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
Explain: Pregnancy care and management for women with Ovarian Neoplasia (cancer)
Possible indicators:
- typically vague and non-specific
- bloating
- abdominal and pelvic discomfort
- increased abdominal girth and reduced appetite
Pregnancy with Ovarian cancer is rare
What are the 3 different classes of obesity
- BMI 30.0–34.9 (class 1)
- BMI 35.0–39.9 (class 2)
- BMI 40 and over (class 3 or morbid obesity)—about two in every 1000 Australian births involve an extremely morbidly obese woman (BMI > 40).
- A fourth class is now used in some centres. A BMI of > 50 kg / m 2 is classed as super-morbidly obese.
What factors contribute to the development of overweight and obesity
Biology
Environment
Lifestyle behaviours
What are the pregnancy related complications of Obesity
- Infertility
- Miscarriage
- Fetal congenital anomaly
- Gestational diabetes
- Thromboembolism
- Preeclampsia
- Abnormalities of the baby’s growth, development and general health
- Maternal sleep apnoea
What are the Labour/Birth related complications of Obesity
- Increased rate of induction of labour
- Slow progress in labour
- Shoulder dystocia—there is some evidence of increased risk of fetal macrosomia
- Postpartum haemorrhage
- Difficulties with providing satisfactory pain relief in labour should the woman require epidural or spinal analgesia
- Increased risk of complications related to caesarean section
- Stillbirth
What are the Postpartum related complications of Obesity
- Increased risk of wound infection following caesarean section
- Increased risk of DVT and pulmonary embolus (particularly following a caesarean section)
- Postnatal depression
- Neonatal death
- Lower breastfeeding rate
Explain: Cervical screening
A number of cervical cells are removed to detect cervical intraepithelial neoplasia (CIN) at the earliest possible time.
- These cells are taken from the squamocolumnar junction between the endocervix (columnar epithelium) and the ectocervix (squamous epithelium) in the transformation zone—
- the squamocolumnar junction is found just at the outside end of the canal (area between internal and external os) where the canal opens into the vagina.
What factors can stimulate an epileptic seizure
- lack of sleep,
- increase in temperature
- hypoglycaemia,
- water intoxication,
- drugs
- emotional and physical stress
- hyperventilation
- strobe lights
- some music
- constipation
