Other Medical Disorders in Pregnancy Flashcards

1
Q

Why does glucose tolerance decrease in pregnancy?

A

Due to altered carbohydrate metabolism and the antagonistic effects of human placental lactogen, progesterone and cortisol

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2
Q

What do we mean when we say pregnancy is ‘diabetogenic’?

A

women without diabetes, but with impaired or potentially impaired glucose tolerance often deteriorate enough to be classified as diabetic in pregnancy

Even slightly increased glucose levels have adverse pregnancy effects - they are reduced by treatment

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3
Q

at what threshold do the kidneys of non-pregnant women start to excrete glucose?

How does this change in pregnancy?

A

11mmol/L

Varies more, but often decreases, so glycosuria may occur at physiological blood glucose concentrations

urinalysis for glycosuria is not a useful diagnostic test

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4
Q

What is the result of raised foetal blood glucose levels?

A

Foetal hyperinsulinaemia

causing foetal fat deposition and excessive growth - macrosomia

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5
Q

What % of pregnant women are affected by pre-existing diabetes?

A

1%

In those on insulin, increasing amounts will be required in these pregnancies to maintain normoglycaemia

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6
Q

What is gestational diabetes?

A

Gestational diabetes refers to diabetes triggered by pregnancy. It is caused by reduced insulin sensitivity during pregnancy, and resolves after birth.

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7
Q

What is the NICE threshold for gestational diabetes?

A

normal:
Fasting: < 5.6 mmol/l
At 2 hours: < 7.8 mmol/l
Results higher than these values are used to diagnose gestational diabetes.

It is really easy to remember the cutoff for gestational diabetes as simply 5 – 6 – 7 – 8.

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8
Q

What are the foetal complications of gestational diabetes?

A

Congenital abnormalities - NTD (2-4 Ames more common in women with established diabetes and are related to periconceptual glucose control)

Preterm labour (natural or induced) occurs in >10% women with established diabetes

Fetal lung maturity - less than with non-diabetic pregnancies

Birthweight - increased

Dystocia - and birth trauma: baby larger. related particularly to poor 3rd trimester glucose control

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9
Q

Why does gestational diabetes result in large babies?

A

foetal pancreatic islet cell hyperplasia leads to hyperinsulinaemia and fat deposition - this leads to increased urine polyhydramnios

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10
Q

What are the maternal complications of gestational diabetes?

A

Insulin requirements - increase by up to 300% by the end of pregnancy
Ketoacidosis - rate but hypoglycaemia may result
UTI
Wound or endometrial infection
Hypertension and pre-eclampsia
Pre-existing ischaemic heart disease
C-section or instrumental delivery
Diabetic nephropathy (5-10%)
can lead to massive proteinuria and deterioration of maternal renal function
Diabetic retinopathy - often deteriorates in pregnancy - may need to be treated

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11
Q

What is the preconceptual care of diabetes?

A

Glucose levels need to be optimum at conception to reduce risk of fatal complications.

HbA1c <6.5% and pregnancy not advised if >10%. Fasting glucose should be 4-7mmol/K if achievable without hypoglycaemia. Metformin and insulin are appropriate, but others must be stopped

5mg folic acid

Statins stopped and anti-hypertensives (labetalol/methyldopa) given instead

Renal function (creatinine <120umol/L), BP and retinae are assessed

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12
Q

What is the aim for glucose levels in pregnancy?

A

Fasting <5.6mmol/L

1hr <7.8mmol/L

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13
Q

What other measures need to be taken during pregnancy to Monitor for diabetes?

A

Renal function checked and retinae screened for retinopathy - if abnormal, this needs to be repeated every trimester

Aspirin (75mg) daily from 12 weeks advised to reduce risk of pre-eclampsia

Foetal monitoring: fetal echo, USS to monitor growth and liquor volume at 32 and 35 weeks

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14
Q

At what week gestation is delivery advised for diabetic women?

