Other medical disorders in pregnancy Flashcards
what does having epilepsy mean for mum in pregnancy?
- is stable on medication, must be advised to continue taking this during pregnancy as frequent seizures can be harmful.
- you may have more seizures when pregnant. pregnancy itself can increase the number of seizures you have as well as tiredness, and also happens if you stop taking your meds or don’t take them regularly. if you have more seizures you must contact a healthcare professional.
- most types of epilepsy will not cause any harm to you or your baby.
- if your epilepsy is poorly controlled, a very rare but serious complication is sudden unexpected death in epilepsy (SUDEP). This may happen more frequently in pregnancy.
what does having epilepsy mean for baby in pregnancy?
- with any pregnancy, there is a risk baby may not develop properly in the womb, and this risk might be higher with some of the anti-epileptic drugs you take.
- problems with baby’s development include spina bifida, cleft lip/palate and heart problems.
- the risk is highest with valproate, which also has the risk of developmental delay-your child may have problems with communication, language and behaviour.
- the risk can be reduced if you take folic acid regularly before conception, and for the 1st 12 weeks of pregnancy-5mg OD.
considerations for a women with epilepsy to make before becoming pregnant?
- let her GP know. may r/f on to a neurologist or specialist in epilepsy to discuss more about what epilepsy means for you and your baby in pregnancy, and can r/v your meds. may continue, may reduce dose, may change meds. this may affect your ability to drive.
- folic acid 5mg OD-a/v to continue using contraception until you have been taking folic acid or 3months.
advice if a woman with epilepsy finds out she has an unplanned pregnancy?
- continue with her antiepileptic medication. although these can pose a small risk to the development of your baby, the risk to both you and your baby of suddenly stopping the medications is much greater. talk to your gp or epilepsy nurse as soon as possible for advice.
- start taking folic acid 5mg daily to reduce the risk if neural tube defects in baby.
extra care for women with epilepsy in pregnancy?
- more antenatal appointments. under the care of midwife, obstetrician and specialist healthcare professional.
- advice regarding ways to reduce your risk of having a seizure-continue to take your meds regularly, and try to get as much sleep/rest as possible.
- take showers rather than baths.
- you will be invited to joint the UK epilepsy and pregnancy register-collect information on the meds women with epilepsy take in pregnancy and the health of their babies, plus advice on medications.
- may have more regular US scans to monitor babies growth if on certain AEDs (levetiracetam, topiramate)
- most women can have a normal vaginal delivery.
- note that after birth breastfeeding is safe.
management of epileptic patients in labour?
- continue taking AEDs as normal.
- can have similar analgesic options to everyone else including gas+air, TENS machines, epidural.
- ensure patient is getting as much support, rest and pain relief as possible, as although low risk of seizure, risk is higher if pt tired, dehydrated and in pain.
what signs of a VTE should a pt be advised to look out for in pregnancy and alert a healthcare professional to?
a DVT is a clot in 1 of the deep veins of your legs, calf or pelvis.
usually the symptoms will occur in only 1 leg. they include:
a red, hot and swollen leg
swelling of the entire leg
pain or tenderness, which you may only find when standing or walking
we worry about these clots as they can break off and travel in your blood to lungs-PE-and this can be life threatening. features of this include: sudden onset SOB chest pain or tightness haemoptysis feeling very unwell or collapsing
RFs woman has before pregnancy for a VTE in pregnancy?
age 35 or older 3 or more babies smoker overweight (BMI 30 or greater) previous VTE FH of VTE medical condition increasing suscpetibility to VTE (thrombophilia) other medical conditions e.g. CVD, lung disease, IBD cancer severe varicose veins
VTE risk factors that arise during pregnancy?
- reduced mobility for long periods
- dehydration e.g. vomiting in early pregnancy
- multiple gestation
- pre-eclampsia
- hospital admission
VTE risk factors that arise after birth of baby?
- within 6 weeks postpartum
- PPH
- C section
- blood transfusion
- very long labour
considerations in labour for a women being treated for a VTE with LMWH?
- woman should not have any more injections if she thinks she is going into labour.
- 24 hrs must pass from last heparin injection before an epidural can be sited for pain relief.
- if labour induction is planned, injections should be stopped 24hrs before planned date.
- if planned C section, stop heparin 24hrs before planned delivery. usually restarted within 4hrs of op.
- if emergency C section is needed within 24hrs of last heparin injection, pt cannot have spinal/epidural, and will require a GA.
considerations with regards to contraception after a woman has had a VTE in pregnancy?
will not be allowed to take oestrogen containing contraceptives (COCP)
advice with regards to future pregnancies if woman has had a VTE during pregnancy?
usually recommended heparin treatment during and after next pregnancy
duration of VTE treatment during pregnancy?
will have to be continued throughout pregnancy, and for at least 6 wks afterwards, may be longer than this.
most common chronic condition in pregnancy?
asthma
