Pregnancy COPIED Flashcards
Name a type of headache that can mimic migraine during pregnancy
Cerebral venuos thrombosis
variable presentations; headache, focal neurological deficits, vomiting or seizures.
An important cause of symptoms that can overlap with those of migraine.
CT or MRI venography is used to make the diagnosis. When diagnosed, 6-12 months of therapeutic anticoagulation is required.
What anti-emetics can you use in pregnancy?
A lack of teratogenesis with; promethazine, cyclizine, chlorpromazine, prochlorperazine, metoclopramide and domperidone.
Ondansetron is a newer agent, and has been successful in cases of severe hyperemesis.
Acid suppression
There is no evidence of teratogenesis with the use of H2 receptor blockers and proton pump inhibitors.
Foetus can “breathe” amniotic fluid into the lungs at what gestational age?
16-22 weeks
- this “breathing” is important for normal lung development (prevents pulmonary hypoplasia).
If membranes rupture, baby needs to be delivered quickly. WHY?
Risk of infection
Symptoms of Idiopathic intracranial hypertension
Tend to be gradually worsening and worse with position (bending over) or Valsalva manoeuvres.
Papilloedema and visual changes can also occur.
Management options in pregnancy include:
Regular lumbar puncture
Acetazolamide
What are the risks of warfarin in pregnancy?
>> chance of fetal intracranial haemorrhaging because warfarin cross the placenta.
Options: switch to LMWH (unless px is very high risk of thrombosis)
Eclampsia
Eclampsia is when seizures occur;
usually preceded by hypertension, proteinuria, or the symptoms listed previously (pre-eclampsia symptoms)
What is Ergometrine used for in pregnancy?
(Acts on adrenergic, dopaminergic and 5-HT2 receptors)
Increases contraction of uterine smooth muscle
Postpartum to reduce bleeding
Risks: >> peripherial vascular resistance
(use Carboprost if Ergometrine ineffective)
What is Toxic shock syndrome? (TSS)
Toxic shock syndrome (TSS) is a multisystem inflammatory response to the presence of bacterial exotoxins.
Associated with tampon use in menstruating women and Group A streptococcal infections - the streptococcal toxic shock-like syndrome (STSS).
Management of gestational diabetes mellitus
Diet, exercise
metformin
Fetal:
regular growth scans
monitor for pre-eclampsia
delivery at 38-39 wks
What’s the story with rubella (german measles) and pregnancy?
NO WOMAN should try to conceive unless the have had rubella, or been immunised.
Most dangerous in 1st trimester.
Can cause blindess, deafness, cardiac abnormalities, mental retardation.
Pre-eclampsia defined
Pre-eclampsia is a multisystem disorder related to inadequate placentation. The definition of the disorder is new onset hypertension and proteinuria which develop after 20 weeks of gestation.
If an egg is not fertilized, the corpus luteum eventually decays cand stops secreting progesterone.
What does it decay into?
a mass of fibrous scar tissue; corpus albicans
Mean gestational age of onset is 34 weeks
More common in first pregnancy and those with multiple pregnancies
Pruritic, urticarial papules and plaques most commonly on abdomen (but sparing umbilicus) and thighs
Rapid resolution after delivery
No fetal issues
Why is there an increased risk of aspiration with pregnant women? (esp. with general anaesthesia)
Reduced gastric motility, in combination with restriction of stomach expansion by the fetus results in gastro-oesophageal reflux, particularly in the third trimester.
Constipation common in pregnancy.
RBC and pregnancy - what happens?
Fall in haemoglobin concentration, haematocrit and red cell count (as expansion of plasma volume is greater than the increase in red cell mass)
No change in mean cell volume or mean cell haemoglobin concentration
2-3 fold increase in iron requirements
Iron deficiency anaemia is common and requires iron supplementation
What happens to platelets during pregnancy?
These fall progressively throughout gestation
gestational thrombocytopenia
5-10% of pregnant women have platelet count of 100-150 x109/L by term
Why to you sometimes get upper right upper side pain with pregnancy/ hypertension?
Liver distension
Cardiac output = stroke volume x heart rate
Cardiac output increases by about 40%, as a result of increased stroke volume and reduced systemic vascular resistance, in combination with an increased heart rate.
The cardiac output is greatest at 24 to 28 weeks of pregnancy. The heart is physiologically dilated and myocardial contractility is increased.
What is macrosomia?
The term “fetal macrosomia” is used to describe a newborn who’s significantly larger than average
What;s the story with (during pregnancy):
Nitrofurantoin
Co-amoxiclav
Trimethoprim
Nitrofurantoin: Haemolytic anaemia in the neonate
Co-amoxiclav: Avoid in women at r_isk of preterm labour (20-36/40)_ - including risk of necrotising enterocolitis in neonate
Trimethoprim: Avoid in first trimester (folate antagonist)
What is PPCM?