A

37-39 weeks as birth trauma more likely

C-section where estimated foetal weight is >4kg.

During labour, glucose levels are maintained with sliding scale of insulin and dextrose infusion

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15
Q

Why does the neonate commonly develop hypoglycaemia?

What is the management of this?

A

become accustomed to hyperglycaemia and therefore has high insulin levels

Levels should be checked within 4 hours - breastfeeding Is strongly advised

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16
Q

What are the factors indicating screening for gestational diabetes?

A
Previous large baby (>4.5kg) 
Unexplained stillbirth 
1st degree relative with diabetes 
BMI >30kg/m2 
Minority ethnic family origin 
Previous gestational diabetes
Large for dates fetus

Women with pregnancy factors - e.g. polyhydramnios or persistent glycosuria

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17
Q

What is the screening for gestational diabetes?

A

24-28 weeks:
An OGTT
The patient drinks a 75g glucose drink at the start of the test. The blood sugar level is measured before the sugar drink (fasting) and then at 2 hours.

Hba1c levels to identify pre-existing diabetes.
Target levels are the same in pre-existing diabetes

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18
Q

What is the management of gestational diabetes?

A

Initially managed with diet and exercise advice.

Fasting glucose less than 7 mmol/l: trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin

Fasting glucose above 7 mmol/l: start insulin ± metformin

Fasting glucose above 6 mmol/l plus macrosomia (or other complications): start insulin ± metformin

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19
Q

What % increase of CO is there in pregnancy? Why does this occur?

A

40%

Due to increase in stroke volume and heart rate and a 40% increase in blood volume

50% decrease in systemic vascular resistance, so BP often drops in 2nd trimester but has returned to normal by term

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20
Q

What % women have a flow murmur during pregnancy?

A

90%

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21
Q

What ECG changes are seen in pregnant women?

A

left axis shift and inverted T waves

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22
Q

What % of women are affected by cardiac disease?

A

0.3%

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23
Q

why does cardiac disease occur in pregnancy?

A

Increased Co –> exercise test (heart may be unable to cope)

decompensation in association with blood loss and fluid overload >28 weeks or soon after labour

Fluid overload can also occur in early puerperium as the uterine involution squeezes a large fluid load into the circulation

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24
Q

How are patients assessed pre-pregnancy for cardiac disease?

A

echo
contraindication of some drugs - ACEi and warfarin

hypertension often managed by beta-blockers ad thromboprophylaxis by LMWH

Fluid balance important = elective epidural analgesia reduces after load - elective forceps helps avoid the additional stress of pushing in severe cases

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25
Q

What are the types of cardiac disease that can onset in pregnancy?

A

Mild abnormalities - e.g. mitral valve prolapse, PDA, uncomplicated VSD/ASD

Pulmonary HTN - e.g. eisenmenger’s because of high maternal mortality, pregnancy = contraindicated

Cyanotic heart disease without pulmonary HTN - usually corrected but there is a particular risk of paradoxical embolism. anti-coagulation is advised

Aortic stenosis - severe disease causes an inability to increase CO when required and should be corrected before pregnancy. Beta-blockage
epidural analgesia is contraindicated in the most severe cases

Mitral valve disease - should be treated before pregnancy.

MI

Peripartum cardiomyopathy

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26
Q

How is mitral stenosis treated in late pregnancy?

A

Beta-blockade used

artificial metal valves are prone to thrombosis, so anti-coagulation is indicated

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27
Q

When does permpartum cardiomyopathy tend to develop?

A

Last month or first 6 months after pregnancy

Frequently diagnosed late.

Cause of maternal death and more than 50% leads to permanent LV dysfunction.

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28
Q

What is the management of peripartum cardiomyopathy?

A

Supportive - diuretics and ACE-i

Significant recurrence rate if subsequent pregnancies

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29
Q

By what volume is tidal volume increased by in pregnancy

A

40% - no change in respiratory rate

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30
Q

What common respiratory condition is common in pregnancy?

