Week 4 - D - Medical Complications in Pregnancy - Hypertension, Diabetes, VTE-DVT-PE, Thyroid, Asthma, Epilepsy

Question 1

Most women in pregnancy are healthy however those with medical disorders require expert care from a MDT. What are the three main members in antenatal care? before involving all the sepcialist doctors

Answer 1

GP Obstetrician Midwife Then can have like cardiologist etc

Question 2

There are a huge number of conditions that can affect pregnancy Antenatal care ensures the optimum health of the mother throughout pregnancy and enables to detect and treat disorders during the pregnancy When was antenatal care first introduced?

Answer 2

Antenatal care was first introduced in 1911

Question 3

After the pregnancy is confirmed - be it urine or blood HCG measurement What is carried out at the booking antenatal visit?

Answer 3

Discussion about advice regarding pregnancy Identify if patient is high risk (red pathway) or low risk (green pathway) Discuss options for birth place of the child Measure mother height, weight and blood pressure

Question 4

What week of pregnancy should the first USS be carried out at? What does the USS tell you?

Answer 4

First scan should be carried out at roughly 12 weeks of pregnancy - 11-14 weeks The USS allows you to date the pregnancy - measuring the head circumference, can use biparietal diameter of the foetus or femur length

Question 5

Why is it important that the first USS scan is accurate for having dating the age of the baby?

Answer 5

it is vital in managing rhesus disease and in diabetic pregnancy

Question 6

When is the next ultrasound scan carried out after the dating scan?

Answer 6

The anomaly scan is carried out at 20weeks

Question 7

How often should visits be carried out after 20 week anomaly scan? How often should visits be carried out after 28 weeks? How often should visits be carried out after 36 weeks?

Answer 7

Monthly visits after 20 week anomaly scan Fortnightly visits after 28 tuntil 36 weeks Weekly visits 37 weeks onwards

Question 8

In mothers who have had possible blood transfusion with the foetus, what immunisation should be given? How much of this should be given if below 20weeks gestational age and if above 20 weeks gestational ge?

Answer 8

Anti-D immunoglobulin should be given to mothers with potential exposure to foetal blood 250 units are given if before 20 weeks gestation 500 units are given if after 20 weeks gestation

Question 9

What is the prophylactic regiment given for anti-D if pregnant mothers choose to take it? Anti-D immunoglobulin is also administered routinely during the third trimester of your pregnancy if your blood type is RhD negative. This is because it’s likely that small amounts of blood from your baby will pass into your blood during this time. What weeks of gestation is it given at? What muscle is the Anti-D immunoglobulin injected into?

Answer 9

Give 500units of Anti-D at 28 and 34 weeks gestation or a single big dose at 28 weeks The anti-D immunoglobulin is preferably injected into the deltoid muscle (best results for IM injection here)

Question 10

What are the things checked at each antenatal visit Here are options:

• Accurately document gestation
• Ultrasound scan
• Blood pressure
• Urinalysis
• Serum HCG
• Foetal heart/kicks
• Symphyseal fundal height

Answer 10

• * Accurately document gestation
• * Blood pressure and Urinalysis
• * Foetal heart/kicks
• * Symphyseal fundal height
• Booking visit @ 8-12 weeks
• Dating USS @ 11-12 weeks (hospital)
• Anomaly Scan at 20 weeks
• Monthly visits till 28 weeks
• Anti D - 28 weeks & 34 weeks
• Fortnightly visits 28-36 & Weekly visits 37 weeks onwards

Question 11

What is the commonest medical problem in pregnancy?

Answer 11

Hyprtension is the commonest medical problem in pregnancy (chronic hypertension or pregnancy induced hypertension)

Question 12

What is pregnancy induced hypertension with proteinuria also knwon as? (previously known as toxaemia of pregnancy)

Answer 12

This is pre-eclampsia (pre-eclampsia toxaemia is the previous name)

Question 13

Hypertensive disorders in Pregnancy If the hypertension is present before the 20th week getsation, what is it? If the hypertension presents after the 20th week what is it? When is it pre-eclampsia?

