Pregnancy Complications

Question 1

What are the investigations for ?DVT/PE in pregnancy?

Answer 1

1st line- duplex US of affected leg
- do this first if symptoms of DVT and PE
- if positive does not require PE investigation

If no symptoms DVT consider CTPA or VQ scan
CTPA- increases risk of breast cancer
VQ increases risk of childhood cancer

Treat with LMWH

No D-Dimer as raised in pregnancy

Question 2

What is the management of thyrotoxicosis in pregnancy?

Answer 2

Propylthiouracil in 1st trimester
- carbimazole associated with increased risk of congenital malformations

Carbimazole 2nd/3rd trimester
- PTU increased risk of hepatotoxicity in 2/3rd trimesters

Maintain thyroxine levels within upper 1/3 or normal

Question 3

What is the management of hypothyroidism in pregnancy?

Answer 3

Check TSH levels every trimester and at 6-8 weeks postpartum
During pregnancy patients often require increased doses of levothyroxine

Question 4

What are features of intrahepatic cholestasis of pregnancy?

Answer 4

Pruritis- intense worse on palms, soles or abdomen
Jaundice
Raised bilirubin

Question 5

What is the management of obstetric cholestasis?

Answer 5

Mild (bili 19-39)- consider planned birth by 40 weeks
Moderate (bili 40-99)- increased stillbirth after 38 weeks- deliver by 39 weeks
Severe (bili >100) consider delivery at 35-36 weeks

Question 6

What are features of acute fatty liver of pregnancy?

Answer 6

Most common in PP or 3rd trimester
Abdo pain
N&V
Headache
Jaundice
Ascites
Hypoglycaemia

Question 7

What investigations are required in fatty liver of pregnancy?

Answer 7

ALT >500

Management- delivery
Increased risk of HELLP syndrome