A

asthma

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31
Q

Why do women on long-term steroids require an increased dose in labour?

A

chronically suppressed adrenal cortex is unable to produce adequate steroids for the stress of labour

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32
Q

What % of women does epilepsy affect?

A

0.5% - seizure control can deteriorate in pregnancy (particularly in labour)

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33
Q

How are epileptic women managed in pregnancy?

A

Epilepsy = significant cause of maternal death
Anti-epileptic treatment should be continued, however, the risk of congenital abnormalities (NTD) is increased due to drug therapy. risk = dose dependent, higher with multiple drug usage and certain drugs

Seizure control with as few drugs as possible + folic acid (5mg/day)

Valproate avoided

Vit-K for enzyme inducing anti-epileptics

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34
Q

What is the risk of the new born developing epilepsy if the mother is epileptic?

A

3%

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35
Q

What drugs are safest for epilepsy in pregnancy?

A

Levetiracetam, lamotrigine and carbamazepine are the safer anti-epileptic medication in pregnancy

Sodium valproate is avoided as it causes neural tube defects and developmental delay

Phenytoin is avoided as it causes cleft lip and palate

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36
Q

When does foetal thyroxine production begin?

A

12 weeks

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37
Q

Before foetuses start producing thyroxine, where do they get their thyroxine from?

A

other - maternal TSH is increased in early pregnancy

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38
Q

What are the causes of hypothyroidism in pregnant women?

A

Hashimoto’s thyroiditis or thyroid surgery

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39
Q

What are the associated risks of hypothyroidism in pregnancy?

A

untreated - high perinatal mortality

subclinical - miscarriage, preterm delivery and intellectual impairment in childhood.

Increased risk of pre-eclampsia , particularly if antithyrozine antibodies are present

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40
Q

What is the cause of hyperthyroidism in pregnant women?

A

Grave’s disease

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41
Q

What is the result of untreated hyperthyroidism?

A

perinatal mortality

anti-thyroid antibodies can cross the placenta and cause neonatal thyrotoxicosis and goitre.

For the mother, thyrotoxicosis may improve in late pregnancy, but poorly controlled disease can lead to a ‘thyroid storm’

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42
Q

What is hyperthyroidism treated with?

A

Propylthiouracil (PTU) in the 1st trimester rather than carbimazole, but it can cross the placenta and cause neonatal hypothyroidism

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43
Q

What is postpartum thyroiditis?

A

Common condition causing post-natal depression

Usually a transient and subclinical hyperthyroidism at about 3 months postpartum followed by about 4 months by hypothyroidism - permanent in 20%

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44
Q

What are the risk factors for portpartum thyroiditis?

A

anti-thyroid antibodies and T1DM

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45
Q

What is the incidence of acute fatty liver in pregnancy?

A

Very rare (1 in 9000) - serious condition that is part of the spectrum of pre-eclampsia

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46
Q

What are the early features of acute fatty liver?

A

malaise, vomiting, jaundice and vague epigastric pain

thirst may occur weeks earlier

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47
Q

What is the management of acute fatty liver in pregnancy?

A

early diagnosis and prompt delivery - correction of clotting defects and hypoglycaemia are needed first

Treatment = then supportive; further dextrose, blood products, careful fluid balance and occasionally dialysis

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48
Q

What are the clinical features of intrahepatic cholestasis of pregnancy?

A

Unexplained pruritus
Abnormal LFT
Raised bile acids

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49
Q

What is the cause of obstetric cholestasis?

A

Obstetric cholestasis is characterised by the reduced outflow of bile acids from the liver.
thought to be the result of increased oestrogen and progesterone levels.

Occurs in 0.7% women
familial
tends to reoccur (50%)

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50
Q

What are the associated risks of obstetric cholestasis

A

Increased risk of stilbirth?
Meconium passage
PPH - stillburth is thought to be due to the toxic effects of bile salts

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51
Q

What is the management of obstetric cholestasis?

