Pregnancy Health Complications Flashcards
What is the acronym for a pregnancy history?
PAMPHLETS (carrying orange booklet around w/ them)
P: Past medical history
A: Allergies
M: Medications, OTC, smoking/alcohol
P: Past obstetric history (how long? any complications?)
H: Handheld record
L: Last menstrual period
E: Events leading to presentation today
T: Tests (routine antenatal tests)
S: Social hx and safety (is she safe?)
What questions might we ask in the setting of perinatal depression? What are our main concerns?
- Past Hx (with or without pregnancy) of depression?
- Currently receiving any support?
- Consider medications (each has a pregnancy safety risk). This requires a risk/benefit analysis.
Main concerns: is she going to harm herself/her baby?
Obesity during pregnancy can increase the risk of…
- Gestational diabetes
- Pre-eclampsia
- Fetal macrosomia (why might this be the case?)
- Birth defects
- Caesarian
How do we treat diabetes during pregnancy?
- Aim for slower weight gain; counsel abt diet/exercise
- Consider screening for diabetes early
Why does pregnancy cause hypercoagulability? What does this predispose to? How do we assess for the risk of this pathology?
- Pregnancy causes hypercoagulability due to vasodilation (stasis), high oestrogen increasing clotting factors, and impaired venous outflow from lower limb w/ large uterus (stasis)
- This predisposes to thromboembolism
- Screen by assessing for past history, existing vascular risk, and consider using anticoags (like LMW heparin)
What are our criteria for hyperemesis gravidarum
- Nausea/vomiting
- Weight loss >5%
- Electrolyte disturbances
- Exclusion of other causes (?GI malignancy)
What causes hyperemesis gravidarum, and how does this affect our differential/treatment?
- Caused by increased hCG. This can be caused by multiple pregnancy, large placenta, or gestational trophoblastic disease (premalignant; can become cancerous)
- When treating, need to consider anti-emetics, IV fluids if needed
How do we treat UTI in pregnancy? Why does this differ from regular screening?
- The core point is that women who get UTIs while pregnant can be asymptomatic
- Therefore, we need to regularly screen. And if there’s any flank pain (even isolated) consider pyelonephritis
Risk factors for gestational diabetes (character)
- Imagine a woman named Jess
- Old, non-white, fat lady eating a hamburger (western diet)
Mgmt of gestational diabetes
- Diet
- Exercise
- (Medication) Metformin +/- insulin
How can pregnancy cause iron deficiency anaemia? How do we diagnose it? How do we treat it?
- Mech: increased demand for iron may outstrip iron stores, leading to anaemia (insufficient haemoglobin)
- Diagnosis: fasting iron studies
- Treatment: Oral iron w/ vitamin C (why?), iron infusion (inform of risks)
Complications of pre-eclampsia across different systems of the body include…
- Proteinuria (damaged glomeruli)
- Thrombocytopaenia/DIC
- Liver RUQ pain
- Stroke
- Pulmonary oedema
- IUGR
Pre-eclampsia management
- Hospital admission; antihypertensives
- Monitor mum (FBC, electrolytes, LFTs - anything that could suggest multisystem pathology), and monitor baby (fetal growth, umbilical artery doppler)
- Consider whether birth (birth is always good for Mum, but premature birth is not good for baby)
What do we take to prevent eclampsia in preeclampsia?
Magnesium sulfate
During what time frame do most seizures occur in the setting of pre-eclampsia (incl. most vs all)
- Most occur within 24hrs of birth
- Almost all occur within 7 days of birth
