Obstetrics Flashcards
HTN in pregnancy
High risk of preeclampsia - give 75mg is 12 weeks/“:
- HTN durin prev pregnants
- CKD
- AI - SLE, antiphospholipid
- DB 1 and DB 2
During 1st trimester BP Falls until 20-24 weeks. Then increases to pre-preg levels at Term
Defined as:
Says >140 or Dias >90
Or an increase above booking readings of >30 sys Or >15 dias
If HTN then categorise into one of:
- pre existing HTN - <20 weeks gestation with no oroteinuria or oedema
- PIH - > 20 wks. No proteinuria or oedema. Resolved following birth. Increased risk Pre-eclampsia or HTN
- pre-eclampsia - htn assoc with proteinuria (>0.3g/24 hr)
Chronic htn In pregnancy
Manage with usual anti htn if safe unless:
- <110 or Dias <70
- sx hypotension
Mx with: labetolol, nifedipine and methyldop
Down syndrome risk
1/1000 at 30
After 30 divide by 3 for every 5 years
RA in preg
sx tend to improve
can give NSAIDS up to 32/52
>32/52 –> inhibits COX 1 +2 which normally inhibits prostagalndin synth –> rise in OG –> Prem closure of PDA
MTX - not safe - stop 6/12 before.
LEflunomide not safe
Sulfasalazine = safe
Low dose steroid - if minor dx = safe
refer to obs anaesthestics –> risk of atlant-axial subluxation
Gestational DB
Screen if RF present: BMI, prev GDM, prev macrosomia, Fhx, ethnicity
(if prev GDM screen as early as pos. if N –> @ 24-28weeks.
if glycosuria 2+ or 1X on two occassions –< screen
Screen = OGTT.
Diagnosis:
Fasting - 5.6
2hrs - 7.8
Mx
- Fasting <7 –> diet + Ex –> 1-2/52 rv –> still high –> metformin –> Insulin
- Fasting >7 –> immed insulin +/- metformin + diet & Ex
