Medical Problems in Pregnancy 2 Flashcards
What is one of the most common medical d.o seen in pregnancy?
> 50% of pregnancy women with hx of epilepsy will ____________
EPILEPSY !
- NO seizure during the pregnancy
What is a.w with having less seizures during the pregnanc?
- good seizure control in the 1st TRIMESTER
- no seizures 9 months PRIOR to pregnancy (92% will remain seizure free)
What kind of risks are HIGHER for women with epilepsy, taking AED?
- IOL
FGR
PPH
When is the risk for C-section higher for WWE; polytherapy or monotherapy?
POLYTHERAPY !
—also incr. risk of STILLBIRTH
What are the fetal risks from maternal seizures?
- 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
What type of seizures has the potential to cause trauma?
- ANY THAT CAUSES loss of awareness
What can generalized tonic-clonic seizures cause?
fetal and maternal hypoxia and acidosis
- risk of abd. trauma: ruptured fetal membranes, subsequent infection and premature labour
What type of seizures are not known to cause adverse fetal outcomes?
- focal seizures
- myoclonic seizures
- absence seizures
What is the most major congenital malformations a.w AEDs?
- neural tube defect
- congenital HEART d.o
- Urinary tract/ skeletal abnormalities and CLEFT palate
Risk of sodium valproate on bby?
- NTD
- facial cleft
- hypospadias
Risk of phenobarbital and phenytoin?
cardiac malformations
Risk of phenytoin and carbamazepine?
- cleft palate
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.
TOPIRAMATE
What incr. the risk of intra-partum seizures?
- stress
- pain
- sleep deprivation
- over-breathing
- dehydration
What is the drug of choice for GTC seizures?
- terminate the seizure in labour ASAp
- BENZODIAZEPINE
How to manage seizure in labour?
- left lateral tilt
- IV LORAZEPAM/ DIAZEPAM
- PR diazepam/ buccal midazolam
- IV phenytoin
- C-section; to expedite delivery
- —if no hx of epilepsy; MgSO4
When is C-section recommended in WWE?
- those with deteriorated seizures, but still are recurrent and prolonged
- at high risk of STATUS EPILEPTICUS
What are some risks for an obese pt during delivery?
IOL
Dysfunctional labour
VTE
operative delivery
What risks does being obese have on the mother?
GDM Miscarriage H/T --> PET VTE PPF C-section - wound infection
Does obesity predispose the bby to congenital anomalies?
yes
- NTD
- spina bifida
- septal anomalies
- cleft palate and lip
- hydrocephaly
- limb reduction anomalies
What difficulties may a anaesthetists have with obese mothers?
- 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 !
