Medical Problems in Pregnancy Flashcards
give examples of direct complications of pregnancy
haemorrhage
sepsis
hypertensive disease eg PET
what are the main causes of maternal mortality in the UK?
cardiac disease
thrombosis/thromboembolism
neurovascular
under/overweight women are at high risk of venous thromboembolism in pregnancy
overweight
what should be considered when assessing what impact a medical condition would have on a pregnancy (consider each trimester)?
effects on mum and fetus drugs 1st trimester - inc risk of miscarriage? 2nd trimester - inc risk of malformation? 3rd trimester- PET? FUGR? parturition- delivery? puerperium- problems after birth?
what physiological cardiac factor decreases in pregnancy
TPR
what is a normal heart rate for a woman at term?
90-100bpm
why is cardiac disease more common in pregnancy?
increasing age
increasing BMI
more women with congenital HD
what is the risk of death from an MI in pregnancy?
1 in 13
woman presents with sudden onset chest pain in pregnancy, what investigation should be done?
ECG
consider CT
a pregnant woman presents with orthopnoea, what should be considered?
peri-partum cardiomyopathy
what kind of hypertension is almost fatal in pregnancy?
pulmonary
what anticoagulant should be given to pregnant women?
LMWH (doesnt cross placenta)
describe “normal” palpitations in pregnancy
occur at rest and/or lying down
when would a woman’s cardiac symptoms contraindicate her to pregnancy?
if she has marked symptoms during daily activities and is asymptomatic only at rest
an aortic root >_mm would contraindicate someone to getting pregnant; why is this?
45
puts them at increased risk of aortic dissection
how do ectopic beats present? are these normal?
“thumping” heartbeat relieved by exercise
Ix for suspected benign palpitations
ECG (24hr ECG if worried)
other causes of sinus tachycardia in pregnancy
sepsis
PE
thyroid problems eg hyperthyroidism
Ix sinus tachycardia
ECG
24h ECG
TFT
ECHO
most common arrhythmia in pregnancy
paroxysmal SVT
Ix cardiomyopathy
ECHO
Ix SVT
ECG
24h ECG
TFT
ECHO
what tumour can cause palpitations and should be investigated in pregnant women with these symptoms?
phaeochromocytoma (do 24hr urinary catecholamines)
why do women get breathless in pregnancy?
physiological hyperventilation
describe the classic presentation of physiological breathlessness in pregnancy
SoB at rest/talking that improves with exertion, common in 3rd trimester
describe the outcomes of women with asthma in pregnancy
1/3 improve, 1/3 stay the same, 1/3 deteriorate
who is a greatest risk of deterioration in pregnancy from asthma?
those who have been in ICU for asthma
severe disease
cessation of therapy for safety concerns
those who didnt improve in last pregnancy
describe asthma treatment pathway in pregnancy
SAME AS NORMAL
- SABA
- add inhaled corticosteroid
- add LABA (stop if desnt work)
- try inc dose of inh steroid or add 4th drug eg leukotriene receptor antagonist
asthma patients should have what kind of delivery?
SVD
what should women get in labour if they’ve been on oral steroids for >2 weeks
IV hydrocortisone
where do DVTs occur in pregnancy
left leg
when is VTE risk highest in pregnancy? why?
puerperium
virchow’s triad is most affected have vascular damage from labour, in hypercoaguable state and blood is in stasis
prophylactic VTE Tx for high risk pregnant women?
LMWH antenatally
what puts women at low risk of VTE?
less than 3 risk factors
what would make a woman at high risk of VTE?
any previous VTE not related to surgery
prophylactic VTE Tx for low risk mothers
mobilisation
hydration
why is warfarin not used as VTE prophylaxis?
teratogenicity
what LMWH is used in tayside? how is the dose worked ou?
dalteparin
done by mum’s weight
how is DVT diagnosed in pregnancy?
compression duplex USS (examination is not always clear)
if compression duplex USS is normal but you suspect DVT, what should you do?
repeat in 1 week
pregnant woman presents with a whole swollen leg and back pain…
iliac vein thrombosis
d dimers are always up during pregnancy T or F
T
Ix iliac vein thrombosis
MRI venography
after how long should a woman previously on warfarin be given LMWH after getting pregnant?
6 weeks
when can women on LMWH during pregnancy be switched back on to warfarin?
can be started on 5th postnatal day
skin change in antiphospholipid syndrome?
livedo reticularis
what precedes the pregnancy loss seen in APS?
FGR
Ix APS in pregnancy?
pregnancy morbidity in PMH
vascular thrombosis
IgM, IgG aCL tests
Tx APS in pregnancy?
low dose aspirin and LMWH
how does seizure frequency change in pregnancy?
usually doesnt change
what risks does a seizure in pregnancy have on baby?
fetal hypoxia and acidosis
= preterm birth, congenital malformations, haemorrhagic disease of newborn
what extra investigation should women with epilepsy be given?
scan of fetal anatomy at 18-20 weeks
what prophylactic medication should women with epilepsy be given?
5mg/day folic acid until the end of 1T
what factors increase the risk of intra-partum seizures?
stress pain sleep deprivation overbreathing dehydration
Tx seizures in labour
benzodiazepines are mainstay
IV lorazepam/diazepam
how can you keep babies safe if mum has epilepsy?
safe feeding position
do activities on the floor eg dressing, playing
low high chairs
avoid maternal fatigue
PET prophylaxis?
aspirin
