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Repro > Pre-existing conditions > Flashcards

Pre-existing conditions Flashcards

1
Q

Sickle cell disease and pregnancy [2]

Pre-pregnancy management:
History [3]
Ix [2]
Rx [2]

A

Worsens physiological anemia in pregnancy
Increased risk of crises and acute chest syndrome

Pre-pregnancy

  • Counselling on risks
  • Check partner status
  • Ensure vaccinations up to date
  • ECHO (pulmonary HTN)
  • Fundoscopy (proliferative retinopathy)
  • Ensure on penicillin
  • Stop ACEi and hydroxycarbamide >3m pre-conception
  • Start folic acid 5mg
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2
Q

Sickle cell disease
Antenatal care [3]
Labour & delivery [2]

A

Antenatal care:

  • Put on high risk antenatal care pathway
  • 75mg aspirin daily from 12w and consider TEDs
  • Monthly MSU, scans approximately 4 weekly

Labour and delivery:

  • Deliver at 38-40w
  • Continuous fetal monitoring
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3
Q

Thalassemia

Beta vs alpha - effects on pregnancy [3]

A

• Beta thalassaemia: no effect on fetus
• Alpha thalassaemia:
- severe anaemia or stillbirth
- hydropic foetuses carry pre-eclampsia and delivery cx (big baby and placenta)

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4
Q

Thalassemia and pregnancy ix [2]

Management [1]

A

Parental blood sampling
Chorionic villus sampling
Avoid iron as levels are usually high already

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5
Q

Hyperthyroidism and pregnancy

Effects on fetus [4]

A

If mother develops TSH receptor abs after 24 GA

  • Premature labour
  • Goitre
  • Polyhydramnios
  • Fetal tachycardia
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6
Q

Hyperthyroidism Mx:
Pre-pregnancy [2]
Antenatal care [2]

A

Pre-Pregnancy:

  • cause of infertility
  • AVOID pregnancy for 4m after radio-iodine treatment

Antenatal:

  • PYTHIOURACIL (doesn’t cross placenta and indicated in new dx of thyrotoxicosis in pregnancy)
  • monitor monthly
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7
Q

Hypothyroidism effects on fetus [4]

Management pre-pregnancy [4] and antenatal [1]

A
  • Increased risk of miscarriage, IUGR, stillbirth
  • pre-eclampsia
  • anaemia
  • LD
  • Pre-pregnancy: associated with infertility, menorrhagia or oligo menorrhoea; optimise T4 pre-conception
  • Antenatal: monitor LEVOTHYROXINE replacement by measuring T4 and TSH each trimester
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8
Q

Chronic kidney disease
Effects on fetus [4]
Pre-pregnancy advice [4]

A
  • Increased risk miscarriage, IUGR, pre-term delivery and fetal death
  • Pre-pregnancy: advise against pregnancy if marked anaemia, HTN, retinopathy or proteinuria
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9
Q

Epilepsy and its effects on fetus [2]

A
  • Anti-epileptics carry increased risk of NTDs, craniofacial problems and developmental delay (LAMOTRIGENE has the LEAST congenital malformations)
  • Increased risk of epilepsy in offspring
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10
Q

Epilepsy mx
Pre-pregnancy [3]
Antenatal [3]

A

Pre-pregnancy:

  • confirm dx by neurologist
  • optimise medication to reduce risk of anomaly
  • start 5mg FOLIC ACID for at least 3m before conception

Antenatal:

  • consultant led; aim for vaginal delivery
  • ensure taking anti-epileptic drug (if woman has stopped, restart if persistent seizures)
  • give oral VITAMIN K in last 4w if on hepatic inducing AEDs (CARBAMAZEPINE, ETHOSUXAMIDE, PHEYNTOIN etc)
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11
Q

Epilepsy
Labour & delivery [3]
Postnatal mx [2]

A
  • LSCS not indicated unless status elipticus
  • Epidural is safe
  • Use BDZ for non-terminating seizures
  • Postnatal - reduce AED to post-pregnancy levels, ensure on effective contraception
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12
Q