A

Resolves with delivery

UDCA (ursodeoxycholic acid) helps relieve itching - reducing bile acid leves
Emollients + antihistamines

High risk of maternal and foetal haemorrhage - vitamin K 10mg/day given from 36 weeks

Induction of labour offered

six week follow up after labour to endure liver function returns to normal

52
Q

By how much does GFR increase by in pregnancy?

What are the effects o this?

A

40%

Urea and creatinine levels decrease

53
Q

What is the threshold risk for pregnancy being v high risk in ckd?

A

> 200mmol/L

54
Q

What are the foetal complications of CKD in pregnancy?

A

Preterm delivery
Pre-eclampsia
IUGR
Polyhydramnios

55
Q

What is the management of CKD in pregnancy?

A

USS for foetal growth
measurement of renal function
screening for urinary infection
control of HTN - in severe cases, dialysis is necczsssay

56
Q

What are urinary infections associated with in pregnancy?

A

Preterm labour
Anaemia
Increased perinatal morbidity and mortality

57
Q

How are urinary infections managed in pregnancy?

A

Urine cultured at booking visit (12 weeks( and asymptomatic bacteruria treated

58
Q

What are the clinical features of pyelonephritis?

What is the predominant cause?

A

Loin pain, rigors, vomiting and fever

E.coli

59
Q

What is antiphospholipid syndrome (APS)

A

When the lupus anticoagulant and/or anticardiolipin antibodies occur in association with adverse pregnancy complications or thrombotic events. Fetal loss = high

60
Q

What are the consequences of APS?

A

Placental thrombosis
Recurrent miscarriage
IUGR
Early pre-eclampsia

61
Q

What is the management for APS?

A

‘high risk’ - serial USS and elective induction of labour at least by term

Treatment with aspirin and LMWH - postnatal ant-coagulation is recommended to prevent venous thromboembolism

62
Q

What are the other protherombotic disorders that can increase risk of pregnancy complications?

A

Antithrombin deficiency
Protein S or C deficience
Prothrombin gene mutation
Factor V Leiden heterozygosity

63
Q

What is hyperhomocysteinaemia associated with?

A

Increased pregnancy loss and pre-eclampsia

Tx - high dose folic acid

Postnatal anticoagulation

64
Q

What are the effects of pregnancy being prothrombotic?

A

Incidence of VTE = sixfold

Blood clotting factors = increased, fibrinolytic activity is reduced and blood is altered by mechanical obstruction and immobility

65
Q

Describe the effects of PE in pregnancy?

A

leading ‘direct’ cause of death

Embolism - mortality 3.5%

Causes chest pain, dyspnoea, tachycardia, raised RR and JVP and chest abnormalities

66
Q

how is PE diagnosed in pregnancy?

A

Doppler ultrasound is the investigation of choice for patients with suspected deep vein thrombosis.

Women with suspected pulmonary embolism require:
Chest xray
ECG

CTPA
V/Q

The Wells score is not validated for use in pregnant women. D-dimers are not helpful in pregnant patients, as pregnancy is a cause of a raised D-dimer.

67
Q

Where do DVTs tend to occur in pregnancy?

A

Iliofemoral and on the left - doppler examination and venogram/pelvic MRI used to diagnose

68
Q

What is the presentation of cerebral venous thrombosis?

A

Headache/stroke

69
Q

How is cerebral venous thrombosis managed?

A

thrombophilia screen before tx with subcut LMWH

dosing = weight based and adjusted according to anti-Factor Xa level

clearance rapid, so level higher

NOT warfarin antenatally (teratogenic)

LMWH/warfarin safe in breastfeeding

Mobilisation + maintenance of hydration. compression stockings

70
Q

Who are given antenatal / postpartum prophylaxis of VTE

A

Antenatal - women @ very high risk e.g. previous VTE
ASAP or from 28 weeks

Postpartum - if used antenatally, then continued or if there is a major or intermediate risk factor or two or more minor risk factors - LMWH is prescribed for at least 10 days and can usually be given 12 hours after delivery

71
Q

What are the criteria for high risk VTE postpartum?

