Problems in Pregnancy Flashcards
What is pre-eclampsia
new HT presenting after 20 weeks gestation with significant proteinuria
Symptoms of pre-eclampsia
Signs
severe headaches visual problems (blurry, flashing lights, double vision) persistent new epigastric pain vomiting breathlessness sudden swelling of face, hands, feet
Signs: liver tenderness low platelet count abnormal ALT or AST clonus HELLP (haemolysis, elevated liver enzymes, low platelets) pailloedema reduced foetal movements
Urgent obstetric admission if: (pre-eclampsia)
new HT after 20 weeks
+ urine dipstick protein
or pre-eclampsia symptoms
or BP 160/110
(other women with new HT, seek urgent specialist advice)
First line treatment for pre-eclampsia
Second line
labetalol 100mg 2x
methyldopa or nifedipine
What is eclampsia
pre-eclampsia plus ne or more seizures
Risk Factors for gestational diabetes
previous history of GDM BMI >30 prev baby weighing 4.5kg+ FH of type 2 or GDM south asian/black caribbean/middle eastern PCOS previous stillbirth
what is OGTT
oral glucose tolerance test: offered to women with risk factors for GDM between 24-28 weeks (bloods taken at fasting and 2 hours after glucose load)
when should hyperemesis gravidarum have ceased?
week 20
common hyperemesis gravidarum presentation
persistent vomiting
weight loss
dehydration and electrolyte imbalance
ketouria (<2+ ketones)
Management of hyperemesis gravidarum
avoid food/smells triggers eat plain crackers in AM eat blank, small, frequent, meals low in carb and fat but high protein ginger acupressure
(hyperemesis gravidarum)
seek urgent medical care if:
very dark urine, or no urination for 8+ hours
abdo pain
If anti-emetic required in pregnancy, give what
antihistamine (cyclizine or oral promethazine) or prothiazine (oral prochlorperazine)
oral metclopamide and ondanzetron shouldn’t be prescribed to pregnant women for longer than 5 days - why?
Long QT syndrome
How many appointments would someone be offered for first pregnancy vs subsequent?
10 vs 7
Who should be given anti-D?
all Rhesus D neg women who don’t have immune anti-D during 3rd trimester
2 vaccinations offered to everyone during pregnancy?
seasonal flu whooping cough (between 16-32 weeks)
When is first USS pregnant?
10-13 weeks
- checks gestational age
- detect multiple pregnancies
- confirm viability
- detect gross foetal abnormalities
- provide component of Down’s screening if desired (via nuchal translucency measurement)
Next USS offered?
at 18-20 weeks
- to reassure no gross structural abnormalities
- to determine placental morphology and localisation
- confirm foetal growth appropriate
How is foetal growth monitored?
symphysis-fundal height poltting
Pre-eclampsia risk factors
40 or older nulliparity interval of 10 years pregnant FH Previous Hx BMI >30 Pre-existing vascular disease (eg. HT) pre-existing renal disease diabetes lupus or antiphospholipid syndrome multiple pregnancy
Screen for pre-eclampsia at every appointment how
BP
urinalysis
What effect can NSAIDs have on foetus in third trimester?
premature closure of ductus arteriosus
is the cut off for anaemia in pregnancy lower/higher in third trimester?
lower (105)
1/2nd: 110
(Normal 120)
2 physiological changes to urogenital tract in pregnancy
what resultant effect does this have
bladder volume increases
detrusor tone decreases
= increased urinary stasis,. compromised ureteric valves, vesicoureteric reflux
= increased UTI risk