Answer 13

Hypertension present at booking or 20 weeks + significant proteinuria

Question 14

Hypertensive disorders in Pregnancy 1.Effect on pregnancy 2.Pregnancy effect 3.Medications 4.Delivery 5.Post partum What is thought to be the pathophysiology behind pre-eclampsia?

Answer 14

The spiral arteries of the endometrium are not successfully invaded by the trophoblast - therefore the maternal blood flow to the foetus is poor The mother attempts to increase the blood pressure in an effort to increase placental blood flow resulting in pre-eclampsia

Question 15

How does the ischaemic placenta result in the widespread endothelial dysfunction in the mother?

Answer 15

The ischemic placenta releases factors which upset the angiogenesis - antiangiogenesis balance leading to endothelial dysfunction in the mother

Question 16

Pre-eclampsia has a multisystem organ involvement - rain, kidney, liver, eyes, placenta, foetus, others (?) What does pre-eclampsia cause for the renal system due to it causing dmaage? What will be increased in the blood?

Answer 16

Causes a decreased GFR which will cause a build up of creatinine in the blood, also increased serum potassium and urea and uric acid There will be oliguria and proteinuria

Question 17

WHat effect can pre-eclampsia have on the liver?

Answer 17

Can cause elevated liver enzymes, epigastric/ruq pain and hepatic capsule rupture

Question 18

The capsule of the liver. A layer of connective tissue surrounding the liver and ensheathing the hepatic artery, portal vein, and bile ducts within the liver What is the name of this capsule? What is the syndrome that pre-eclampsia can cause?

Answer 18

This is Glisson’s capsule The syndrome is HELLP syndrome Haemolysis Elevated Liver enzyme Low Platelet count

Question 19

How can pre-eclampsia affect the placenta?

Answer 19

Can cause placental abruption IUGR - intra-uterine growth restriction - nutrients and waste not properly exhanged Intra-uterine death

Question 20

What is placental abruption?

Answer 20

A placental abruption is a serious condition in which the placenta partially or completely separates from your uterus before your baby’s born. The condition can deprive your baby of oxygen and nutrients, and cause severe bleeding that can be dangerous to you both.

Question 21

What are the investigations used for pre-eclampsia?

Diagnosis and further investigations to see if it has affected other organs

Answer 21

Pre-eclampsia is easily diagnosed during the routine checks you have while you’re pregnant Measure blood pressure and urinalysis for protein

Once diagnosed further investigations are carried out:

• Urea&Electrolytes - raised in serum
• Serum urate
• LFTs elevated
• FBC - low platelets
• Use CTG - cardiotocography

Question 22

At the booking visit for pre-eclampsia, the risk factors for the mother having pre-eclampsia are assessed What can be given as prophylactic treatment for pre-eclampsia? What supplements are usually given in pregnancy?

Answer 22

Prophylactic treatment:

• 75mg Aspirin given daily if the patient has one high risk or more than 1 moderate risk factor for pre-eclampsia
• Folic acid (400 micrograms) should be taken when trying to conceive and for the first 12 weeks of pregnancy to protect against neural tube defects (NTD), -
• daily 10 micrograms of vitD daily whilst pregnant and breastfeeding

Question 23

If the patient has hypertension at less than 20 weeks, look for a secondary cause What is the only way to cure pre-eclampsia?

Answer 23

The only way to cure pre-eclampsia is to deliver the baby

Question 24

What medications used to treat hypertension should be stopped during pregnancy?

Answer 24

Stop ACEinhibitors and ARBs due to increased risk of foetal renal damage

Question 25

What medications can be used to treat hypertension in pregnancy?

