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