Medical Problems in Pregnancy Flashcards
What are the booking bloods
FBC Blood group Haemaglobinopahies Infection screen - hep B, HIV, rubella, VDRL Random blood glucose
when is booking visit
8-12 weeks
when is dating ultrasound
11/12weeks
when are monthly visits until
28weeks
when is anti d given
28 and 24 weeks
when are fortnightly visits
28-36 weeks
when are weekly visits
37 weeks to deliverly
what is done at each antenatal visit
gestation BP urinalysis FSH fetal heart
when can you diagnose pre existing hypertension in pregnancy
Htn at booking or before 20 weeks
when is gestational hypertension diagnosed
new HTN more than 20 weeks without proteinuria
Preeclampsia
new HTN after 20 weeks and significant proteinuria
what do you give women with significant risk factors for preeclampsia
aspirin
What anti hypertensive medications should be avoided in pregnancy
ACE and ARBs
What antihypertensives are used in pregnancy
labetalol
methydopa
nifedipine - if monotherapy fails
what are the target BP controls in pregnancy
less than 150/80-100
less than 140/90 if organ damage
reduce medication doses if BP less than 130/90
what is there a greater risk of to the baby in hypertension in prgnancy
IUGR
placental abruption
when do you deliver in preeclampsia
37 weeks
what are the risks to the fetus with diabetes in pregnancy
miscarriage IUGR neurol tube defects macrosommia polyhydramniois neonatal hypoglycaemia
what diabetic treatments can be used in pregnancy
diet
metformin
insulin
when would you induced in diabetes
consider at 37-38 weeks in PRE EXISTING DIABETES
38 weeks in GDM on INSULIN, 41 weeks if just diet and everything else normal
what is there an increased risk of in polyhydramnios
malpresentation
preterm labour
cord prolapse
what does macrosomia increase the risk of
shoulder dystocia
what is the aim HBA1c in pregnancy
less than 6 percent
what extra scans are done in gestational diabete
28, 32 and 36 week growth scan
what is there an increased risk of in polycythaemia
thrombotic events
jaundice
what is the leading cause of maternal death in the uk
venous thromboembolism
what medication is given to treat VTE in pregnancy
LMWH
what coagulation changes occur in pregnancy
factors seve, eight, ten and fibrinogen levels increased
antithrombin three levels decreased
when would you give anticoagulant prophylaxis in pregnancy
four or more risk factors - give straight away
three or more rsiks factors- give after 28 weeks
what do you give prophylactically in high risk for vte post natally
6 weeks postnatal LMWH
give for 10 days in intermediate risk
in which leg are DVTs more common in
left
how should investigations and management be done for a dvt in preganncy
not a d dimer
ultrasound
therapeutic heparin
TEDs for up to two yeards
name a low molecular weight heparin
daltaparin
how long should therapeutic doses of heparin be given after a dvt in pregnancy
for three months after delivery or 6 months after treatment whichever is longer
what are the risk factors of heparin
haemorrhage
heparin induced thrombocytopenia
osteopenia
how do you manage a potential PE in pregnancy
Give heparin!
first do chest x ray then CTPA if abnormal or high clinical suspicion
how often is the chest x ray normal in pe
half the time
what can you see on x ray f there is a pe
etelectasis
effusion
oedema
what is the worry with CTPA
increased risk of breast cancer
should heparin be stopped in labour
yes
how long before an epidural should anticoagulants be stopped
24 hours if therapeutic
12 hours if prophylactic
is warfarin safe in breastfeeding
yes
how long should PE therapy be given for
at least 6 weeks post natal and 3 months in total
is warfarin safe in pregnancy
no - particularly avoid in 6-12 weeks as tetatrogenic
if given stop six weeks before labour
what should you do in women with hypothyroid in pregnancy
increase levothyroxine in first trimester
do tft every trimester
what is the effect of pregnancy on hyperthyroidism
worsens in first trimester due to hcg
gets better in second and third trimester
effects of hyperthyroid on fetus
IUGR
preterm labour
thyroid storm
what should epileptic women be given in pregnancy
high dose folic acid 5mg
vit K from 36 weeks if taking hepatic enzyme inducing anticonvulsants due to risk of fetal vit k deficiency and haemorrhagic disease of the newborn
when is the risk of seizures highest in pregnancy in epileptics
peripartum period
which anticonvulsant should definterly be avoided in pregnnacy
phenobarbitone - due to risk of neonatal convulsions
what additional scans do epileptic women get in pregnancy
anomaly scan detailes 18-20 weeks
cardiac scan 22 weeks
what delivery should be done in pts with epilepsy
c section only is recurrent seizures in late pregnancy or labour
should antiepileptics be continued in labour
yes
what is the post partum management in epilepsy
neonate gets vit K
risk of sudep increased in pregnancy and post natal period