Answer 25

Labetalol Methyldopa / hydralazine Nifedipine

Question 26

What is the only medicine actually licensed for the treatment of hypertension in pregnancy? Why is methyldopa sometimes contraindicated?

Answer 26

* Labetalol is the only licensed drug for the treatmnet of hypertension in pregnancy * As Methyldopa is an inhibitor of the DOPA-decarboxylase aromatic amino acid which converts L-DOPA to dopamine peripherally - this can lead to potential depression * (DOPA-decarboxylase inhibitors given in parkinsons to reduce peripheral dopamine in an attempt to increase central nervous system dopamine)

Question 27

What are the routes of administration of labetalol, hydralazine and nifedipine (usually given when monotherapy doesnt work ie a top up)? What are their mechanisms of action?

Answer 27

Labetalol - dual alpha and beta antagonsim - can be given IV or oral Nifedipine - calcium channel blocker - Oral Hydralazine - smooth muscle relaxant and acts as a vasodilator primarily in resistance arterioles - IV Methyldopa can be give oral or IV as well

Question 28

What BP would anti-hypertensives be given in pregnancy? What is 1st and 2nd line? What is given in a severe hypertensive episode?

Answer 28

Only give anti-hypertensives to treat hypertension in pregnnacy if Bp > 150/100 1st line - labetalol - dual alpha and beta antagonism (used orally here, can be IV when severe hypertension) 2nd line - methyldopa - orally or nifedipine - calcium channel blocker that can be given orally If a severe hypertensive episode (BP - >160/110) - give IV labetalol or IV hydralazine

Question 29

What is the target blood pressure in pre-eclampsia if no organ damage? What is the target blood pressure in pre-eclampsia if organ damage?

Answer 29

Aim for BP <150/80-100 mmHg If target organ damage (eg. renal damage, causing proteinuria or retinal damage), aim for BP <140/90 mmHg

Question 30

What maternal organs can pre-eclamspia effect again? What effect can it have on the placenta? IMportant to monitor growth scans of baby

Answer 30

Can affect kidney, liver, eyes, (brain) Can cause placental abruption, IUGR, Intrauterine death

Question 31

If vaginal delivery in pre-eclampsia, the pregancy is induced at 37 weeks 34 weeks if c-section in pre-eclampsia What is given at 35-36 weeks to help foetal surfactant production as it is immature?

Answer 31

Betamethasone IM given at 35-36 weeks to help foetal surfactant production

Question 32

When tonic-clonic seizures appear in a pregnant woman with high blood pressure and proteinuria, what is this diagnosis and what is given as treatment?

Answer 32

Eclampsia Magnesium sulphate is given as treatment if seizures do arise

Question 33

What can be given as prophylaxis in symtpomatic pre-eclampsia patients to prevent eclampsia and also reduce maternal deaths? What is given to treat toxicity as this drug can potentially cause respiratory depression?

Answer 33

Magnesium sulphate Clacium gluconate is given as treatment if respiratory depression does occur due to magnesium sulphate toxicity

Question 34

Diabetes has a major impact on the foetal and maternal health The rates of gestational diabetes are increasing What effects does maternal diabetes have on the foetus?

Answer 34

Maternal diabetes means there is maternal hyperglycaemia which will be passed on to the foetus making the baby produce high levels of insulin leading to foetal hyperinsulinaemia Can also be a risk of pre-eclampsia in mum

Question 35

What can foetal hyperinsulinaemia cause? In the womb - insulin promotes foetal growth As children - growth hormone promotes growth As a teenager - sex hormones promote growth

Answer 35

Foetal hyperinsulinaemia can cause foetal macrosomia, neonatal hypoglycaemia

Question 36

What can foetal macrosomia cause? What is foetal macrosomia defined as? What can polyhdraminios cause?

Answer 36

Foetal macrosomia - can cause risk of brith injury due to shoulder dystocia Polhydramnios can lead to the risk of preterm labour and cord prolaspe

Question 37

Define foetal macrosomia and polhydramnios (AFI)?