What is the management?

A

if LMWH used antenatally

Previous VTE

72
Q

What are the intermediate risk factors for VTE postpartum?

What is the management

A
Thrombophilia
Caesarean in labour
BMI >40 
prolonged hospitalisation
IV drug abuser
medical illness 

1 week LMWH if 1+

73
Q

What are the moderate risk factors for VTE postpartum?

What is the management?

A
BMI >30 
Age >35 or parity >3 
Smoker
Elective caesarian
Varicose veins
Current systemic infection
Pre-eclampsia 
Immobility 
PPH
Rotational delivery
Labour >24h 

I week LMWH if 2+

74
Q

What are the risks associated with BMI >30 in pregnancy?

A
Thromboembolism
Pre-eclampsia
Diabetes
C-section
Wound infection
Difficult surgery
PPH
maternal death 

Higher rate of congenital abnormalities

75
Q

What is the management of obesity in pregnancy?

A

High dose folic acid (5mg)
vitamin D
High risk if >35 (screening for diabetes and closer BP surveillance)

Formal anaesthetic risk assessment and antenatal thromboprophylaxis if >40

Elective C-section?

76
Q

When is the most high risk time for mental illness in pregnant women?

A

early postnatal

77
Q

What are the red flag signs for mental illness?

A

Recent significant change in mental state
Emergence of new symptoms
New thought
Acts of violent self harm
New and persistent expressions of incompetency as mother
Estrangement from the infant

78
Q

What are the risks of BPAD?

A

Lifetime risk - 1%
Onset most commonly during child-bearing age

Delivery can precipitate in women with bipolar

79
Q

What are the treatments for BPAD?

A

Mood stabiliser
anti-psychotics
anti-convulsants
Lithium

Tx decisions = cost/benefit to foetus

80
Q

What is the presentation of postpartum psychosis?

A

Psychiatric emergency - presents suddenly in the early postnatal period with psychotic and severe mood sx

Acute risk of suicide, self-harm or neglect, neglect of the baby, intentional self-harm to the baby = rare

81
Q

What % of pregnant/postnatal women are affected by depression?

A

10-15%

highest in post-natal period

82
Q

What is the management of depression in pregnancy?

A

CBT - first line in mild to moderate depression

Anti-depressants = effective in severe depression
Sertraline preferred
Paroxetine - congenital malformations and avoided

NB withdrawal and short-term side effects of anti-depressants have been seen in neonate

83
Q

What are the types of anxiety disorders than can affect pregnant women?

A
GAD 
Panic disorder
Phobias
OCD - may increase in perinatal period 
PTSD - traumatic experience during delivery

Tokophobia - fear of childbirth

84
Q

What is the management of anxiety in pregnancy?

A

Psychological therapies first line
medications reserved for severe cases (anti-depressants)
BDZ not recommended in pregnancy - dependency, neonatal withdrawal and oversedation

85
Q

What % of women are affected by schizophrenia?

A

1% women over the course of a lifetime

most common during childbearing age

86
Q

What is the management of schizophrenia in pregnancy?

What are the effects of these?

A

Long-term treatment with antipsychotics
Not shown to be teratogenic
However, olanzapine and quetiapine = weight gain and therefore gestational diabetes

Treatment usually continued due to high risks of relapse if medication stopped permanently

87
Q

What recreational drugs are used in pregnancy and what are the effects of these?

A
OPIATEs  
COCAINE 
ECSTASY
BDZ
Cannabis
88
Q

What are the effects of opiate use in pregnancy?

