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3 Reproduction > Medical Problems in Pregnancy > Flashcards

Medical Problems in Pregnancy Flashcards

1
Q

what is the uk maternal mortality rate

A
  1. 8/100,000
  2. 8 women died per every 100,000

ethnicity, age and weight associated with increased risk

overweight women have a higher risk of blood clots

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2
Q

what are some common medical problems in pregnancy

A 
Diabetes 
Hypertension 
Cardiac disease 
Respiratory disease - asthma 
Venous thromboembolism 
Connective tissue disease - anti-phospholipid syndrome 
Epilepsy 
Obesity
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3
Q

what to consider if someone has a medical disorder in pregnancy

A

How does pregnancy affect disorder

How does disorder affect pregnancy

  • for mother and fetus
  • drugs
  • consider impact on each trimester

How can you reduce risk and improve outcomes

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4
Q

common heart disease in pregnancy

A 
pulmonary hypertension 
congenital heart disease 
acquired heart disease 
cardiomyopathy 
artificial heart valves 
ischaemic heart disease 
arrhythmias
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5
Q

what signs are negative predictions for the outcome of heart disease in pregnancy

A 
pulmonary hypertension 
NYHA heart failure classification 
Presence of cyanosis 
TIA/arrythmia 
Heart failure 
Left heart obstruction 
Aortic root >45mm
Myocardial dysfunction (EF<40%)
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6
Q

normal heart disease changes in pregnancy

A

palpitations
extra-systoles
systolic murmurs

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7
Q

what heart disease signs are often fatal in pregnancy

A

pulmonary hypertension

fixed pulmonary vascular resistance

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8
Q

what types of palpitations do you get in pregnancy

A

Physiological (common, occur at rest/lying down)

Ectopic beats (common thumping released by exercise)

Sinus tachycardia (part of normal pregnancy but need to exclude pathology)

SVT (super ventricular tachycardia) - usually predates pregnancy

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9
Q

what happens to lung function during pregnancy

A 
Increased O2 consumption 
Increased metabolic rate 
Increased resting minute ventilation 
Tidal volume 
Respiratory rate stays the same 
Functional residual capacity decreases 
Vital capacity stays the same 
FEV1 and PEFR stays the same 
PaO2 increases 
PaCO2 decreases 
Arterial pH increases
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10
Q

characteristics of breathlessness in pregnancy

A 
very common - up to 75% of women 
increased awareness of physiological hyperventilation 
more common in third trimester 
rest/talking makes it worse
improves with exertion
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11
Q

what is the most common chronic medical disorder to complication pregnancy

A

Asthma
7% of women of child bearing age have it

10% will have an acute exacerbation in pregnancy

associated with maternal mortality

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12
Q

what is the prognosis of asthma in pregnancy

A

may improve, may deteriorate or may remain unchanged

deterioration often due to decreased therapy due to safety concerns

those who improve may have deterioration during post partum

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13
Q

impact of asthma on pregnancy

A

poorly controlled asthma may adversely affect fetal development

poorly controlled asthma is higher risk that the medication used to prevent it

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14
Q

asthma management

A

Step 1 - inhaled SABA
Step 2- inhaled pregnancy
Step 3 - add LABA, if LABA still not controlling, increase steroid, if no response to LABA stop LABA and increase inhaled steroid

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15
Q

asthma management specific to pregnancy

A

Aim for vaginal birth
Acute asthma during labour is unlikely due to endogenous steroids

increased risk of cystic fibrosis for women with moderate-severe asthma

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16
Q

Epidemiology of VTE in pregnancy

A

4-6x increase in risk of VTE in pregnancy
incidence 1-2 per 1000

85-90% of DVTs occurring during pregnancy arise in the left leg

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17
Q

what is Virchow’s triad

A

hyper coagulability
venous stasis
vascular damage

18
Q

what are the symptoms of DVT

A 
swelling 
oedema 
leg pain or discomfort 
tenderness 
increased leg temperature 
lower abdominal pain 
elevated white cell count
19
Q

how do you test for DVT

A

Compression duplex ultrasound

if normal and clinical suspicion is high then repeat to exclude extending calf vein thrombosis

if iliac vein thrombosis is suspected consider MRI venography

20
Q

Symptoms and signs of a pulmonary embolism

A 
Dyspnoea 
Chest pain 
Faintness 
Collapse 
Haemoptysis 
Raised JVP 
Focal signs in the chest 
Symptoms and signs associated with DVT
21
Q

what are the 2 investigations for PTE

A

CT pulmonary angiogram

V/Q scan

22
Q

benefits to CTPA

A

readily available
may detect other pathology
better sensitivity and specificity
low radiation dose to fetus

