Medical Problems in Pregnancy Flashcards
How should ectopic beats be investigated?
ECG (thumping and relieved by exercise)
How should sinus tachycardia be investigated?
ECG, FBC, TFTs, Echo (physiological but need to exclude pathology)
How should SVT be investigated?
ECG, 24hr ECG, FBC, TFTs (paroxysmal and usually predates pregnancy)
How should hyperthyroidism be investigated?
TFTs, ECG
How should phaechromocytoma be investigated?
ECG and 24hr catecholamines (presents with increased HR, hypertension, sweating and headache)
What is the most common breathing problem in pregnancy?
Asthma (around 10%)
What is the course of asthma like in pregnancy?
1/3 will get worse, 1/3 will stay the same, 1/3 will get better
What is the risk of asthma treatment to foetal development?
No known risk - it is a lot more deterimental to the foetus to have poorly controlled asthma
What is the main reason for poorly controlled asthma in pregnancy?
Cessation of medication due to health concerns - needs appropriate counselling
What is the risk of VTE in pregnancy and why?
4-6x the population norm - due to the hypercoagulable state (increased oestrogen, VWF etc) and stasis.
How long does it take for VTE risk to return to baseline?
6 weeks post-partum
What is the indication for VTE prophylaxis?
Previous VTE/PE, medical comorbidities, high risk thrombophillia
What is the VTE prophylaxis given in pregnancy?
LMWH
Does LMWH cross the placenta/breast milk?
No - warfarin does cross the placenta but it is safe in breastmilk
How do you diagnose a PE in pregnancy if there are clinical indicators?
ECG and CXR then CTPA/V/Q scan
if CXR is normal then a CTPA is preferred over a VQ scan
never do a D-Dimer as these are already elevated in pregnancy
How is VTE diagnosed in pregnancy?
Compression duplex USS
How long should LMWH be continued for?
6 weeks postnatal or 3 months postpartum
Which drugs can be used in treatment of connective tissue disease during pregnancy?
Steroids, azathioprine, sulphasalazine, hydroxychloroquine, rituximab
Which drugs should be avoided in the treatment of CTD during pregnancy?
NSAIDs, methotrexate, cyclophosphamide, gold
What is APS?
this is anti-phopholipid syndrome and is an acquired thrombophilia
What are the lab markers of APS?
anti-phospholipid, anti-cadiolipin, lupus anticoagulant
What are the clinical indicators of APS?
> 3 miscarriages <10weeks
1 late miscarriage >10 weeks
1 preterm with evidence of early severe PET or FGR
How is APS treated?
If diagnosis but no history of thrombosis then LDA and monitoring
If previous thrombosis then LDA and therapeutic LMWH
If history of recurrent miscarriage, late miscarriage, severe PET or FGR then LDA and prophylactic LMWH
How does epilepsy behave in pregnancy?
> 50% will have an improvement in epilepsy
if seizure free for 9 months prior to pregnancy then 92% will be free during pregnancy
How likely is it that a seizure will occur during labour?
unlikely due to the presence of endogenous steroids being released
…, …, and … seizures are unlikely to affect the foetus
focal, abscence and myoclonic
Which seziures do pose a threat to the foetus?
GTC but also loss of consciousness does expose risk of trauma
What risks does GTC pose to foetus?
Trauma, PROM, foetal hypoxia and acidosis
How should epilepsy be treated in pregnancy?
Avoidance of sodium valproate (risk of NT defects and orofacial clefts) but lamotrigine, levetiracetam and carbamazepine are all fine
monotherapy is better than polytherapy
