Medical Problems In Pregnancy (CVD, Asthma, VTE, Obstetric Cholestasis, Connective Tissue, Epilepsy, Obesity) Flashcards
Most common causes of maternal death in pregnancy? (Top 3)
Cardiac disease,
Thrombosis/thromboembolism,
Neurological
List 7 types of heart disease that may present/need monitoring during pregnancy
Pulmonary hypertension, Congenital heart disease, Acquired heart disease, Cardiomyopathy, (incl. peri-partum cardiomyopathy) Artificial heart valves, Ischaemic heart disease, Arrhythmias
Prevalence of heart disease in pregnancy is rising. Pregnancy with a heart disease is associated with x _ risk oof MI?
x3-4 times risk
Most women with heart disease in pregnancy have no previous history so should all receive ECG if present with chest pain. T/F?
True
Orthopnoea is associated with what heart disease in pregnancy?
Peri-partum cardiomyopathy
If pregnant woman presents with palpitations, what are 6 possible causes and which are normal in pregnancy?
Physiological - normal Ectopic beat, normal Sinus tachycardia - normal, SVT, Hyperthyroidism, Phaeochromocytoma
How do palpitations caused by physiological palps present?
Palpitations occur at rest/lying down
How do palpitations caused by ectopic beats tend to occur?
Thumping,
Relieved by exercise
How does palpitations caused by phaeochromocytoma present?
With headache, sweating and hypertension
What investigation should be carried out in pregnant women with palpitations caused by ectopic beats?
ECG
What investigations should be carried out in pregnant women with palpitations caused by sinus tachycardia? (4)
ECG,
FBC,
TFT,
Echo
What investigations should be carried out in pregnant women with palpitations caused by SVT? (4)
ECG,
24hr ECG, (cos paroxysmal)
TFT,
Echo
What investigations should be carried out in pregnant women with palpitations caused by hyperthyroidism? (2)
ECG,
TFT incl FT4
What investigations should be carried out in pregnant women with palpitations caused by phaeochromocytoma? (2)
24hr catecholamines,
US
Lung function during pregnancy - which increase and which decrease? O2 consumption, metabolic rate, tidal volume, functional residual capacity, PaO2, PaCO2, arterial pH
O2 consumption - up, metabolic rate - up, tidal volume - up, functional residual capacity - down, PaO2 - up, PaCO2 - down, arterial pH - up
Breathlessness in pregnancy is very common/very rare and tends to improve/worsen with exertion?
Very common - up to 75% of women, improves with exertion
What is most common chronic medical disorder to complicate pregnancy?
Asthma
Asthma affects pregnant women in 1/3s. Explain this?
1/3 worsen,
1/3 stay the same,
1/3 improve
5 step management for asthma is same for pregnant women and non-pregnant. What are the 5 steps?
1: inhaled SABA,
2: inhaled steroid & SABA,
3: add LABA, if good continue, if ok but not good enough continue LABA and increase steroid, if no response stop LABA and increase steroid,
4: trial inhaled high dose steroid/add 4th drug e.g. leukotriene receptor antagonist, SR theophylline or oral B2 agonist,
5: oral steroids on top of inhaled
Why is acute asthma unlikely during labour?
Due to endogenous steroids
Asthma management stays the same during pregnancy as effects of medication less on pregnancy than asthma attack has. T/F?
True
In pregnancy there are two main severe clinical pathologies in terms of thrombosis. What are they?
Dural vein sinus thrombosis - brain failure,
Pulmonary artery thromboembolism - heart & lung failure
Presentation for dural venous sinus thrombosis and diagnosis?
Headache,
Neurological symptoms e.g. dizziness/stroke symptoms, seizure,
Diagnosis on magentic resonance venogram
Why women in pregnancy more prone to VTE?
Virchow’s triad - hyper-coagulability, venous stasis, vascular damage
Signs and symptoms of DVT (8)
Oedema & swelling, Leg pain/discomfort, Groin pain, Lower abdo pain, Tenderness, Increased leg temp, Elevated white cell count, Fever
List 3 types of thrombophilia that makes pregnant patients risk higher for VTE?
Antithrombin deficiency,
APS,
Protein c deficiency
How many times more likely is VTE to occur in pregnancy than in non-pregnancy?
X4-6 times more likely in pregnancy
85-90% of DVTs occuring during pregnancy arise in the right leg. True/false?
False!! LEFT LEG