23
Q

benefits of V/Q scan

A

high negative predictive value in pregnancy

low radiation dose to maternal breast tissue

24
Q

how do you treat PTE/DVT in pregnancy

A

LMWH

warfarin is teratogenic

25
Q

what impact does warfarin have on a foetus

A

Warfarin embryopathy

  • midphase hypoplasia
  • stippled chondral calcification
  • short proximal limbs
  • short phalanges
  • scoliosis
26
Q

what anticoagulation can be used in post-natal

A

Heparin
Warfarin

neither are contraindicated in pregnancy

start warfarin on 5th post-natal day

anticoagulant therapy continued until at least 6 weeks post-natal until at least 3 months post partum

27
Q

Connective tissue disease complications in pregnancy

A 
Miscarriage 
Pre-eclamptic toxicity 
Abruption 
Foetal growth restriction 
Still birth 
preterm birth 
labour/delivery 
post-natal

Disease related

  • lupus flare, renal haematological
  • Antiphospholipid syndrome
  • rheumatoid
  • scleroderma
28
Q

what drugs cannot be used to treat CTD in pregnancy

A 
NSAIDS 
Clyclophosphamide
Methotrexate 
Chlorambucil 
Gold 
Penicillamine 
MMF 
Leflunamife
29
Q

what drugs can be used to treat CTD in pregnancy

A 
Steroids 
Azathioprine 
Sulfsalazine 
Hydroxycholoquine 
Aspirin 
some biologics
30
Q

what is antiphosphlipid syndrome

A

An acquired thrombophilia

aPL (antiphospholipid antibodies) - reacted with the phospholipid component of the cell membrane

anticardiolipin antibodies and lupus anticoagulant

APS described the clinical syndrome associated with these antibodies

31
Q

what are the clinical features of anti-phospholipid syndrome

A 
Arterial/venous thrombosis 
Recurrent early pregnancy loss 
Late pregnancy loss 
Placental abruption 
Severe early onset pre-eclampsie 
Severe early fetal growth restriction
32
Q

how do you diagnose antiphospholipid syndrome

A

Vascular thrombosis
(venous, arterial, small vessel)
Pregnancy morbidity
(>3 miscarriages <10 weeks, >1 fetal loss >10 weeks, >1 preterm birth (less than 34 weeks))

LgM/LgG aCL

LA

33
Q

How do you manage antiphospholipid syndrome in pregnancy

A

No thrombosis/adverse pregnancy outcome

  • low dose aspirin
  • maternal/ fetal observance

previous thrombosis

  • stop warfarin
  • give low dose aspirin and LMWH

recurrent early pregnancy loss

  • LMWH
  • Low dose aspirin

lade fetal loss/severe pre-eclampsia toxicity/ foetal growth restriction

  • low dose aspirin
  • LMWH
34
Q

how does seizure frequency change in pregnancy

A

improved or unchanged

> 50% of women have no seizures during pregnancy

35
Q

fetal risks of epilepsy seizures

A

Maternal abdominal trauma
PPROM (premature pre-rupture of membranes - early waters breaking)
Preterm birth
hypoxia/acidosis

congenital malformations 
adverse perinatal outcomes 
long-term developmental effect s
haemorrhage disease of the new born 
risk of childhood epilepsy
36
Q

how do you reduce the risk in women with epilepsy who are pregnancy

A

5mg daily of folic acid

Minimise exposure to valproate and other poly therapy - aim to change medication prior to conception

37
Q

how does epilepsy effect labour and birth

A

most women have normal labour and vaginal birth

2.6% will have a seizure

38
Q

what increases the risk of intrapartum seizure

A 
stress 
pain 
sleep deprivation 
over-breathing 
dehydration
39
Q

how do you treat seizures in labour

A

benzodiazepines- IV lorazepam/diazepam

IV phenytoin

may need to expedite deliver by CS

40
Q

how to you reduce the risk to the baby if the mother has epilepsy

A 
avoid maternal fatigue 
get a safe area for the baby if mother feels unwell 
safe feeding position 
lowest setting for high chairs 
dress baby on floor 
carry baby in padded sling/carrycot 
handle-release pram break 
additional support for bathing
41
Q

what does obesity increase the risk of in pregnancy

A 
miscarriage 
gestational diabetes 
hypertension/precelampsia 
VTE 
Cystic fibrosis 
Post partum haemorrhage 
wound infection 
congenital anomalies 
macrosomnia 
shoulder dystocia 
still birth 
neonatal death
42
Q

management of obesity in pregnancy

A 
Weight assessed at booking 
Pre-eclampsia prophylaxis - aspirin 
thromboprohpylaxis 
detailed US 
oral glucose tolerance test 
obstetric US to asses fetal growth 
anaesthetic review 
MDT plan for labour and birth 
post natal review

3 Reproduction (49 decks)

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