Module 8 Flashcards
Antiepileptic drugs
Generic name
Trade Name:
Category in pregnancy:
Carbemazepine and lamotrigine
Tegretol and lamictal
Ampicillin cat B,
maternal mortality rate
5.5 per 100,000 women giving birth in 2020
most common cause maternal mortality rate
motor vehicle trauma and cancer
ovarian cysts - symptoms
pain, abdominal discomfort-fullness, indigestion, early satiety, urinary urgency, urge to defecate, painful bowel movements, painful sex or none
ovarian cysts - diagnosis
palpation, USS, MRI, CT scan
bartholins cysts
obstruction of the bartholin’s glands on either side of the vaginal opening causing fluid build up, usually painless but may become infected requiring surgical draining under GA and hospital admission with IV ABX
gynaecological conditions
Endometriosis
Structural anomalies
Batholin’s cyst
Uterine fibroids
ovarian cysts
PCOS
Genital tract infections
Abnormal cervical screening
Recurrent UTI
Incontinence
Cancer
cervical cancer
breast cancer
ovarian neoplasia (cancer)
ectopic pregnancy
fistuale/FGM
uterine fibroids
Non-cancerous growth on the uterus wall
Generally don’t affect fertility
May complicate pregnancy and labour, risks for fetal malpresentation, labour dystocia, LSCS and PPH
Symptoms menstrual changes, aetiology unknown
cancer affects …
approx 1 in 2000 pregnancies
most common cancers in pregnancy
melanoma 1:1000,
breast 1:3000,
cervical 1:4500,
hodgkin lymphoma 1:1000-6000,
ovarian 1:8000
estrogen is thought to be
an established growth factor in cancers and therefore accelerated disease occurs in pregnancy
elective pre-term labour cancer
32-34 weeks
is often favoured by medical staff and the woman, so her condition can be assessed and more appropriate treatments can be administered such as radiation and cytotoxic drugs
cervical cancer - HPV
human papillomavirus is the cause of both invasive cervical cancer and the premalignant change in the cervical epithelium. HPV is transmitted sexually but not considered a STD.
risk factors of HPV/cervical cancer
multiple sexual partners, experiencing sex at an early age, sex with a male partner who has had multiple partners, oral contraceptive pill more than 4 years.
stage 1 cervical cancer
carcinoma confined to the cervix
stage 2 cervical cancer
carcinoma is beyond the cervix into surrounding tissue
stage 3 cervical cancer
carcinoma extends to the pelvic wall
stage 4 cervical cancer
carcinoma beyond the pelvis involvement of bladder and rectum or distant organs such as lungs
breast cancer stage 0
non invasive not in surrounding tissue
breast cancer stage 1
invasive where tumour measures less than 2 cm with no lymph node involvement
breast cancer stage 2
measures a minimum of 2 cm and maximum of 5 cm or has spread to the lymph nodes in the axilla of the affected breast
breast cancer stage 3A
size greater than 5 cm or lymph node involvement
breast cancer stage 3B
tumour has spread to the breast skin, chest wall or internal mammary lymph nodes
breast cancer stage 3C
tumour of any size, spread to the clavicle with lymph node involvement
breast cancer stage 4
any size, spread to both lymph nodes and distant organs
signs and symptoms of breast cancer
fatigue, anaemia, anorexia, depression, sepsis, pain or metastasis
consultation after treatment breast cancer
Pregnancy after treatment should be in consultation with oncologist, breast surgeon and obstetrician, wait at least 2 years after treatment
ovarian neoplasia (cancer) stage 1
limited to ovaries
stage 2 ovarian cancer
involving one or both ovaries with pelvic extension
stage 3 ovarian cancer
involving one or both ovaries with peritoneal deposits outside the pelvis
stage 4 ovarian cancer
involving one or both ovaries not limited to the pelvis
stage 4 ovarian cancer
involving one or both ovaries not limited to the pelvis
how many weeks to expedite delivery for ovarian cancer
32 weeks to minimise delay in treatment
neurological disorders
epilepsy
multiple sclerosis
bells palsy
cerebrovascular disease and stroke
epilepsy
characterised by recurrent seizures
seizure triggers
stress, anxiety, lack of sleep, lack of feed, excess alcohol, binge drinking, drugs, dose of antiepileptic drugs, flickering lights, illness and health condition, antidepressants and antihistamines, hormonal changes
epilepsy affects
0.5% of pregnancies
pre-conception care epilepsy
folic acid supplementation, counselling to review current medications, explain risk of fetal defects, review of hx, reduce medication where possible, 5mg of folic acid 12 weeks before pregnancy and continue until the end of the first trimester due to the increase risk of folate deficiency, antenatal screening, Vitamin K, consider seizure risk for labour and pain relief, encourage breastfeeding, safety advice in the postnatal period
complications epilepsy
status epilepticus (>30 min), sudden unexpected death, trauma, maternal mortality.
epilepsy management
obstetric management, seizure control, congenital malformation, folic acid supplementation, antenatal screening, Vitamin K supplementation, no pethidine
multiple sclerosis
chronic inflammatory autoimmune disease
of the CNS that mostly affects women and those in the childbearing age group
Characterised by destruction of the myelin sheaths (lesions) in the brain and spinal cord and has a variety of classification types e.g. relapsing-remitting, primary progressive
ms effect on pregnancy
pregnancy has a protective
benefit against relapses, however increased chance of relapses postnatally when physical and emotional stressors are greater and results in immune activation
meds for ms
Immunomodulatory agents (IMAs) e.g. beta interferon and glatiramer (Copaxone) are not recommended in pregnancy and lactation
bells palsy
An idiopathic inflammatory reaction involving the facial nerve and resulting in facial paralysis
Three times more common in pregnant women than those of similar age
May be caused by oedema, hypertension or secondary to infection
Most cases resolve without treatment
Treatment eye care, high dose steroids, emotional support
cerebrovascular disease and stroke 3 categories
ischaemic (from decreased blood flow), thrombotic (a venous event), haemorrhagic (subarachnoid haemorrhage due to a ruptured blood vessel)
signs and symptoms of cerebrovascular disease and stroke
abrupt onset of neurological symptoms and needs urgent medical review
risk factors cerebrovascular disease and stroke
hypertension, heart disease, previous ischaemic attacks, diabetes, vasculitis, smoking, obesity, excessive alcohol, over 35, thrombophilia, dehydration, infection, smoking, operative delivery, 6 or more pregnancies, ⅔ have no risk factor
complications of cerebrovascular disease and stroke
can result in death or permanent disability, dizziness, weakness, numbness, paralysis, headache, slurred speech, partial vision loss
Preconception care review prior to pregnancy where a hx is present, titrate aspirin up, cease warfarin and change to heparin, consult with haematology, support and reassurance
labour care cerebrovascular disease and stroke
regular obs, TEDs, hydrate and mobilise, supportive care
