Pregnancy Complications (Pt 1) Flashcards
define eclampsia
progression of pre-eclampsia (>140/90mmHg) to eclamptic fits
management of eclampsia
ABC approach place in left lateral tilt position IV magnesium sulphate IV labetalol or hydralazine minimise fluid therapy
define pre-eclampsia
new onset hypertension (>140/90mmHg) after 20wks of pregnancy with:
proteinuria
creatinine (90mmol/L)
increased transaminases
risk factors of pre-eclampsia
nulliparity
>40yrs of age
obesity
multiple pregnancy
investigations of pre-eclampsia
urinalysis
bloods
USS of foetus
prophylaxis of pre-eclampsia
provide mother with 75-150mg aspirin from 12wks gestation
conservative management of pre-eclampsia
diet modification
advise rest and avoidance of stressful situations
frequent BP and urine protein checks
medical management of pre-eclampsia
anti-hypertensive medication (e.g. labetaolol, nifedipine or methyldopa)
complications of pre-eclampsia
eclampsia
organ failure
HELLP syndrome
intra-uterine growth restriction
pre-term delivery
define HELLP syndrome
presence of:
haemolysis
⬆️ liver enzymes
⬇️ low platelets (< 100x10)
symptoms of HELLP syndrome
headache nausea and/or vomiting epigastric pain RUQ pain blurred vision peripheral oedema
risk factors of HELLP syndrome
> 35yrs
nulliparity
previous gestational hypertension
multiple pregnancy
management of HELLP syndrome
blood transfusion
foetus delivery
define gestational diabetes
a state of insulin resistance induced by the metabolic strain of pregnancy that is diagnosed within the 24-28th wks of pregnancy
risk factors of gestational diabetes
increased maternal age high BMI smoking PCOS non-caucasian ancestry
clinical features of maternal gestational diabetes
polyuria
polydipsia
nocturia
fatigue
clinical features of gestational diabetes in foetus
⬆️ syphysio-fundal height
⬆️ foetal weight
signs of polyhydraminos
investigations of gestational diabetes
urine dipstick
fasting and random blood glucose
oral glucose tolerance testing (OGTT)
initial management of gestational diabetes if fasting glucose <7mmol/L
trial diet and exercise for 1-2wks followed by metformin and then insulin
initial management of gestational diabetes >7mmol/L
start insulin +/- metformin
initial management of gestational diabetes if >6mmol/L + macrosomia
insulin +/- metformin
delivery management in gestational diabetes
no delivery later than 40(+6) weeks gestation
if no spontaneous delivery prior, opt for C-section
define molar pregnancy (hydatiform mole)
an imbalance in the number of chromosomes from mother and father, causing failure of conception
describe complete molar pregnancy
formed from 1 sperm and an empty egg
has no genetic material
sperm replicates to form diploid paternal cell
causes no foetal tissue, just swollen and proliferated chorionic villi
describe incomplete molar pregnancy
formed from 2 sperm and a normal egg
has both maternal and paternal genetic material
variable evidence of foetal tissue present
clinical features of molar pregnancy
vaginal bleeding nausea hyperemesis gravidarum enlargened uterus thyrotoxicosis
investigations of molar pregnancy
serum β-hCG
trans-vaginal US
- will show ‘snowstorm’ appearance
management of molar pregnancy
urgent referral to specialist for potential complications
suction curettage for uterus removal of tissue
2 weekly surveillance of serum and urine β-hCG
next steps if β-hCG levels fail to fall following management of molar pregnancy
suspect choriocarcinoma and refer to specialist and provide methotrexate based chemotherapy
following a molar pregnancy, how long should patients wait before trying to become pregnant again?
1 year
