Week 12 - pregnancy and prescribing Flashcards
gender inclusive language
important to consider inclusivity of language
treat patients as individuals, try to avoid assumptions
read clinical notes before seeing patients
definition of sex
refers to biological aspects of an individual as manifested by their anatomy, which are determined by their genes, hormones and interactions
definition of gender
more complex, is a personal, internal perception of oneself as a man, woman or neither. gender may not match sex assigned at birth
gender inclusive language in pregnancy
pregnant woman
pregnant person
folic acid
required for purine and pyrimidine synthesis
amino acid conversions
closure of neural tube requires rapid proliferation or neuroepithelial cells - requires significant nucleic acid synthesis
woman advised to take folic acid 400mcgms daily when trying to conceive until 12 weeks of pregnancy - start as soon as they are aware of pregnancy if not taking
alcohol in pregnancy
no safe level of consumption
more significant exposure causes foetal alcohol syndrome
alcohol screening - TACE
tolerance - how many drinks does it take to feel a buzz/get drunk
annoyed - by people asking you to cut down
have you ever felt need to CUT down
eye opener - drink first thing in the morning
foetal alcohol spectrum disorder
leading preventable cause of birth defects
alcohol is teratogen with irreversible CNS effects
facial dysmorphism common
characteristic facial features of foetal alcohol spectrum disorder
low nasal bridge
thin upper lip
smooth philtrum
small palpebral fissures
methotrextate
common drug treatment in RA
can cause miscarriage and/or serious birth defects, can affect growth in utero
dihydrofolate reductase
converts dihydrofolate to tetrahydrofolate - involved in purine and pyrimidine synthesis
methotrexate is competitive inhibitor of DHF
- reduces cell division
- reduces amino acid synthesis
- antagonises action of folic acid
multiple case reports and series of congenital defects - cranial anomalies, congenital heart disease, limb defects
pregnancy and RA
pre-pregnancy counselling with rheumatologist and obstetrician
should be off methotrexate for 3 months before conception
disease under control - hydroxychloroquine, sulfasalazine are safe DMARDs
sodium valproate
used in epilepsy treatment
seizure - sudden change in behaviour caused by electrical hypersynchronisation of neuronal networks in cerebral cortex
epilepsy is recurrent seizures
sodium valproate and pregnancy
neural tube like defects occur in 1-2% of foetuses (20x risk of general population)
associated with cardiac, oral and urogenital malformations
must not be used in women or girls of child bearing age unless in pregnancy prevention programme
pregnancy prevention programme
GP recall relevant patients taking sodium valproate - give counselling and information leaflet, ensure highly effective contraception
review by specialist - is drug indicated? give patient information, ensure highly effective contraception, signed consent
angiotensin converting enzyme inhibitor (ACEi)
treatment for hypertension, heart failure, renal failure
angiotensin receptor blockers (ARBs) have similar uses
what does angiotensin converting enzyme do
converts angiotensin 1 to angiotensin 2
what do ACE inhibitors do
block conversion of angiotensin 1 to angiotensin 2
what do ARBs do
block reception of angiotensin 2
ACEi/ARB in pregnancy
exposure in second and third trimester associated with:
- oligohydramnios (reduced amount of amniotic fluid)
- renal failure
- low blood pressure
- pulmonary hypoplasia
- respiratory distress syndrome
fetal circulation has low perfusion pressures
has high angiotensin 2 levels to maintain renal function - reduced renal function, less amniotic fluid
ACEi/ARB may also reduce placental blood flow - reduced foetal growth
ACEi/ARB in first trimester
explain data to patient
use alternative if possible - not always in diabetic renal disease
if planning on conceiving detect pregnancy early, if period delayed withhold ACEi/ARB and get pregnancy test
stop for duration of any pregnancy
non steroidal anti inflammatory drugs in pregnancy
avoid during 3rd trimester
may cause rare but serious kidney problems leading to reduced amniotic fluid and associated complications
foetal circulation
ductus arteriosus enables oxygenated blood to pass from pulmonary artery to aorta, thereby bypassing lung
right ventricle have 65% of cardiac output
pulmonary vascular resistance high
circulation after birth
ductus arteriosus closes
functional closure in 24 hours
complete anatomic closure takes 2-3 weeks
ductus arteriosus (DA)
blood vessel kept open by prostaglandin E (PGE) which causes vascular smooth muscle to relax
PGE produced by placenta and by DA
PGE levels drop after birth allowing closure of DA
NSAIDs mechanism of action
arachidonic acid > endoperoxidase via cyclooxgyenase > prostaglandins, thromboxan and prostacyclin
NSAID inhibits cyclooxygenase resulting in loss of prostaglandins - loss of PGE
premature closure of DA
cardiac output directed through pulmonary circulation
leads to pulmonary hypertension - cardiac failure, foetal hydrops (fluid accumulation in tissues and organs