Answer 37

Foetal macrosomia - estimated foetal weight greater than the 90th centile Polhydramniso - Amniotic fluid index greater than 25 Deepest vertical pocket - greater than 8cm

Question 38

Polycythaemia, or erythrocytosis, means having a high concentration of red blood cells in your blood. How can foetal hyperinsulinaemia lead to polycythaemia?

Answer 38

The increased levels of insulin can cause increased erythropoetin production leading to an increased concentration of red blood cells in the blood This makes the blood thicker and less able to travel through blood vessels and organs. Many of the symptoms of polycythaemia are caused by this sluggish flow of blood.

Question 39

What does neonatal hypoglycaemia risk for the foetus? It is a condition linked to the brain

Answer 39

RIsk factor for causing cerebral palsy in the foetus

Question 40

What are risk factors for diabetes in pregnancy? (What are three ethnicities that increase the risk)

Answer 40

Previous GDM Relatives having the condition BMI > 30 Previous birth to a baby weighing >4.5 kg (10pounds) Afro-carribean or middle eastern or south asian PCOS

Question 41

What is the HbA1c cut off for diagnosing Type 1, Type 2 and gestational diabetes?

Answer 41

HbA1c should not be used to diagnose gestational or Type 1 diabetes HbA1c of 48mmol/mol (6.5%) is recommended as the cut off for diagnosing diabetes in Type 2 diabetics

Question 42

When is the screening oral glucose tolerance test carried out? What are the cut offs for diabetes diagnosis in gestational pregnancy? Fasting plasma glucose? Oral glucose tolerance test (one and 2 hours after 75g glucose is given after fasting)

Answer 42

Screening OGTT is carried out at 24-28 weeks pregnancy

The adoption of internationally agreed criteria for gestational diabetes using 75 g OGTT is recommended:

• * ƒ fasting venous plasma glucose ≥5.1 mmol/l, or
• * ƒ one hour value ≥10 mmol/l, or
• * ƒ two hours after OGTT ≥8.5 mmol/l.

Question 43

Diabetic control during pregnancy is very important - diet, metofrmin or insulin What is the aim for the HbA1c level? What screening is carried out every trimester?

Answer 43

Aim for HbA1c levels of less than 6% Retinal screening is carried out each trimester if the mother is known to have diabetes

Question 44

When is the induction of labour recommended in mothers with diabetes in accordance to NICE guidelines?

Answer 44

Induction of labour is recommended at 38 weeks gestation

Question 45

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Answer 45

The foetal hyperinsulinaemia causes the foetus to be producing high levels of insulin. After delivery, the baby continues to have high levels of insulin but no longer has the high level of glucose coming from the mother and therefore goes into hypoglycaemia - if the levels become too low the baby can be given IV glucose

Question 46

Normal folic acid supplementation - 400micrograms folic acid daily while you are trying to get pregnant and until you are 12 weeks pregnant. WHat is given in diabetic woman?

Answer 46

In diabetic woman they are ona high dose of folic acid supplementation daily 5mg daily 3 months prior to conception and up till 12 weeks gestation

Question 47

What is the main cause of maternal death in the UK?

Answer 47

VTE - venousthromboembolism Pregnancy is a hypercoagulable state

Question 48

How does virchows triad further increase the risk of clots during pregnancy?

