Obstetrics - Maternal conditions in pregnancy Flashcards
HTN in pregnancy
Pre-existing < 20 weeks
Gestational > 20 weeks
Pre-eclampsia > 20 weeks
- HTN
- Proteinuria
Eclampsia
- Pre-eclampsia
- Generalised TC seizures
Pre-eclampsia definition
AFTER 20 weeks
HTN
Proteinuria
Pre-eclampsia RFs
Previous HTN in pregnancy CKD AI disease DM Chronic HTN
Family Hx 1st pregnancy > 40 > 10 years between pregnancies BMI > 35 Multiple pregnancy
Pre-eclampsia pathophysiology
Abnormal invasion of spiral arteries
Increased resistance
Release of inflammatory cytokines
= HTN
Failure of spiral arteries to convert to vascular sinuses
Pre-eclampsia diagnosis
HTN > 140/90
Proteinuria > 0.3g / 24 hours
Mild/moderate < 160/110
Severe > 160/110 + Complications
Pre-eclampsia symptoms
Headaches
Visual disturbances
Papilloedema
Ankle clonus
Hyperreflexia
RUQ pain
Pre-eclampsia management
Labetalol
Nifedipine
Hydralazine
Aspirin if high risk
Delivery < 38 weeks!
Pre-eclampsia maternal complications
Eclampsia
HELLP syndrome
Pulmonary oedema
CV haemorrhage
Liver failure
Renal failure
Pre-eclampsia foetal complications
IUGR Premature delivery Placental abruption Oligohydramnios Foetal distress
Pre-eclampsia indications for delivery
> 38 weeks
Platelets < 100,000
Progressive LFTs
Eclampsia
Eclampsia
Pre-eclampsia + TC seizures
Management - Deliver!
IV magnesium sulphate - Prevent seizures
Normal BP in pregnancy
Falls in first trimester
20-24 weeks - Starts to increase
Pre-eclampsia RFs - Take 2
NOPE 2 FAT
Nulliparity
Obesity
Previous HTN in pregnancy
Extremes of age
2 - DM2
Family Hx
AI disease - Antiphospholipids
Twins
HELLP syndrome
Coagulation cascade activation
Haemolysis Elevated Liver enzymes Low Platelets
HELLP syndrome presentation
N/V
RUQ pain
Lethargy
HELLP syndrome management
Delivery!
Maternal diabetes screening and diagnosis
OGTT
- Booking visit
- 24-28 weeks
Fasting > 5.6
Random > 7.8
Maternal diabetes RFs
South Asian
Mediterranean
Afrocaribbean
BMI > 30
First degree relative
Previous DM
Previous macrosomic baby
Gestational diabetes management
First 2 weeks - Diet and exercise
No change - Give METFORMIN
Fasting > 7 - GIVE INSULIN
Gestational DM monitoring
Serial USS every 2-4 weeks
Fetal echo at 20 weeks
Pre-existing DM management
Pre-conception - Folic acid
Stop oral meds - Except metformin
Continue insulin if required
DM maternal complications
Prematurity
PPH
Polyhydramnios
DM foetal complications
IUGR
Macrosomia
Shoulder dystocia
Comorbidities
Defects
- NTD
- CHD
Baby blues
Peaks at 5th day
Subsides within 5 days
Tearful
Anxious
Management
- Monitor and reassure
- CBT
Post-partum depression presentation
Onset - 1 month!
Peak - 3 months
Depression
Uninterested in baby
Guilt and anger
Thoughts of harming the baby
Post-partum depression investigations and management
Edinburgh screening test
CBT
Paroxetine
Post-partum psychosis
Onset - 2-3 weeks
Manic
Depression
Schizophrenia
Management - Admit
Rhesus disease conditions
Mother is Rh NEGATIVE
Baby is Rh POSITIVE
Rhesus disease pathophysiology
1st pregnancy - Sensitisation
- Foetal blood crosses into maternal circulation
- Maternal immune response to Rh +ve antigens
- IgM produced CANNOT CROSS PLACENTA
2nd pregnancy - Re-exposure
- Memory B-cells produce rapid response IgG
- IgG crosses into foetal circulation
- Haemolysis of foetal RBCs
- Foetal hydrops
Rhesus disease testing
Maternal blood test at booking visit - 28 and 34 weeks
Assessment of foetal anaemia
- MCA doppler
- Foetal blood sampling
Kleinbauer test
- Measures amount o foetal Hb transferred to mother’s bloodstream
Babies born to Rh -ve mother should have cord blood sampled at delivery
- Coombs test demonstrates antibodies on RBCs of baby
Rhesus disease prevention
Anti-D Ig
Give to non-sensitised mothers at 28 and 34 weeks
Rhesus disease sensitising events
ToP Miscarriage > 12 weeks Ectopic APH Blunt abdo trauma
Surgery
Foetal blood sampling
Amniocentesis
Chorionic villous sampling
External cephalic version
Delivery
Rhesus disease affected foetus
Oedema - Hydrops fetalis Jaundice Anaemia Hepatosplenomegaly HF Kernicterus
Rhesus disease - Treatment of affected foetus
Transfusion
UV phototherapy
Chorioamnionitis
Bacterial infection of amniotic fluid, membranes or placenta
Emergency!