Cardiac disease mx
Antenatal [4]
Labour and delivery [3]

A

Antenatal:

  • never ignore, incl. Marfan
  • regular combined clinic for HTN mx
  • excl. pulmonary oedema and arrhythmia on all visits
  • admit if cardiac failure and refer for echo

L&D:

  • aim for vaginal delivery at term w/ shortened 2nd stage if fixed cardiac output
  • LSCS if advised by cardiology
  • SYNTOCIN only (AVOID ergometrine)
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13
Q

Rheumatoid arthritis
How does it affect mothers?
Pre-pregnancy management [3]

A
  • Symptoms tend to improve in pregnancy but tend to have a flare following pregnancy
  • Pre-pregnancy:
  • defer conception until stable if early or poorly controlled
  • STOP methotrexate 6m before conception (for men and women)
  • STOP leflunomide
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14
Q

Rheumatoid arthritis
Drugs [3]
Labour and delivery [1]

A
  • SULFASALAZINE or HYDROXYCHLOROQUINE safe
  • low dose corticosteroids also safe
  • NSAIDs safe up to 32w but not after as cause premature DA closure
  • refer to obstetric anaesthetist due to risk of atlanto-axial subluxation
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15
Q

SLE
Effects on mother [3]
Effects on baby [2]

A
  • Increase in mild to moderate exacerbations with skin involvement
  • If renal involvement; increased risk of HTN and pre-eclampsia
  • If GN and reduced creatinine clearance chances of liver birth are 50:50
  • Maternal antibodies can cause self-limiting sun sensitive rash on baby
  • Anti-Ro and La antibodies can cause congenital heart block
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16
Q

SLE
Pre-pregnancy [1]
Antenatal drugs [2]
Labour and delivery [1]

A

• Pre-pregnancy: aim for at least 6m disease free with no cytotoxics
• Antenatal:
- 75mg ASPIRIN daily
- disease control with HYDROXYCHLOROQUINE or AZATHIOPRINE
• L&D:
- if on oral PREDNISLONE require IV HYDROCORTISONE in labour

17
Q 
APS
Diagnosis [2]
Effects on fetus [2]
Management of recurrent fetal loss or VTE [3]
Postnatal mx
A

Dx: Antibodies present on 2 tests taken 8w apart +/- hx arterial thrombosis

  • Lupus autoantibodies and /or cardiolipin antibodies occur alone or with another CTD > 1st trimester loss or placental thrombosis causing IUGR and fetal death
  • <20% chance of making it to term if untreated

VTE or recurrent fetal loss:

  • ASPIRIN 75mg daily from conception
  • AND LMWH from 6w with regular growth
  • AND Doppler scans from 20w

• Postnatal: LMWH or WARFARIN (can breastfeed on both)

18
Q

Psychiatric drugs and pregnancy:
SSRIs [2]
Lithium mx [4]
Anti-psychotics [3]

A
  1. SSRIs:
    - Sertraline can be used in pregnancy
    - Avoid paroxetine
  2. Lithium
    - Teratogenic causing Ebstein’s anomaly
    - Only use if no alternatives
    - ECHO + 4 weekly drug monitoring for toxicity
    - Avoid breastfeeding
  3. Anti-psychotics
    - Rates of fetal anomaly higher in schizophrenic event without drugs
    - Risperidone causes increased prolactin
    - Check OGTT
19
Q

What are the risks of using sertraline on the baby? [3]
Why do we avoid paroxetine in pregnancy?
Effects of lithium use on baby? [2]

A
  • SERTRALINE can be used in pregnancy but
  • small risk of congenital heart defects in 1st trimester
  • persistent pulmonary HTN in 3rd trimester
  • neonatal withdrawal
  • AVOID paroxetine:
    increased risk of congenital malformations especially in 1st trimester
  • Lithium use causes neonatal thyroid anomalies, floppy baby syndrome

Repro (34 decks)

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