Medical Problems in Pregnancy 2

Question 1

What is one of the most common medical d.o seen in pregnancy?

> 50% of pregnancy women with hx of epilepsy will ____________

Answer 1

EPILEPSY !

• NO seizure during the pregnancy

Question 2

What is a.w with having less seizures during the pregnanc?

Answer 2

• good seizure control in the 1st TRIMESTER

- no seizures 9 months PRIOR to pregnancy (92% will remain seizure free)

Question 3

What kind of risks are HIGHER for women with epilepsy, taking AED?

Answer 3

• IOL
  FGR
  PPH

Question 4

When is the risk for C-section higher for WWE; polytherapy or monotherapy?

Answer 4

POLYTHERAPY !

—also incr. risk of STILLBIRTH

Question 5

What are the fetal risks from maternal seizures?

Answer 5

• maternal abdominal trauma
• PPROM
• Preterm birth
• hypoxia/ acidosis
• MAJOR/ minor congenital malformations
• adverse perinatal outcomes
• haemorrhagic disease of the newborns
• risk of childhood epilepsy
• adverse perinatal outcomes

Question 6

What type of seizures has the potential to cause trauma?

Answer 6

• ANY THAT CAUSES loss of awareness

Question 7

What can generalized tonic-clonic seizures cause?

Answer 7

fetal and maternal hypoxia and acidosis

• risk of abd. trauma: ruptured fetal membranes, subsequent infection and premature labour

Question 8

What type of seizures are not known to cause adverse fetal outcomes?

Answer 8

• focal seizures
• myoclonic seizures
• absence seizures

Question 9

What is the most major congenital malformations a.w AEDs?

Answer 9

1. neural tube defect
2. congenital HEART d.o
3. Urinary tract/ skeletal abnormalities and CLEFT palate

Question 10

Risk of sodium valproate on bby?

Answer 10

• NTD
• facial cleft
• hypospadias

Question 11

Risk of phenobarbital and phenytoin?

Answer 11

cardiac malformations

Question 12

Risk of phenytoin and carbamazepine?

Answer 12

• cleft palate

Question 13

There is a rising concern for a particular drug, used to to treat migraines; d.t its incr. risk of orofacial cleft.

Name the drug.

Answer 13

TOPIRAMATE

Question 14

What incr. the risk of intra-partum seizures?

Answer 14

• stress
• pain
• sleep deprivation
• over-breathing
• dehydration

Question 15

What is the drug of choice for GTC seizures?

Answer 15

• terminate the seizure in labour ASAp

- BENZODIAZEPINE

Question 16

How to manage seizure in labour?

Answer 16

• left lateral tilt
• IV LORAZEPAM/ DIAZEPAM
• PR diazepam/ buccal midazolam
• IV phenytoin
• C-section; to expedite delivery
• —if no hx of epilepsy; MgSO4

Question 17

When is C-section recommended in WWE?

Answer 17

• those with deteriorated seizures, but still are recurrent and prolonged
• at high risk of STATUS EPILEPTICUS

Question 18

What are some risks for an obese pt during delivery?

Answer 18

IOL
Dysfunctional labour
VTE
operative delivery

Question 19

What risks does being obese have on the mother?

Answer 19

GDM
Miscarriage 
H/T --> PET 
VTE 
PPF 
C-section 
- wound infection

Question 20

Does obesity predispose the bby to congenital anomalies?

Answer 20

yes

• NTD
• spina bifida
• septal anomalies
• cleft palate and lip
• hydrocephaly
• limb reduction anomalies

Question 21

What difficulties may a anaesthetists have with obese mothers?

Answer 21

• diff. to obtain IV access
• diff. with regional anaesthesia
• assess for general anaesthesia
• —often unsatisfactory epidural analgesia done
• —-anaesthetic review to be done at 34 weeks !