5% of pregnancies
Chorioamnitis RFs and presentation
RFs
- Preterm premature ROM
- ARM
Presentation
- Uterine tenderness
- ROM - Foul odour
- Signs of maternal infection
Group B strep RFs
Previous infection - 50% risk
Premature ROM
Premature delivery
Maternal pyrexia
Group B strep investigations and management
Swab @ 35-37 weeks
SEPSIS 6
Prophylactic ben pen if…
- Previous GBS
- Maternal pyrexia > 38
- Preterm labour
VTE RFs
Previous VTE
Pre-eclampsia
Multiple pregnancy
CS
+ many many more
VTE investigations and management
D-dimer
?DVT - USS
?PE - ECG + CTPA
LMWH
- 28 weeks to 6 weeks post-natal
Compression stockings
Anaemia in pregnancy
First trimester < 110
2nd/3rd trimester < 105
Post-partum < 100
Anaemia in pregnancy screening and management
Booking + 28 weeks
Ferrous sulphate
Anaemia in pregnancy complications
Iron deficiency
- Pre-term
- Low birth weight
Folate deficiency - NTD
Amniotic fluids embolism aetiology
Age ^
Induction of labour
Amniotic fluid embolism presentation
During labour or immediately postpartum
Cyanosis
SOB
Sweating
Coughing
Tachycardia
Tachypnoea
Hypotension
Shivering
Amniotic fluid embolism management
MDT
Supportive
Pulmonary artery catheterisation
Teratogenic drugs
Warfarin - Skeletal
ACE - Growth retardation
SSRI - CHD + PPHTN
Vitamin A - Cleft palate
AEDs
NSAIDS
Teratogenic infections
CHRiST
CMV - Hearing, growth, skin Herpes - Herpes infantum Rubella - CHD, deafness SOFT CHEESE - Listeria - Meningitis Toxoplasmosis - Cerebral calcification
Polyhydramnios definition and aetiology
Pools of liquor > 10cm
Idiopathic
Multiple pregnancy
Foetal anomaly
- Impaired swalling
- Renal problems
Maternal
- DM
- Renal
Polyhydramnios clinical features
Taut uterus
Foetus difficult to palpate
Large for date
Polyhydramnios investigations and management
USS
< 34 weeks + Severe
- Amnioreduction
Polyhydramnios complications
Premature delivery
Abnormal lie
Oligohydramnios
< 500ml at 32-36 weeks
Aetiology
- PROM
- Post-date
- Pre-eclampsia
- Foetal renal problem
- IUGR
Intrahepatic cholestasis
Itching of soles and palms
Risk of preterm delivery and stillborn
Induce labour at 37 weeks
Ursodeoxycholic acid
Vitamin K - Prevent PPH
Mastitis
Can continue breast feeding
Flucloxacillin > 24 hours
Complications - Abscess
Galactocele
Occurs when woman stops breastfeeding
Painless
No systemic signs
No erythema
Leave alone
Engorgement
Bilateral
Pain and discomfort
Worse just before a feed
Fever
Red breast
Poor milk flow
Expression of milk relieves discomfort
Suppressing lactation
Stop feeding - Reduce reflex
Supportive bra
Analgesia
Cabergoline - Suppresses prolactin release
Maternal complications
Pre-eclampsia
vs
GDM
Pre-eclampsia
- Eclampsia
- HELLP
- CV accident
- Liver failure
- Renal failure
- Pulmonary oedema
GDM - PPH
Foetal complications
Pre-eclampsia
vs
GDM
Pre-eclampsia
- IUGR
- Premature
- Placental abruption
- Foetal distress
- Oligohydramnios
GDM
- IUGR
- Macrosomia
- Shoulder dystocia
- NTD
- CHD
- Polyhydramnios
- Premature
