Systemic Disease in Pregnancy Flashcards
In pregnancy, there is an increase/decrease in the levels of thyroxine-binding globulin (TBG).
increase
In pregnancy, there is an increase in the levels of thyroxine-binding globulin (TBG). This causes
an increase in the levels of total thyroxine but does not affect the free thyroxine level.
Untreated thyrotoxicosis increases the risk of
fetal loss, maternal heart failure and premature labour
most common cause of thyrotoxicosis in pregnancy
Graves’ disease
activation of the TSH receptor by
HCG may also occur - often termed transient gestational hyperthyroidism.
HCG levels will fall in
second and third trimester
Thyrotoxicosis mx
‘Propylthiouracil is used in the first trimester of pregnancy in place of carbimazole, as the latter drug may be associated with an increased risk of congenital abnormalities. At the beginning of the second trimester, the woman should be switched back to carbimazole
propylthiouracil is associated with an increased risk of
severe hepatic injury
maternal free thyroxine levels should be kept in the which part of the normal reference range to avoid fetal hypothyroidism
upper third
thyrotrophin receptor stimulating antibodies should be checked at what gestation
30-36 weeks gestation
thyrotrophin receptor stimulating antibodies should be checked why?
helps to determine the risk of neonatal thyroid problems
block-and-replace regimes should not be used in pregnancy
true
radioiodine therapy is contraindicated in pregnancy
true
thyroxine is safe during pregnancy & breastfeeding
true
serum thyroid-stimulating hormone measured when in hypothyroidsm?
each trimester and 6-8 weeks post-partum
women require an increased/decrease dose of thyroxine during pregnancy
increase
by up to 50% as early as 4-6 weeks of pregnancy
most common liver disease of pregnancy.
Intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) occurs in around ?% of pregnancies and is generally seen in the ?trimester
Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) occurs in around 1% of pregnancies and is generally seen in the third trimester
Intrahepatic cholestasis of pregnancy sx
pruritus, often in the palms and soles no rash (although skin changes may be seen due to scratching)
Intrahepatic cholestasis of pregnancy ix
raised bilirubin
Intrahepatic cholestasis of pregnancy mx
ursodeoxycholic acid is used for symptomatic relief
weekly liver function tests
women are typically induced at 37 weeks
Intrahepatic cholestasis of pregnancy complications?
Complications include an increased rate of stillbirth. It is not generally associated with increased maternal morbidity
Acute fatty liver of pregnancy is rare complication which may occur when?
in the third trimester or the period immediately following delivery.
Acute fatty liver of pregnancy sx
abdominal pain nausea & vomiting headache jaundice hypoglycaemia
Acute fatty liver of pregnancy severe disease may result in?
pre-eclampsia
Acute fatty liver of pregnancy ix
ALT is typically elevated e.g. 500 u/l
Acute fatty liver of pregnancy mx
support care
once stabilised delivery is the definitive management
Gilbert’s, Dubin-Johnson syndrome, may be exacerbated during pregnancy
true
Rx smoking
Increased risk of miscarriage (increased risk of around 47%)
Increased risk of pre-term labour
Increased risk of stillbirth
IUGR
Increased risk of sudden unexpected death in infancy
Rx alcohol
Fetal alcohol syndrome (FAS)
learning difficulties
characteristic facies: smooth philtrum, thin vermilion, small palpebral fissures, epicanthic folds, microcephaly
IUGR & postnatal restricted growth
Binge drinking is a major risk factor for FAS
Rx cannabis
Similar to smoking risks due to tobacco content
Rx cocaine
Maternal risks
hypertension in pregnancy including pre-eclampsia
placental abruption
Fetal risk
prematurity
neonatal abstinence syndrome
Rx Heroin
Risk of neonatal abstinence syndrome
pregnancy is a hypercoagulable state
true
Pregnancy: DVT/PE majority occur ?
last trimester
Pregnancy: DVT/PE pathophysiology
increase in factors VII, VIII, X and fibrinogen
decrease in protein S
uterus presses on IVC causing venous stasis in legs