Medical Problems in Pregnancy Flashcards
List common medical problems in pregnancy
VTE Diabetes Hypertension Cardiac disease Asthma CTD (antiphospholipid syndrome) Epilepsy Obesity
What are the significant cardiovascular changes that occur in pregnancy?
Increased CO
Increased HR
List common cardiac conditions that require management in pregnancy
Pulmonary hypertension Congenital or acquired heart disease Cardiomyopathy Artificial heart valves Ischaemic heart disease Arrhythmia
Which emergency condition is a patient with Marfan’s syndrome at risk of during pregnancy?
Aortic dissection
Arrhythmia during pregnancy are typically benign. True/ False?
True
Palpitations, extrasystoles and systolic murmurs.
When do physiological arrhythmias typically occur?
At rest or lying down
State the name for the common arrhythmia described as a ‘thumping’ and is relieved by exercise . How is it diagnosed?
Ectopic beats
ECG
Which type of arrhythmia is a part of normal pregnancy?
Sinus tachycardia
Exclude other pathology (ECG, FBC, TFT, echo)
What type of arryhtmia is typically detected at pregnancy, but is found to predate pregnancy?
Supraventricular tachycardia
O2 consumption and tidal volume increase during pregnancy. What is the anatomical explanation for this change in lung function?
Increased level of diaphragm
When is breathlessness in pregnancy most common?
3rd trimester
State the most common chronic medical disorder to complicate pregnancy
Asthma
Asthma always gets worse during pregnancy. True/ False?
False
May improve, deteriorate or remain unchanged
Outline the stepwise management of asthma during pregnancy
- SABA
- inhaled steroid
- LABA
- If good response, continue
- If poor response, stop
- If inadequate response, increase dose of steroid
- LABA
- Trial of increased dose of steroid
Consider adding 4th drug (LTRA, theophylline) - Oral steroid and continuation of inhaled steroid
When is risk of VTE highest for a pregnant women?
Post-partum
What is the most common site of DVT in pregnancy?
Left leg
Popliteal DVT is the most common type of DVT in pregnancy? True/ False?
False
Ileo-femoral, unlike DVT in non-pregnnacy
What is the leading cause of maternal death in pregnancy?
Venous thromboembolism
Outline the pathogenesis of VTE
Virchows triad
- Hypercoagulability
Venous stasis
Vascular damage
List risk factors for VTE during pregnancy
Previous VTE (not related to surgery) Thrombophilia Co-morbidity (cancer, HF, SLE, IBD, DM, nephrotic syndrome, preclampsia) IVDU, smoker, obesity Any surgery Age > 35 or partity > 3 Family history
List clinical signs of DVT, which can also be present during normal pregnancy
Swelling Oedema Leg pain or discomfort Tenderness Increased leg temperature Lower abdominal pain Increased WCC
List investigations used to diagnose DVT in pregnancy
Compression Duplex US
Repeat in 1w if normal to exclude calf vein thrombosis
If iliac vein thrombosis suspected after compression duplex US, which investigation should be requested?
MRI venography
List clinical signs of PE during pregnancy
Dyspnoea Chest pain Faintness/ collapse Haemoptysis Raised JVP Focal signs in chest Signs assoc. DVT
