Medical Problems in Pregnancy and Labour Flashcards
maternal mortality is highest in what geographical region?
central africa
what are the most common causes of maternal death in the UK?
cardiac causes
VTE
what factors increase the risk of maternal mortality in pregnancy?
multiple health problems
vulnerabilities (children in social services, drug/alcohol abuse)
ethnicity
age
medication
overweight / obese
what are the most common medical problems (both direct and indirect) in pregnancy?
diabetes hypertension cardiac disease respiratory disease asthma VTE connective tissue - APS / SLE epilepsy
why is heart disease a common complication of pregnancy?
heart works around 40% harder during pregnancy - increased CO
if patients have a known congenital cardiac condition, how should they be managed in pregnancy?
pre-pregnancy counselling (esp on medication)
maximise scans (regular ECHO)
why do acquired heart conditions obviously start in pregnancy?
heart is asked to work a lot harder so disease traits may start to show
when is peri-partum cardiomyopathy usually diagnosed?
at time of birth
what symptoms are common with peri-partum cardiomyopathy?
orthopnoea (breathless when lying down)
how is continuity of care across different specialities managed in pregnant women with underlying conditions?
hand held / one track records
*these can be accessed by any clinician the pregnant patient sees
by how much does pregnancy increase the risk of MI and how is this prevented?
3-4x increased risk
check ECG (+CT) if required
the presence of what cardiac features would predict poor outcomes in pregnancy?
pulmonary hypertension cyanosis TIA arrhythmia heart failure left heart obstruction aortic dissection MI
if patients have valvular heart disease or arrhythmias increasing risk of stroke, how should they be anticoagulated in pregnancy?
LMWH (does not cross placenta)
stop before delivery due to haemorrhage risk
warfarin can be recommenced 5 days post natal and is safe in breastfeeding
what palpitations can occur in pregnancy?
physiological (at rest / lying down)
ectopic beats (relieved by exercise)
sinus tachycardia (normal in pregnancy)
SVT (usually predates pregnancy)
hyperthyroidism
phaeochromocytoma (rare, associated with headache, sweating, HT)
describe the main respiratory changes that occur during pregnancy?
less residual capacity
increased O2 capacity to take in enough O2 for mother and foetus
SOB is common in 3rd trimester
SOB often improves with exertion (walking along corridor)
asthma = common in pregnancy
how is asthma normally treated in pregnancy?
treated as if patient is not pregnant
steroids safe for use in pregnancy
minimise asthma attacks as this can affect mother, placenta and thus foetal development
acute asthma during labour is unlikely - true or false?
true - due to endogenous steroids
what vascular factors cause increased risk of VTE in pregnancy?
virchow’s triad
- hyper coagulability
- venous stasis
- vascular damage
how should VTE be screened for?
DVT - look for symptoms / signs (swollen, hot, red limb)
PE - pleuritic pain, SOB etc
if suspicious of DVT
- whole leg doppler (inc groin)
- if negative, repeat in 1 week
how is a suspected DVT managed?
LMWH (weight based) taken twice daily
- enoxaparin / dalteparin
what investigations can be used to investigate a PE, and which of these may be avoided in pregnant women?
CTPA
- not used in pregnancy due to increased breast tissue and vasculature that can take up radiation (risk of breast cancer)
V/Q scan
what teratogenic effects can warfarin cause?
midface hypoplasia stippled chondral calcification short proximal limbs short phalanges scoliosis
for how long should anticoagulation be continued after pregnancy?
until at least 6 weeks post-natal AND at least 3 months post-partum
connective tissue diseases such as APS and SLE can cause what complications to the actual pregnancy?
miscarriage pre eclampsia abruption growth restriction (due to small vessel disease affecting placenta) still or preterm birth