Answer 48

Stasis - uterus compresses venous return increasing blood stasis Hypercoagulability - pregnancy causes this (hormones etc) Endothelial damage - varciose veins in pregnancy (valvular dysfunction)

Question 49

VENOUS THROMBOEMBOLISM is still the MAIN CAUSE OF MATERNAL DEATH (CEMACH) Pregnancy is a ‘pro-coagulable’ state ? Evolutionary to ↓ risk of PPH What are the clotting factors that are in increased levels in pregnancy? affects both intrinsic and extrinsic pathways

Answer 49

Clotting factors VII, VIII and X and fibrinogen

Question 50

What does clotting factor VIII bind to to prevent its degradation whilst inactive in circulation? If this substance is deficiency, it causes a disease which can cause frequent bleeds

Answer 50

Clotting factor VIII binds to Von-Willebrand factor (vWF) which is a glycoprotein involved in haemostasis - deficiency in this factor leads to Von Willebrands disease

Question 51

Royal College of Obstetricians and Gyanecologists have guidelines on when to give thromboprophylaxis during pregnancy Different scores correspond to the different times from when to considering starting thromboprophylaxis * If the total score >/= 4 antenatally, when is thromboprophyaxis given? * If the toal score 3 antenatally, when is thromboprophylaxis given?

Answer 51

If total score >/= 4 antenatally - consider thromboprophylaxis from the first trimester If total score is 3 antenatally, consider thromboprophylaxis from 28 weeks

Question 52

What score does the patient need for thromboprophylaxis postnatally?

Answer 52

Patient needs a score of >/=2 postnatally to consider 10 day thromboprophylaxis

Question 53

Risk assessment for venousthromboembolism

• * What score for considering thromboprophylaxis from first trimester?
• * What score for considering thromboprophyaxis from 28 weeks?
• * What score for considering thrombophylaxis for 10 days postnatally?
• * If the patient is admitted to hospital during the peuperium, consider thromboprophylaxis, how long is this period?

Answer 53

• Score of >/=4 antenatally - consider thromboprophylaxis from first trimester
• Score of 3 antenatally - consider thromboprophyaxis from 28 weeks
• Score of >/=2 postnatally - consider thromboprophylaxis
• Peuperium lasts the 6 weeks after pregnancy

Question 54

What is the thromboprophylaxis treatment in a pregnant women?

Answer 54

Give Low molecular weight heparin (LMWH) eg enoxaparin

Question 55

What is deep vein thrombosis? 50% are asymptomatic is it more common in males or females?

Answer 55

Deep vein thrombosis is when their is a deep thrombosis in one of the veins in the legs 50% are asymptomatic and it is more common in males than females

Question 56

Suspect DVT is leg pain/discomfort - especially left side, swelling, or oedema What is the test doen to diagnose a DVT? What medication is given if suspecting a deep vein thrombosis in pregnancy before testing?

Answer 56

Therapeutic heparin is given if suspecting a DVT Compression duplex ultrasound is carried out to diagnose a DVT in a pregnant women

Question 57

Why is D-dimer test not used to help in the diagnosis of DVT in pregnancy?

Answer 57

D-dimer (or D dimer) is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. Normal pregnancy is associated with alterations of the hemostatic system toward a hypercoagulable state. Elevated markers of coagulation and fibrinolytic system activation, such as D-dimer, indicate increased thrombin activity and increased fibrinolysis following fibrin formation throughout pregnancy.

Question 58

What is management / treatment of DVT in pregnancy?

Answer 58

Initially elevate the leg and then mobilise using stockings - Use TED stockings Heparin is available in two different forms: standard (unfractioned) heparin low molecular weight heparin (LMWH) Usually give the stockings, advise exercise and LMWH (1st line over standard unfractioned heparin)

Question 59

How long is the LMWH continued in pregnancy? How long is standard unfractioned heparin continued in pregnancy if this is the option used?

Answer 59

Give LMWH until 3 months after delivery or for 6 months after treatment started - whichever is longer Standard unfractioned heparin is the same i believe

Question 60

What are the side effects of heparin? (this covers both the standard unfractioned and LMWH)

Answer 60

Haemorrhage Hypersensitivity Allergy at injucntion site heparin induced thrombocytopenia is a possibility

Question 61

In investigation for a pulmonary embolus - ABGs (patient will be respiratory alkalsois), ECG then CXR In women with suspected PE who also have symptoms and signs of DVT, what is carried out?

