Problems in Pregnancy Flashcards
What is the most common cause of maternal mortality during pregnancy in the UK?
Cardiac disease
Give some examples of heart disease that may be affected in pregnancy
Pulmonary hypertension Congenital heart disease Cardiomyopathy Artificial heart valves Ischaemic heart disease Arrhythmia
Give examples of heart disease where women are advised not to get pregnant
Pulmonary hypertension
NYHA class III/IV
TIA
Aortic root > 45mm (Marfan’s)
What causes of palpitations may be seen in pregnancy?
Physiological Ectopic beats Sinus tachycardia Paroxysmal SVT Hyperthyroidism Phaeochromocytoma
What is the main cause of breathlessness in pregnancy?
Increased awareness of physiological hyperventilation (physiological)
What is the most common chronic medical disorder seen in pregnancy?
Asthma
Why do patients commonly find their asthma worsens at the start of pregnancy?
As they stop taking their medication
Asthma will always affect pregnancy no matter how well controlled. True/false?
False - well controlled asthma does not affect pregnancy outcomes
When should a pregnant woman be given IV hydrocortisone?
If on oral steroids for > 2 weeks with no effect
Why is VTE so common during pregnancy?
Hypercoaguable state
Reduced blood flow
Vascular damage at term
What is used to treat any VTE that occurs during pregnancy?
LMWH
What investigation is used for suspected DVT in pregnancy?
Compression duplex USS
What investigation is used for suspected iliac vein thrombosis in pregnancy?
MRI venography
What is the main disadvantage of CTPA for a suspected PE in pregnancy?
Large radiation dose to maternal breast tissue
Who should decide on whether to use CTPA or V/Q in a pregnant woman?
The patient herself
Warfarin is teratogenic and can cause embryopathy. True/false?
True
Only LMWH can be used for anticoagulation post-natally. True/false?
False - both LMWH and warfarin can be used post-natally
What are some disease-related complications of connective tissue disease in pregnancy?
Lupus flare
APS
Rheumatoid arthritis
Scleroderma
What drugs for CTD are safe to use in pregnancy?
Steroids Azathioprine Sulfasalazine Hydroxychloroquine Anti-TNF
Give some clinical features of anti-phospholipid syndrome related to pregnancy
Recurrent early pregnancy loss
Placental abruption
Early onset pre-eclampsia
Fetal growth restriction
What is the general management of APS in pregnancy?
Aspirin +/- LMWH
Most women with epilepsy have the same/fewer seizures during pregnancy. True/false?
True
Give some potential fetal risks from maternal epilepsy
Abdominal trauma (fetal maternal haemorrhage)
Premature membrane rupture
Preterm birth
Hypoxia
All women with epilepsy are offered a detail USS assessment of fetal anatomy at what stage?
18-20 weeks
What are the most common congenital defects associated with anti-epileptic drugs?
Neural tube defects
Congenital heart disorders
Skeletal abnormalities
Cleft palate
What should all epileptic women take before starting pregnancy?
5mg/day folate
A women has a seizure in labour. What is the drug class of choice?
Benzodiazepines
Describe the change of blood pressure in pregnancy
Falls in early pregnancy and reaches its lowest point at 22-24 weeks gestation before steadily rising until term
How is hypertension in pregnancy defined?
> 140/90 mm Hg on 2 occasions
>160/110 mm Hg once
What is pregnancy induced hypertension?
Hypertension occurring in the second half of pregnancy resolving within 6 weeks of delivery
What is the classic triad of pre-eclampsia?
Hypertension
Proteinuria
Oedema
What occurs in normal placentation in relation to the spiral artery?
Trophoblasts invade the tunica media of the spiral artery dropping resistance and allowing blood supply to placenta
What occurs in the pathophysiology of pre-eclampsia?
Endothelial cells invade the tunica media of the spiral artery causing thrombosis
Give some body systems affected by pre-eclampsia
CNS Renal Hepatic Haematological Pulmonary Cardiovascular
What CNS disease can occur in pre-eclampsia?
Intracranial haemorrhage
Cerebral oedema
Cortical blindness
CN palsy
Give some effects of pre-eclampsia on the renal system
Decreased GFR
Proteinuria
Increased serum urate
Increased creatinine/K/urea
What syndrome is a common sign of liver disease due to pre-eclampsia?
HELLP syndrome - haemolysis; elevated liver enzymes; low platelets
What effects can pre-eclampsia have haematologically?
Decreased PV
Thrombocytopenia
Haemolysis
DIC
What cardiac conditions can occur in pre-eclampsia?
Pulmonary oedema
Pulmonary embolism
Give some symptoms of pre-eclampsia
Headache Visual disturbance Epigastric/RUQ pain N+V Oedema
Give some signs of pre-eclampsia
Hypertension
Proteinuria
Disorientation
Hyper-reflexia
What investigations are carried out in pre-eclampsia?
U&Es Serum urate LFTs FBC Coagulation screen
When is urate considered abnormal in pregnant women?
If it is above 10% of weeks of gestation
Give some risk factors for pre-eclampsia
Older age Increased BMI FHx First pregnancy Multiple pregnancy Molar pregnancy Pre-existing renal disease/hypertension Diabetes
Multiparous women tend to develop more severe pre-eclampsia. True/false?
True
What medication is given to women at high risk of pre-eclampsia?
75mg/day aspirin
What investigation can be used to predict pre-eclampsia?
Maternal uterine artery doppler
What tends to be first-line in treating hypertension in pregnancy?
Labetolol
What other drugs can be used to treat hypertension?
First line - methyldopa and nifedipine
Second line - hydralazine and doxazocin
What drugs should be avoided when treating hypertension in pregnancy?
Diuretics/ACEIs
It is normal for women to have a reduction in fetal movements. True/false?
False - must be assessed urgently
What is the only cure for pre-eclampsia?
Delivering the baby
Give some indications for birth in pre-eclampsia
Term gestation
Unable to control BP
Eclampsia
What is eclampsia?
A tonic-clonic seizure occuring with features of pre-eclampsia
What antihypertensives are used to control BP in eclampsia?
IV labetolol + hydralazine
What is used to treat an eclamptic seizure?
Magnesium sulfate
