Pre existing medical conditions Flashcards
What organ does cholestasis involve
what % of preg does it occur in
liver
0.7%
name some symptoms of cholestasis
severe itching of hands and feet with no rash abnormal LFTs fever nausea dark urine / pale stools mild jaundice in the woman
Describe breif physiology of cholestasis
reduction or stoppage of bile flow somewhere between liver cells and duodenum. this means bilirubin leaks into bloodstream rather than joining with bile in the liver
Give some reasons as to why the bile flow would be blocked in liver in cholestasis
- cytomeglavirus HIV Hepatitus Sickle cell disease Auto immune diseases Bacterial infections
Risks to pregnancy of cholestasis
preterm labour fetal comprimise meconium staining stillbirth / misscarriage (1-2% if bile acids 40, 4-5% is bile acids 80.. so IOL offered if bile acids over 40)
Pathway of care for cholestasis
weekly LFTs and bile acids
IOL offered if bile acids above 40
IOL offered at 37-38wks
Vit k daily as the absorption of this is affected in the liver
ursodexycholic meds to help reduce bile acids and thus itching
What hormones does the thyroid produce
What stimulates this
T3 = triodythyroine
T4 = thyroxine
Hypothalymus releases TRH -> anti. pit gland releases TSH -> thyroid releases T3 T4
Hypothyroidism what is it symptoms causes preg complications preg pathway
Under-active in producing T3 and T4
tiredness, weight gain, depression, dry skin, heart disease
immune system attacks glands, over/under comsuption of iodine (preg/F should be 250mg a day), treatment for hyperthyroidism , thyroid cancer, removal of thyroid
hypertension , preeclampsia, anemia, PPH, premature birth , birth defects, SGA, stillbirth, Hypothroisism in baby
Levothyroxine meds, CS, 4 weekly bloods to test for TFTs, TSHs, increase thyroxine from 4 weeks
Hyperthyroidism what is it symptoms causes preg complications preg pathway
Overactive gland in T4
tachcardia, weight loss, tremors, depression and anxiety , hair loss
same as hypothyroidism (immune system attacks glands, over/under comsuption of iodine (preg/F should be 250mg a day), treatment for hyperthyroidism , thyroid cancer, removal of thyroid)
antithyroid drugs stops production of T3 T4
stillbirth, birth defects , hypertension, heart failure
same as hypothyroidism (Levothyroxine meds, CS, 4 weekly bloods to test for TFTs, TSHs, increase thyroxine from 4 weeks )
Epilepsy symptoms
depends on the effected part of the brain
- jerking/shaking
- loss of awareness
- stiffness
Epilepsy pregnancy complications and pathway
- physical and emotional stress
- injury
- neural tube defects in fetus
- defects from anti epileptic meds (sodium valporate 40% babies had problems)
- CS
- continue on meds
- folic acid preconception
- regular scans
- FBC - up meds if Hb low
- observe PN !
- add to UK epilepsy register
PCOS
stands for?
why does it happen?
poly cystic ovary syndrome
endocrine disorder caused by rasied male hormones (testosterone / androgens)
these hormones antagonise oestrogen and affect female reproductive system
Symptoms of PCOS
preg complications
preg pathway
hair growth, acne, ovary cysts, pelvic pain, obesity, irregular cycle, anxiety and depression
30-50% chance of misscarriage , delay in lactation, preeclampsia, GDM, premature birth, CS, fetus PCOS, raised insulin levels (200-250%)
MLC unless complications
GTT
diet and exercise discussion
Amount of blood in non preg vs preg body
3.5-4l vs 4-5l
Anemia caused by ..
physiological vs pathological
increase in volume of blood not matched by production of RBC and plasma = haemodilution (drop in hb) = physiological anemia
Pathological is just a drop in iron levels
what can you test in blood levels to determine anemia?
what is the normal range
serum ferritin levels (iron storage protein)
12-150mg
symptoms , preg complications and preg pathway of anemia
tiredness, shortness of breath, dizzy, pale
blood transfusion risk , physical harm , SGA, low birth weight, neonate motor development
Hb below 105 = iron supplement (ferrous sulphate or fumerate) or citron
refer if Hb below 90 , needs IV supplement
FBC monitor
During pregnacy what is there an increase in cardiac wise ?
Heart rate
circulating blood volume
cardiac output = from 5 to 7 litres per minute
difference between congeital / aquired
Congenital = already pre existing .. known but may of been no problems to dat e
Aquired = problem which has not yet been diagnosed
Cardiac symptoms
fatigue (heart unable to meet body needs)
Shortness of breath (cant circulate quick enough
Hypertension
Palpations
Chest pain
Peripheral odema (inadequate venous return)
Pregnancy complications of cardiac
stillbirth
Maternal cardiovascular compromise = reduced placental perfusion causing FGR
risk of haemorrhage due to maternal anticoagulation
inheritance
maternal death
maternal cyanosis
Preg pathway of cardiac
Labour of cardiac
PN care
pre conception councelling
multidisciplinary care (MLC, CLC, cardiac team)
Anticoagulant therapy
AN care and birth must be planned
SVD preferable
avoid IOL - prostagladins increase cardiac output, can result in tachycardia
no direct pushing
epidural is method of choice ( due to it decreasing CO
NEVER USE SYNTOMETRINE (acts on smooth muscle = heart)
CO peaks at 15-30 mins after so strict obvs at this time
adequate analgesia
