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
A D-dimer test should be carried out in pregnancy to investigate PE. True/False?
False
Never do D-dimer in pregnancy, do a CTPA or VQ scan instead
What drug is used to combat PE in pregnancy?
Heparin
List some side effects of heparin
Haemorrhage
Hypersensitivity
Thrombocytopenia
Osteopenia
Warfarin can be used to manage PE in pregnancy. True/ False?
False
Warfarin crosses placenta and is teratogenic, convert to LMWH by 6 weeks
Warfarin is suitable for use while breastfeeding. True/ False?
True
It is not contraindicated - commence warfarin on 5th post-natal day
Which medications used in the treatment of CTD are safe for use in pregnancy?
Steroids Azathioprine Sulfazaline Hydroxychloroquine Aspirin
What is anti-phospholipid syndrome and how does it present?
Acquired thrombophilia which presents with:
Arterial/ venous thrombosis
Recurrent early pregnancy loss (>2 in <10w)
Late pregnancy loss (preceded by FGR) at >10w
Placental abruption
PET (>1 preterm birth)
Outline the pathogenesis behind APS
AP autoantibodies react with phospholipid component of CM
How is APS diagnosed in the lab?
IgM/ IgG aCL (medium/ high titre)
LA
On 2 occassions more than 6 weeks apart
How is APS managed?
Previous thrombosis: LDA + treatment dose of LMWH
Fetal loss/ severe PET/ FGR: LDA + prophylactic LMWH
In a person with epilepsy, during which trimester are they at increased risk of seizures?
1st trimester due to hyperemesis and haemodilution
What are the risks of seizures during pregnancy?
Spontaneous miscarriage PPH Hypertension/ PET Preterm birth Fetal growth restriction Congenital malformation Childhood epilepsy
Which epileptic drug is especially associated with neural tube defects?
Sodium valproate
Outline management options for epilepsy during pregnancy
Use lowest effective dose of AED
Detailed 20w US for fetal anomaly
Folic acid 5mg/day to reduce congenital malformations
Baby safety
Outline management optons for epilepsy during labour
Aim for vaginal birth, may need C section Continuous fetal monitoring IV lorazepam/ diazepam IV phenytoin PR diazepam/ buccal midazolam
If no history of epilepsy, how are seizures managed during labour?
Magnesium sulphate
What are the maternal risks of obesity during pregnancy?
Miscarriage GDM Hypertension/ PET VTE PPH
What are the fetal risks of obesity during pregnancy?
Congenital anomalies Macrosomia Shoulder dystocia Still birth Neonatal death
Outline management options for obesity during pregnancy
Maternal BMI at booking PET prophylaxis (Aspirin) Thromboprophylaxis Detailed US OGTT Anaesthetic review
List pregnancy-related MSK problems
Back pain
Pelvic girdle pain
Diastasis of rectus abdominus muscle (DRAM)
Carpal tunnel syndrome
What is diastasis recti?
Seperation of the two sides of the rectus abdominus muscle due to stretching of the linea alba
