Medical problems in pregnancy Flashcards
What are the 3 types of liver disease in pregnancy? (3)
Intrahepatic cholestasis
Acute fatty liver of pregnancy (severe fulminating illness)
Haemolysis (in pre-eclamptic toxaemia)
What physiological change in pregnancy puts increased risk on women with pre-existing heart disease? (1)
40% increase in blood volume in pregnancy, women with heart disease are unable to adequately increase cardiac output.
This increases risk of uterine hypo perfusion and pulmonary oedema.
What is chronic hypertension in pregnancy? (2)
Hypertension that is either present before conception or detected before 20/40.
Name 3 drugs that are acceptable for treatment of hypertension during pregnancy. (3)
Methyldopa, nifedipine, labetalol
NB ACEi are teratogenic
Define eclampsia. (1)
Name 2 symptoms of impending eclampsia. (2)
Tonic-Clonic seizures on a background of pre-eclampsia.
Severe headaches, vomiting, pain just below the ribs, visual disturbance, sudden swelling of face, hands or feet.
What is the management for a mother presenting with eclampsia? (3)
A/B: oxygen, maintain patency, ventilate if necessary
C: Left tilt, large-bore IV access, evaluate pulse and bp
Meds: IV magnesium sulphate 4g
Post-seizure: control BP, strict fluid management, may require CVP monitoring, deliver baby once stabilised, consider ITU
What is HELLP syndrome? (1)
HELLP syndrome is haemolysis, elevated liver enzymes and low platelet count.
What is gestational hypertension? (1)
Gestational hypertension is new hypertension presenting after 20 weeks without significant proteinuria.
What is pre-eclampsia? (1)
Pre-eclampsia is new hypertension presenting after 20 weeks with significant proteinuria.
What is severe pre-eclampsia? (1)
Severe pre-eclampsia is pre-eclampsia with severe hypertension and/or with symptoms, and/or biochemical and/or haematological impairment.
Define mild, moderate and severe hypertension. (3)
Mild hypertension 140-149 / 90–99 mmHg
Moderate hypertension 150-159 / 100-109
Severe hypertension 160+ / 110+ mmHg
Name any 2 of the features that would put a woman at high risk of developing pre-eclampsia. (2)
How should she be managed? (1)
CKD, chronic hypertension, previous gestational hypertension in previous pregnancy, Type 1 or 2 DM, SLE or phospholipid syndrome.
If any of high risk factors give aspirin 75mg after 12 weeks gestation until birth.
Name any 2 moderate risk factors for developing pre-eclampsia. (2)
When should these women be treated? (2)
First pregnancy Age >40 More than 10 years since previous pregnancy Multiple pregnancy BMI >35 at booking FH of pre-eclampsia
If more than 1 moderate risk factor give aspirin 75mg daily from 12 weeks until birth.
What should the target blood pressure be for hypertension in an uncomplicated chronic hypertensive lady? (1)
What should the target blood pressure be for hypertension in chronic hypertensive lady with evidence of end-organ damage? (1)
Keep lower than 150/100
Keep lower than 140/90
What gestation should birth be offered to women with chronic or gestational hypertension with bp less than 160/110? (1)
After 37 weeks