A

not teratogenic BUT preterm delivery, IUGR, stillbirth, developmental delay, sudden infant death syndrome
methadone advised - some neonates experience severe withdrawal and convulsions

89
Q

What are the effects of cocaine use?

A

probably teratogenic, can cause childhood intellectual impairment, IUGR, placental abruption, preterm delivery, stillbirth and SIDS

90
Q

What are the effects of ecstasy use?

A

teratogenic, increased risk of cardiac defects and probably gastroschisis
pregnancy complications are similar to cocaine

91
Q

What are the effects of cannabis use?

A

Abuse of other drugs makes attribution of risk difficult - may cause IUGR and affect later childhood development

92
Q

What are the effects of alcohol use in pregnancy?

A

<3 units a week - no consistent evidence of harm

May cause miscarriage in first 12 weeks - at higher levels, the incidence of IUGR and birth defects increases

Alcohol abuse in pregnancy - fetal alcohol syndrome. Facial abnormalities, growth restriction, small/abnormal brain and developmental delay (>18 units/day)

Alcohol spectrum disorder - lesser variants of the syndrome

USS may not detect syndrome but is used to monitor fetal growth

93
Q

What are the risks of smoking in pregnancy?

A
Miscarriage
IUGR
preterm brith 
Placental abruption 
Stillbirth 
SIDS
Childhood illness

Pre-eclampsia less common -

encouraged to stop/cut down - nicotine replacement

94
Q

What is the % increase of blood volume in pregnancy?

What is the effect of this?

A

40%

Relatively greater than the increase in red cell mass - result = net fall in Hb concentration, such that the lower limit of normal = 11g/dL

95
Q

What is the effect of a high HB level in pregnancy?

A

increased risk of pregnancy complications (preterm and IUGR) - possibly because it reflects low blood volume, as fond in pre-exlampsia and because of its association with smoking

96
Q

What % of women are affected with iron deficiency anaemia?

A

> 10%

80% of women not receiving iron have depleted stores by term

97
Q

What is the treatment of IDA?

A

Oral iron - increase of up to 0.8g/dL/week but can cause GI upset
in severe cases, IV iron is quicker and may prevent the need for blood transfusion

98
Q

What other anaemias are pertinent in pregnancy?

A
Folic acid (more common than) 
B12

MCV usually increased, so red cell folic acid and vitamin B12 levels are low

99
Q

What is the treatment of b12/folic acid deficieny

A

Oral folic acid and vitamin B12

100
Q

What prophylaxis are given against anaemia and why?

A

Routine iron supplements

further foetal and neonatal anaemia have adverse outcomes although their relationship to maternal iron stores = unknown

Dietary advice and Hb checked at booking, 28 and 34 weeks

Iron + folic acid if Hb <11 and <10.5 in 2nd trimester

101
Q

Who receives a higher dose of folic acid (5mg)

A

epilepsy, diabetes, obesity or previous history of NTD

normal dose is 0.4mg

102
Q

Why is influenza dangerous in pregnancy?

A

Accounted for 10% of all maternal deaths in the UK and US in 2009-10

Pregnancy particularly with co-morbidity increases susceptibility to severe disease

103
Q

What medications are recommended for treatment of influenza in pregnancy?

A

Relenza (zanamirr)

More severe - tamiflu (oseltamivir)

ICU and extracorporeal membrane oxygenation

104
Q

What is the best management of influenza in pregnancy?

A

Prevention - vaccination of pregnant women at any stage of pregnancy is strongly advised during winter months - vaccine has not known adverse foetal effects and will reduce both maternal and foetal mortality

105
Q

What is the adult Hb molecule made up of? How does HbF change to become HbA?

A

Two alpha chains and two beta chains bound together to form a tetramer

Foetal Hb molecule is normally replaced with HbA after birth and is made of two alpha chains and two gamma chains

106
Q

What is the cause of sickle cell disease?

