampsia

A 
Genetic predisposition
Inadequate trophoblast invasion of spiral arteries
Reduced uteroplacental perfusion
Placental damage + apoptosis
Release of circulating factors
Endothelial cell dysfunction
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8
Q

What are the symptoms of preeclampsia

A

Headache, visual disturbance, epigastric/liver pain, vomiting
Brisk refleces, clonus, oedema

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9
Q

What are the complications of preeclampsia

A

Renal failure, pulmonary oedema, eclampsia, HELLP syndrome

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10
Q

How is preeclampsia treated

A

Antihypertensives- Labetalol, Nifedipine, Methyldopa
Fluid restriction
Diuretics if pulmonary oedema
MgSO4

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11
Q

What haematological conditions occur in pregnancy

A

Anaemia- iron deficiency, folate deficiency, associated with LBW, prematurity
Thrombophilia- major cause of maternal death, pregnancy = prothrombotic state. Manage anticoagulation around deliveru
Venous thromboembolism, bleeding disorders, thrombocytopenia

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12
Q

What respiratory conditions occur in pregnancy

A

Asthma- optimise control pre-pregnancy, pregnancy safe medication. Risk of FGR due to inadequate placental perfusion, prematurity due to deterioration in maternal condition
Treat with short or long acting beta 2 agonists, inhaled steroids, theophyllines, steroid tablets, Leukotriene antagonist

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13
Q

What are low risk cardiac disease conditions

A

Mitral regurg, Aortic regurge, ASD, VSD

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14
Q

What are high risk cardiac disease conditions

A

Aortic stenosis
Coarctation of aorta
Metallic valves
Cyanosis

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15
Q

How is cardiac disease managed during pregnancy

A

Prepregnancy- assess risk of complications, ensure safe medication
Predict + prevent heart failure using echo/ECG
Anticoagulation with mechanical heart valves
Monitor fetal growth + wellbeing
Timing + mode of delivery

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16
Q

What is obstetric cholestasis

A 
Most common liver disease in pregnancy
Genetic predisposition
Presents with itching but no rash
Abnormal liver function
Resolves after delivery
Risk of fetal complications related to level of bile acids
Risk of recurrence >80%
Treatment- Ursodeoxycolic acid. Doesnt reduce fetal complications but improved biochemical abnormalities
17
Q

What is hyperthyroidism

A

Uncommon
Maternal risk of thyroid crisis with cardiac failure
Medication- Propylthiouracil for maternal liver fialure, Carbimazole for fetal abnormalities

18
Q

What is hypothyroidism

A

Common
Untreated can cause miscarriage and impaired neurodevelopment
Aim for adequate thyroxine replacement in 1st trimester

19
Q

How is diabetes managed preconception

A

HbA, Folic acid 5mg
Stop ACE inhibitors and statins
Retinal screening
Renal function + microalbuminuria

20
Q

What are the maternal risks of diabetes

A 
Diabetic ketoacidosis
Hypoglycaemia
Progression of retinopathy
Preeclampsia
Premature labour
21
Q

What are the fetal/neonatal risks of diabetes

A 
Miscarriage
Macrosomia, shoulder dystocia
Fetal abnormality
Stillbirth
Neonatal hypoglycaemia, respiratory distress, hypeocalcaemia
22
Q

Why does maternal diabetes affect fetus

A

Maternal hyperglycaemia causes excessive glucose transfer across placenta, secondary fetal hyperinsulinaemia

23
Q

How can maternal diabetes be treated

A

Insulin- Basal bolus regime, carbohydrate counting, insulin pump
Metformin
Glibenclamide

24
Q

How does renal disease occur in pregnancy

A

In healthy kidneys pregnancy causes 50% increase in renal blood flow + GFR
Serum creatinine, urate + albumin fall
Pelvicalyceal system + ureters dilate, predisposition to ascending infection + pyelonephritis

25
Q

What are the maternal risks of renal disease

A

Severe hypertension, deterioration in renal function, preeclampsia, caesarean section

26
Q

What are the fetal risk of renal disease

A

Premature delivery, growth restriction, stillbirth, abnormalities due to maternal drug therapy
Outcome depends on degree of renal dysfunction, maternal blood pressure, creatinine level, proteinuria

27
Q

What is the antenatal care for renal disease

A

Risk assessment pre pregnancy
Multidisciplinary care
Close monitoring of renal function + BP
Regular assessment of fetal growth

28
Q

How does pregnancy affect neuroendocrine disorders

A

Epilepsy- increase in seizure frequency 25-33%
SUDEP 1/500-1000 people. More common when not taking anticonvulsants- sometimes avoided in pregnancy
Anticonvulsants associated with risk of fetal abnormalities

29
Q

What are the safest anitconvulsant medications

A

Keppra
Lamotrigine
Cabemezipine
(sodium valproate highest risk)

30
Q

How is epilepsy managed in pregnancy

A 
Proconception assessment
Screening for fetal anomalies
Control seizures
Plan for delivery
Postpartum support
31
Q

What effect does epilepsy have on fetus

A

Hypoxia associated with maternal seizures

Injury from falling

Fetus (18 decks)

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