Peripartum cardiomyopathy (PPCM) ; dilated cardiomyopathy
“deterioration in cardiac function presenting typically between the last month of pregnancy and up to six months postpartum. “
Decrease in left ventricular ejection fraction (EF) with associated congestive heart failure and an increased risk of arrhythmias, thromboembolism.
Legal requirements for termination before 24 weeks
- requires two doctors to sign -
For mothers <16 years : Fraser guidelines apply
If it reduces the risk to a woman’s life;
or
If it reduces the risk to her physical or mental health;
or
If it reduces the risk to physical or mental health of her existing children;
or
If the baby is at substantial risk of being seriously mentally or physically handicapped.
Normal heart sounds in pregnancy
Normal findings in pregnancy include an ejection systolic murmur, a loud first heart sound, a third heart sound and ectopic beats.
What is the first line treatment of moderate 150/100 or severe hypertension 160/110 in pregnancy?
Labetalol
What is Gestational Trophoblastic Disease?
Def: A spectrum of histologially distinct diseases originating from the placenta.
a group of disorders which range from molar pregnancies to malignant conditions such as choriocarcinoma.
If there is any evidence of persistence of GTD the condition is referred to as gestational trophoblastic neoplasia (GTN).
Levels of hCG can be of diagnostic value, and ultrasound.
referral for follow-up to a trophoblastic screening centre
Do you need to investigate pruritus in pregnancy?
Liver function tests should be checked, particularly if it is mainly the palms and soles that are affected and/or it occurs in the third trimester.
These symptoms make obstetric cholestasis more likely.
Coagulation and pregnancy
Prothrombin time and activated partial thromboplastin time remain unchanged in pregnancy, so do not reflect the profound changes that result in a hypercoagulable state
Increased factors VIII, IX and X and fibrinogen, reduced fibrinolytic activity and a decrease in antithrombin and protein S all contribute
Pre-eclampsia- inadequate placentation; what’s the worry?
Fetal growth restriction and/or intrauterine death can result from pre-eclampsia.
Placental abruption is also more common.
What are ossible causes of shortness of breath in a pregnant woman? (7)
- Physiological
- Anaemia
- Asthma
- Pulmonary embolism
- Pneumonia
- Pneumothorax
- Pulmonary oedema
what is scotoma
a partial loss of vision or blind spot in an otherwise normal visual field
When can the foetus perceive sound and light?
sound: 24-26 weeks
light: 28 weeks
Pregnancy-induced hypertension defined
development of hypertension in the absence of proteinuria or other features of pre-eclampsia.
Usually occurs after 20 weeks gestation and resolves within 6 weeks postpartum, (can remain elevated for up to 3 months postpartum).
What is hyperemesis gravidarum?
Hyperemesis gravidarum occurs in less than 1% and is when vomiting is severe enough to cause dehydration and biochemical derangement.
Immediate management of acute pulmonary oedema during pregnancy
Oxygen
diuretics
regular ECGs
Is glycosuria is diagnostic of diabetes mellitus in pregnancy?
No. Glucose loss during pregnancy is normal
Atopic eruption of pregnancy
Commonest pregnancy specific dermatosis, and is associated with atopy. It mainly occurs in the second or third trimester, more commonly in multiparous women. It is characterised by patches of intensely itchy papules which become excoriated. Treatment includes emollients, antihistamines and topical steroids.
How does pregnancy affect the thyroid gland?
50% more thyroid hormone is required to maintain circulating levels of free T4.
Maternal iodine requirements increase due to increased renal clearance.
Usual TFT tests in early pregnancy may suggest hyperthroidism. This is because HCG is structurally similar to TSH, thus early pregnancy causes >> T4 production and TSH suppression.
No limit on gestation time (for termination) if:
Risk to the mother’s life.
Risk of grave, permanent injury to the mother’s physical/mental health
Substantial risk that, if the child were born, it would have such physical or mental abnormalities as to be seriously handicapped.
Maternal diabetes and fetal health…
Poor glycaemic control in the first trimester is associated with an increased rate of congenital abnormalities (particularly neural tube defects and congenital heart disease) and miscarriage.
Studies have shown that the rate of congenital abnormalities increases as the HbA1c increases.
The risk of miscarriage is higher with co-existent renal disease or hypertension.
- Heart beats at 4-5 weeks gestation
- After birth, change in PaO2 causes constriction of umbilical vessels, ductus arteriosus, foramen ovale, ductus venosus
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Gestational pemphigoid
Can occur any time in pregnancy, but usually in third trimester
Often occurs on abdomen (involving umbilicus), spreading to limbs, palms and soles
Associated with low birthweight, preterm delivery and stillbirth
Neonate can be affected by same eruption, which is mild and transient
Developmental milestones of an embryo
