Other Medical Conditions in Pregnancy: Gynaecological, Neurological etc Flashcards
List some gynaecological conditions seen in pregnancy
Ovarian cysts Bartholin's cysts Uterine fibroids PCOS Fistulae Gential tract infections
Explain: Ovarian cysts
are fluid filled cysts on the ovary.
- Usually resolve on their own
Diagnosed: U/S, MRI, CT scan and palpation
List symptoms of ovarian cysts
- Nil (in some cases)
- Pain
- Abdominal discomfort-fullness
- Indigestion
- Early satiety
- Urinary urgency
- Urge to defaecate
- Painful bowel movements
- Pain with sexual intercourse
Explain: Bartholin’s Cyst
cyst on the bartholin gland on the labia
- Caused by: blockage in the gland or infection (bacteria and STI)
- Needs to be drained if Abx not effective or severe
Explain: Fibroids
Non-cancerous growth on the uterus wall
- May complicate pregnancy
and labour
- Risks: fetal malpresentation, PPH, labour dystocia, LSCS
Types:
- Ramural – grow on muscular wall
- Sub-mucosal – develop on the uterine lining
- Subserous – grow on the exterior wall of the uterus
- Pedunculated – grow
on the exterior wall
and are attached by a stalk
Generally don’t affect
fertility
List symptoms of Fibroids
Nil-mild symptoms
- bladder and bowel issues: rectal pain, abdominal pain
- Menstrual cycle changes: frequent bleeding, break through bleeding, clots in between cycle
List some Neurological conditions in pregnancy
- Epilepsy
- Multiple sclerosis
- Bells palsy
- Cerebrovascular disease
Explain: Epilepsy in pregnancy
Affects 0.5%
Pregnancy has an unpredictable and variable influence on epilepsy and depends on the nature of epilepsy and seizure control
Practice point: Pre-conception care and folic acid supplementation
- Need surveillance of medications due to fetal malformation risk
Explain: Management for epilepsy in pregnancy
Pregnancy:
- Seizure control
- AEDs
- Major congenital malformation: Surveilance
- Folic acid supplementation
- Antenatal screening : anatomical ultrasound
- Vitamin K supplementation
Labour:
- no Pethidine, may induce a seizure
Postpartum: potential Vitamin K metabolism disturbances in the newborn which may lead to haemorrhagic disease
Explain: Multiple Sclerosis in pregnancy
Is a 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
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
- Spinal, epidural and G.A can all be used safely in MS patients
- Immunomodulatory agents (IMAs) e.g. beta interferon and glatiramer (Copaxone) are not recommended in pregnancy and lactation
Explain: Bell’s Palsy in pregnancy
An idiopathic inflammatory reaction involving the facial nerve and resulting in facial paralysis
- 3x more common in pregnant women
Signs:
- Droopy eyelid, dry eye or excessive tears
- Facial paralysis, twitching or weakness
- Drooping corner of mouth, dry mouth, impaired taste
May be caused by:
- oedema
- hypertension
- secondary to infection
Most cases resolve without treatment
- Treatment: eye care, high dose steroids, emotional support
Explain: Cerebrovascular Disease/ stroke in pregnancy
Cerebrovascular accidents = strokes and result from cerebral infarction.
- These occur when the flow of blood carrying essential oxygen to the brain is disrupted causing brain cells to die
3 categories:
- Ischaemic from decreased blood flow as a result of vascular occlusion
- Thrombotic from a venous event
- Haemorrhagic such as a SAH due to a ruptured blood vessel
S/S:
- abrupt onset of neurological symptoms and needs urgent medical review
Explain: Pregnancy care and management for women with Epilepsy
Pregnancy issues:
- Women with epilepsy are likely to have healthy pregnancies
- care should be shared between the obstetrician, midwife and a neurology specialist
- Seizures controlled with AED meds
Labour/Birth issues:
- continue meds
- EFM: possible fetal hypoxia, tachycardia
- OB management
- midwifery care as normal
Postnatal issues:
- monitor for seizure <24hrs
- montior newborn for haemorhagic disease as maternal AED interferes with VitK metabolism
- BF ok
- AED dose r/v
- safe environment for maternal/infant bonding and feeding in case of seizure
Explain: Pregnancy care and management for women with Cerebrovascular disease and stroke
Possible indicators:
- Dizziness
- Weakness
- Numbness
- Paralysis in limb or side of body
- Headache
- Slurred speech
- Partial vision loss
Pregnancy issues:
- ? Warfrin embryopathy is fetus exposed to warfin from 6-12wks
- Consult with heamatology
- screen for thrombophilia
- risk assessment for CVA
- multidisciplinary care with specialists
Labour/Birth issues:
- medical management
- Surgical management posisbility
- TEDS
- hydration and fluid
- regular obs
Postnatal issues:
- risk of thrombotic and ischemic stroke
- thromboprphylaxis
- Medical r/v
- specialist follow-up
Explain: Pregnancy care and management for women with Multiple Sclerosis
Possible indicators: Often there is an acute onset of symptoms inc. - diplopia - vertigo - bladder incontinence - loss of vision - fatigue - muscular weakness
Pregnancy issues:
- no effect on pregnancy
- AN care as normal
- Consult w/ neurologist
Labour/Birth issues:
- care as normal in most cases
- If mother has had prolonged AN corticosteroid use: hydro-cortisone cover is required
- IDC or frequent voiding required
Postnatal issues:
- exacerbation of MS increases 20-40% <6months
- fatigue: requires additional practical support
- BF ok
- r/v MS therapy
- thrombo-prophylaxis may be required
