Medical Problems in Pregnancy Flashcards
What are direct, indirect, and incidental maternal deaths?
Directly attributable to pregnancy
Indirect - worsening of preexisting condition
Incidental - not related to pregnancy
How does CO and TPR change in pregnancy?
Increases by 50% - at 19 weeks
TPR falls - 8 weeks
How does respiratory change?
Hyperventilation and increase tidal volume, reduced functional residual capacity as diahpragm rises
REnal change?
GFR increases by 55%
Gastro change?
Progesterone reduces LOS tone and GI motility
Metabolic cchange?
Hepatic; increased sterod metabolism, diabetogenic
Haemochange?
Anaemia of pregnancy, hypercoaguable state
How do you position pregnancy women?
L tilt to reduce aorto-caval compression and supine hypotension
How does fluid resus differ?
Increase blood volume
How does the airway differ?
Increased risk of aspiration
What are the considerations in arrest?
Defibrillation is safe
Decide at 4 minutes, delivery by 5 minutes of no output
- Increases the chance of survival of mother and baby
Increase volume of distribution so more fluids
Why is pulmonary HT bad?
Because the TPR is going to decrease so pul pressure needs to decrease
What are the implications of increased CO?
LV dysfunction
Diseases of fixed output
Aneurysm formation
How is increased heart rate problematic?
Decreased ventricular filling time
What are the worst conditions to have in pregnancy?
Pulmonary HT
Cyanotic heart disease
What mechanism of delivery is best?
Vaginal delivery with spontaneous labour
What do you do in the post natal period in cardiac?
Diuresis early
Slow oxytocin to avoid PPH
Contraception
How do you prevent VTE?
Pre-existing risk factor Mx
Intercurrent risk factors - immobilisation, OHSS
Delivery risk factors - long labour, dehydration
Postnatal - immobilisation, dehydration
How do you detect of DVT in pregnancy
US very sensitive
V/Q scan +/- CTPA
How are VTE treated?
Low molecular weight heparin - ongoing as well
What are low/high risk periods for radiation/imagining?
Low:D0-D9 post conception
High: W3-W11 - but no adverse effect at
What are the overall recommendations for exposure?
No single diagnostic procedure results in a radiation dose significant enough to threaten the well being of developing embryo and foetus
What are the 4 M’s of diabetes in the first 13 weeks of pregnancy?
Miscarriage
Malformation
Macrosomia
Mortality
