Problems in Pregnancy Flashcards
how does maternal hyperglycaemia affect the fetus
fetal hyperinsulinaemia
what does fetal hyperinsulinaemia lead to
Increased fetal growth
what are the effects of increased fetal growth
Increased oxygen demands
Neonatal hypoglycaemia
Polyhydramnios
what does hypoglycaemia put neonates at risk of
cerebral palsy
what does macrosomia put fetus at risk of
shoulder dystocia
when is labour induced in mother with pre-existing diabetes
37-38 weeks
which ethnicities are more at risk of gestational DM
South asian, middle eastern, African
what diabetes meds are safe in pregnancy
Metformin
Insulin
when is labour induced in mothers with gestational DM
38 weeks
Treatment of venous-thrombo embolism
LMWH
Why is pregnancy a pro-thrombotic state
Virchow’s triad:
stasis: secondary to venous compression by pregnant uterus
Hypercoagubility: effects of pregnancy
Vascular damage: varicose veins
what causes the hypercoagulability
Increased levels of factor 7,8,9,10,12
Increased fibrinogen
Increased platelets
Decreased levels of factor 11 and antithrombin 3
Investigation of DVT in pregnancy
Duplex USS
Is D-Dimer assessment safe in pregnancy?
NO
Do duplex ultrasound for suspected DVT
Treatment of DVT in pregnancy
Heparin
which leg is DVT more common in
Left
Rule of treating a DVT in pregnancy
Treat then see- therapeutic heparin before confirmation if diagnosis is suspected
prophylaxis for DVT
TED stockings
why is heparin good in pregnancy
does not cross the placenta
safe for fetus
side effects of heparin
Haemorrhage
Hypersensitivity
Heparin induced thrombocytopenia
Osteopenia
Investigation for suspected PE
1st line: CTPA
2nd line: Xray
Next step if CTPA for suspected PE is negative
bilateral compression duplex dopplers
why should an Xray be performed in a suspected PE
PE may also cause effusion, pulmonary oedema ect
Can heparin be continued in labour
no it should be stopped
If a woman has a thrombotic event in pregnancy, how long should she remain on LMWH
Remainder of pregnancy
6 Weeks post natal
total 3 months at least
why is warfarin avoided
teratogenic
avoided weeks 6-12
stopped 6 weeks before labour
can you breastfeed on warfarin
YES
used after pregnancy
management of pregnant lady with hypothyroidism
INCREASE levothroxine by 25-50mcg in first trimester
repeat thyroid function test every trimester
management of pregnant lady with hyperthyroidism
PTU in 1st trimester
Carbimazole in 2nd/3rd trimester
Beta blockers (propanolol)
effects of uncontrolled maternal hyperthyroidism on the fetus
IUGR
Pre-term labour
Thyroid storm (severe hyperthyroidism, resp + cardiac collapse, exaggerated reflexes)
treatment of a thyroid storm
lugols iodine
steroids
beta-blockers (labetolol)
fluids
effects of uncontrolled hypothyroidism on the fetus
Neurological underdevelopment
Prematurity
Pre-eclampsia, post partum haemorrhage
respiratory changes seen in pregnancy
Increased resp rate - causes respiratory alkalosis Increased oxygen demand Tidal volume increases Residual volume decreases expiratory reserve decreases
what is unchanged in pregnancy with regards to respiration
FEV1
PEFR
Management of asthma in pregnancy
optimise control
use of B2 agonist +/- inhaled corticosteroids
What is the worry with epilepsy in pregnancy
major fetal malformations due to drug treatment: neural tube defects, heart defects
why is there increased chance of seizures in first trimester
due to hyperemesis and haemodilution
what needs to be given to women taking hepatic enzyme inducing anticonvulsants (carbamazepine, phenytoin)
vitamin K 10-20mg from 34-36 weeks
when is risk of seizure highest
peripartum period
why is there deterioration of epileptic control in pregnancy
Decreased drug levels due to nausea + vomiting, increased volume of distribution and drug clearance
lack of drug absorption during labour
Hyperventilation during labour
which anti-epileptic drugs are most associated with neural tube defects
carbamazepine
valproate
which anti-epileptic drug is most associated with orofacial defects
phenytoin
which anti-epileptic drugs are most associated with cardiac defects
valproate
phenytoin
malformations seen in fetal anticonvulsant syndrome
Dysmorphic features (V shaped eye brows, low-set ears, broad nasal bridge, irregular teeth)
Hypertelorism (wide apart set eyes)
Hypoplastic nails and distal digits
what do epileptic women need to take pre-conceptually
5mg folic acid
why should anti-epileptic drugs be continued in labour
increased risk of fits around time of delivery
post-partum management of neonate with epileptic mother
1mg IM Vit K
asian woman with jaundice + pruritis
obstetric cholestasis
ursodeoxycholic acid
tx of itchy jaundice
