Medical problems in pregnancy Flashcards
list cardiac problems in pregnancy
pulmonary hypertension ischaemic heart disease valve disease arrhythmias peri-partum cardiomyopathy congenital heart disease
pulmonary HTN is fatal in pregnancy, true or false
true
list causes of palpitations
physiological sinus tachycardia SVT Ectopic beats hyperthyroidism phaeochromocytoma
there is an increase/decrease in residual lung capacity in pregnancy
decrease
what is the commonest respiratory condition to complicate pregnancy
asthma
is treatment of asthma in pregnancy any different to normal treatment of asthma
no, same treatment
steroids are safe/unsafe in pregnancy
safe
what should you look out for in pregnant women taking steroids
weight gain –> GDM
immunosuppression –> infections, vaccines
what is the management of asthma
- SABA
- SABA + ICS
- SABA + ICS + LABA
- Increase ICS dose
- add 4th drug
- PO prednisolone
which drugs should be avoided in pregnant asthamtics
NSAIDs and haemabate
what happens to the risk of VTE in pregnancy
increases!
where are VTEs most commonly found
ileofemoral region in left leg
what is Virchows triad
hypercoaguability
venous stasis
vascular damage
LMWH is/not safe to use in pregnancy and does/not cross the placenta
safe to use and does not cross the placenta
which imaging technique is safer to investigate PE in pregnant women and why
V/Q scan
avoid high dose radiation
warfarin does/not cross the placenta
DOES cross the placenta
therefore teratogenic
when should you convert warfarin to LMWH in pregnancy
6 weeks
which anticoagulants can be used post natally
heparin and warfarin (can be used in breast feeding)
what are pregnancy complications of autoimmune disorders
miscarriage PET abruption FGR stillbirth prematurity
what are treatment related consequences of connective tissue disorders
teratogenic medications
sepsis
DM
osteoporosis
autoimmune conditions tend to get better/worse in pregnancy
better
which CTD medications are safe to use in pregnancy
steroids azathioprine sulfasalazine HCQ aspirin monoclonal antibodies
which CTD medications are NOT safe to use in pregnancy
gold penicillamine methotrexate NSAIDs MMF leflunamide
what is anti-phospholipid syndrome
acquired thrombophilia with aterial, venous and small vessel thrombosis
clinical features of APLS
recurrent miscarriages, DVT/PE, stroke, MI
IUGR, PET
antibodies of APLS and how do you test for these
anti-cardiolipin
anti-B2glycoprotein
lupus anticoagulant
2 tests, 3 months apart
how do you diagnose APLS
> =3 miscarriages <10wk
=1 foetal loss >10wk
=1 preterm birth due to PET or placental insufficiency
management of APLS
low dose aspirin
stop warfarin
LMWH
risks of maternal seizures
maternal abdominal trauma eg haemorrhage Pre term premature rupture of membranes prematurity hypoxia/acidosis foetal abnormalities haemorrhagic disease of the newborn childhood epilepsy
which AED is not teratogenic
lamotrigine
which AED are teratogenic
Na valproate
phenytoin
carbamazepine
what increases the risk of peri partum seizures
stress pain sleep deprivation hyperventilation dehydration
management of intra partum seizures
long acting BZD
AED through labour
c-section if high risk of SE
left lateral tile to avoid comrpession of aortocaval vessels
consequences of obesity in pregnancy
subfertility miscarriage IOL, instrumental delivery PPH, infection, VTE foetal macrosomia, bith injury
foetal abnormality common in mothers with DM
VSD
if there is a high suspicion of DVT but the scan is clear what could you do
give LMWH - see doses on NICE or RCOG
time it with delivery to prevent haemorrhage
is warfarin teratogenic
yes
is warfarin teratogenic
yes and it can anticoagulate the baby and cause IVH