A

Recessive disorder - Abnormal beta chain formation (S chain) - resulting in an abnormal Hb molecule made of two alpha chins bound to two S chains

found in people with Afro-Caribbean ancestry

107
Q

What is the effect of heterozygous HBS?

A

35% HbS and usually have no problems

108
Q

What is the effect of homozygous HbS?

A

‘crises’ of bone pain and pulmonary symptoms - pulmonary hypertension and proliferative retinopathy may occur.

They will have chronic haemolytic anaemia for life.

109
Q

What are maternal complications of sickle cell anaemia in pregnancy?

A

Acute painful crises (35%)
Pre-eclampsia
Thrombosis

110
Q

What are foetal complications of sickle cell anaemia in pregnancy?

A

Miscarriage
IUGR
Preterm labour
Death

111
Q

What is the management of sickle cell anaemia in pregnancy?

A

In conjunction with a haemoglobinopathy specialist - advice on avoiding dehydration and seeking help early is important:

Hydroxycarbamide is probably teratogenic and so stopped
Penicillin V is continued
High dose folic acid
Aspirin and LMWH indicated
Monthly bring culture
Iron avoided - prevent overload
112
Q

How are crises managed in pregnancy?

A

hydration
analgesia
often antibiotics and anti-coagulation

USS every 4 weeks and delivery normally indicated by 38 weeks

113
Q

What is the cause of alpha thalassaemias?

A

impaired synthesis of the alpha chain in the Hb molecule

Occurs in largely South-East Asian origin

4 genes are responsible for a chain synthesis.

114
Q

What is the effect of all 4 deletions?
3?
1 or 2?

A

Individuals with all 4 deletions die in utero, those with 3 gene deletions have lifelong requirement for transfusions and those with 1 or two deletions are carriers and usually well with mild anaemia

115
Q

What is the cause of beta thalassaemia?

A

impaired synthesis of the beta chain in the Hb molecule

recessive disorder and the heterozygous state on a defective chain causes little illness, although a chronic anaemia which can worsen during pregnancy

116
Q

What is the effect of beta thalassaemia?

A

Chronic haemolytic anaemia = present and multiple transfusions cause iron overload

therefore, hepatic and cardiac dysfunction, endocrine disease (thyroid and parathyroid) and diabetes

117
Q

What are the maternal complications of beta thalassaemia

A

Fertility reduced, liver disease, cardiac failure and diabetes = common

118
Q

What are the foetal complications of beta thalassamias?

A

growth restriction and foetal demise = more common

prenatal diagnosis is offered if the partner is heterozygous for either the beta or alpha form

119
Q

Why is preconceptual planing crucial in beta thalassaemia?

A

Chelation therapy is probably teratogenic and avoided in 1st trimester - Desferiozamine can be used after this time - USSis used 4 weekly

120
Q

What is FGM?

A

Partial or total removal of the external female genitalia or injury to the female genital organs for non-medical reasons

121
Q

Describe the classification of FGM

A

Type 1 - clitoridectomy - partial or total removal of the clitoris or of the prepuce

Type 2 - excision - partial or total removal of the clitoris and labia minora and labia majora

Type 3 - infibulation - narrowing of the vaginal opening by cutting and repositioning the labia without removal of the clitoris

Type 4 - all other non-medical procedures to the female genitalia for non-medical purposes

122
Q

Which countries practice FGM?

A

Africa
Middle East
Malaysia
Indonesia

123
Q

What is the cause of FGM?

A

Ideas of preservation of virginity
Promoting hygiene
Adherence to cultural norms
Religion - not condoned in Bibal or Koran

124
Q

What are the complications of FGM?

A
Pain
Bleeding
Infeciton
Urinary retention
Damage to pelvic organs
Death
125
Q

What are the longer term complications of FGM?

A
Failure to heal
UTI
Difficulty urinating or menstruating 
Chronic pelvic infection 
Vulval pain due to cysts or neuromas
Pain during sex
Infertility
Fistula 
Severe perineal trauma during childbirth