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preg Flashcards

1
Q

which diabetic complication can worsen in pregnancy?

A

diabetic retinopathy

screening shortly after booking + at 28wks

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2
Q

aspirin for diabetic mothers?

A

low dose aspirin from12wks until delivery

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3
Q

post natal care of diabetic mothers

A

women with GD - can stop medications immediately after birth
- follow up fasting glucose after 6wks

pre-existing - lower insulin doses + wary of hypoglycaemia
- insulin sensitivity will increase after birth + with breastfeeding

monitor baby for neontal hypoglycaemia

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4
Q

monitoring neonate for hypoglycaemia

A

maintain their blood sugar aboove 2mmol/l
if falls below - IV dextrose of nasogastic feeding

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5
Q

delivery in women with pre-existing diabetes

A

planned delivery between 37+38+6wks
(GD up to 40+6wks)

sliding scale insulin regime considered during labour for women with T1DM
- dextrose + insulin infusion titrated to blood sugar levels - also considered with poorly controlled GD or T2DM

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6
Q

criteria of hypertension in pregnancy

A

> =140/90 on 2 occasions
or
160/110 once

(>30 systolic >15 diastolic increased compared to 1st trimester)

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7
Q

when to admit pregnant mums with hypertension

A

sBP >160
abnormal blood tests
- creatinine >90
- ALT >70
- platelet count <150

signs of impending eclampsia or pulmonary oedema
suspected fetal compromise

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8
Q

complications of preexisting hypertension in pregnancy

A

PET x2
fetal growth restriction
abruption

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9
Q

management of pre-existing hypertension in pregnancy

A

STOP ACEi, ARBs + thiazides

start - labetalol or nifedipine (CCB)

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10
Q

gestational hypertension

A

2nd half of pregnancy (>20wks) - resolves within 6 weeks postnatally
- no proteinuria or PET features
- 15% progress to pre-eclampsia
- high rate of recurrnece

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11
Q

mangement of gestational hypertension

A

urine dip + blood tests weekly
serial growth scans
admit those with BP >160/110

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12
Q

postnatal Mx for pre-existing hypertension/gestational hypertension

A

birth usually >37wks unless poorly controlled hypertension
- monitor BP daily after birth
- stop methyldopa within 2 days

for GH - reduce if BP <130/80
- continue antihypertensives - review 2 weeks post-natal by GP
- further review 6-8wks post natal

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13
Q

pre-eclampsia

A

pregnancy indiced hypertension assoc with organ damage, notably proteinuria
- occurs after 20wks gestation when spiral arteries of placenta form abnormally
–> leads to high vascular resitance in these arteries

without treatment - maternal organ damage, fetal growth restriction, seizures, early labour, death

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14
Q

pre-eclampsia risk factors

A

preexisting hypertension
previous hypertension in pregnancy
existing autoimmune conditions - SLE
diabetes
Chronic kidney disease

older than 40 bmi >35
more than 10yrs since previous pregnancy
multiple pregnancy
first pregnancy
FH of pre-eclampsia

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15
Q

pathophysio of pre-eclampsia

A

spiral arteries fail to adapt to become high capaticance, low resitance vessels
- high vascular resitance + poor perfusion of placenta

-> oxidative stress on placenta leads to release of inflammatory chemicals -> systemic inflammation + impaired endothelial function

stage 1 - abnormal placental perfusion - placental ischaemia

stage 2 - maternal syndromes - anti-angiogenic state assoc with endothelial dysfunction
- vasoconstriction
- increased -
— capillary permeability
— expression of CAM
— prothrombotic factors
— platelet aggregation

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16
Q

pre-eclampsia presentation

A

triad
- hypertension
- proteinuria
- oedema

headache, N+V
visual disturbances or blurriness
RUQ or epigastric pain - liver swelling
reduced urine output
brisk reflexes
SGA fetus

can be asymptomatic at time of 1st presentation

17
Q

diagnosis of preeclampsia

A

Systolic BP >140mmHg
Diastolic BP >90mmHg

Plus any of –
o Proteinuria (1+ or more on urine dipstick)
o Organ dysfunction – raised creatinine, elevated liver enzymes, seizures, haemolytic anaemia
o Placental dysfunction – fetal growth restriction or abnormal Doppler studies

18
Q

management of pre-eclampsia (pre-birth)

A

150mg aspirin from 12wks gestation until birth if they have
- 1 high risk factor
- 2 or more moderate RF

1st = labetolol
2nd = nifedipine
3rd = methyldopa - stop within 2 days of birth

IV hydralazine - antihypertensice in critical care _ in severe pre-eclampsia or eclampsia
IV magnesium sulphate - given during labour + 24hrs after to prevent seizures

19
Q

management of pre-eclampsia (birth + post-natally)

A

Fluid restriction during labour in severe pre-eclampsia or eclampsia to avoid fluid overload
o Restrict input to 80ml/hr

Planned early birth may be necessary if BP is uncontrolled or complications
o Corticosteroids given to women having premature birth

After delivery, switch to one or a combo of –
o Enalapril – first line
o Nifedipine or amlodipine – first line in black African or caribbean patients
o Labetolol or atenolol – 3rd line

20
Q

HELLP syndrome

A

Combination of features that occurs as a complication of pre-eclampsia + eclampsia

Haemolysis
Elevated Liver enzymes
Low Platelets

21
Q

Eclampsia

A

Tonic clonic (grand mal) seizures assoc with pre-eclampsia
>1/3 will have seizure before onset of hypertension/proteinuria
More common in teenagers

IV magnesium sulphate is used to manage seizures
o 4g IV over 5-15min
o If further seizure – 2-4g Mg SO4
o Admin for 24hrs

22
Q

pregnant women with no previous history of epilepsy presenting after first trimester with seizure

A

eclampsia management -> IV mag sulphate

23
Q

heart disease in pregnancy

A

3-4x risk of MI in pregnancy

sinus tachycardia - part of normal pregnancy, Ix
ectopic beats - common “thumping, relieved by exercise

24
Q

is warfarin contraindicated to breastfeeding

A

NO

25
Q

drugs contraindicated in pregnancy

A

NSAIDs >32weeks
cyclophosphamide
methotrexate
Gold
penicillamine
MMF

26
Q

drugs okay in pregnancy

A

steriods
azathioprine
sulfasalazine
hyrozychloroquine
aspirin
etanercept/infliximab/adalimumab
rituximab

27
Q

management of antiphospholipid disease in pregnancy

A

No thrombosis/adverse pregnancy outcome
o Low dose aspirin (LDA)
o Maternal + fetal surveillance

Previous thrombosis
o On warfarin -> stop warfarin
o LDA + LMWH (treatment dose)

Recurrent early pregnancy loss
o LDA + LMWH (prophylaxis dose)

Late fetal loss / severe PET / FGR
o LDA + LMWH (prophylaxis dose)

28
Q

teratogenic impacts of antiepileptics

A

sodium val - neural tube defects
- facial cleft
- hypospadias

cardiac malformations - phenobarbital + phenytoin

cleft palate - phenytoin + carbamazepine

29
Q

management of maternal epilepy

A

benzodiaxepine -> to terminate seizure ASAP
left lateral tilt
IV lorazepam/diazepam
PR diazepam/buccal midazolam

no history of epilepsy -> MgSO4

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