Answer 61

In women with suspected PE who also have symptoms and signs of DVT, compression duplex ultrasound should be performed.

• * If compression ultrasonography confirms the presence of DVT, no further investigation is necessary and treatment for VTE should continue
• * If negative carry out a CTPa or V/Q scan

Question 62

In women with suspected PE without symptoms and signs of DVT, what investigation is carried out?

Answer 62

In women with suspected PE without symptoms and signs of DVT, a ventilation/perfusion (V/Q) lung scan or a computerised tomography pulmonary angiogram (CTPA) should be performed.

Question 63

CXR is normal in 50% of women with a PE - the radiation dose is negligible to the foetus When the chest X-ray is abnormal and there is a clinical suspicion of PE can technically choose between V/Q scan or CTPA Why is CTPA chosen more often? (informed consent required for both)

Answer 63

CTPA increases the risk of lifetime maternal breast cancer however V/Q increases the likelihood of childhood cancer for the foetus

Question 64

What anticoagulant is given for the treatment of a PE? How long is it continued for?

Answer 64

Heparin is given - probably LMWH Anticoagulants should be continued for at least 6 weeks postnatal (for a minimum duration of therapy of 3 months).

Question 65

Are heparin and warfarin okay in breastfeeding? When is warfarin not given in pregnancy? / When can warfarin be started on over heparin in the postpartum anticoagulation treatment for the PE?

Answer 65

Warfarin is not given in pregnancy as it is teratogenic Both warfarin and heparin are safe in breastfeeding Warfarin can be started on day 2/3 postpartum instead of conitnuing with the heparin (remember total treatment duration needs to be at least 6 weeks postpartum and 3 months treatment duration in total)

Question 66

In women with hypothyroidism, the levothyroxine intake has to increase How much is the levothyroxine treatment increased by? How often are thyroid function tests carried out?

Answer 66

Increase levothyroxine by 25-50micrograms TFTs every trimester

Question 67

What is the treatment of hyperthyroidism normally? What is used as treatment during pregnancy?

Answer 67

Normally carbimazole is the 1st line treatment of hyperthyrodiism In pregnancy, as Propylthiouracil is less likely to cross the placenta, this is given to the mother and change to carbimzole in the third trimester

Question 68

Asthma is very common in pregnancy There are changes in the pulmonary function tests due to mechanical changes to the lungs in pregnancy What happens to the CO2 in pregnancy? What happens to the PO2? What happens to the tidal volume?

Answer 68

More CO2 is blown off because progesterone signals the brain to lower Co2 levels PO2 and vital capacity of the lungs remain the same Tidal volume of the lungs increases

Question 69

Most women-no adverse effects on pregnancy outcome •Severe, poorly controlled-asthmatics associated with hypoxaemia may adversely affect fetus Treatment of asthma in pregnancy is the same as the treatment in non-pregnant women What is the 1st line treatment?

Answer 69

SABA (short-acting B2 agonist) - salbutamol + Inhaled corticosteroid - beclomethasone

Question 70

Epilepsy de-novo in pregnant is very rare If there is a seizure in pregnancy, what could this make you think? What percentage of women of childbearing age does epilepsy effect?

Answer 70

If there is a seizure in pregnancy, this could make you think of eclampsia Epilepsy effects ~0.5% of women of childbearing age

Question 71

There is an increased risk of seizures in the 1st trimester of pregnancy due to hyepremesis and haemodilution When is vitamin K given to the mother in pregnancy and why?

Answer 71

Give vitamin K from 36 weeks to the mother if she is taken hepatic enzyme inducer anti-convulsants eg carbamezapine (hopefully will reduce risk of foetal vit K deficiency and haemorrhagic disease of the newborn)

Question 72

It is important to have good preconception counselling to mothers wishing to become pregnant - especially in epilepsy Women having how many seizures per month are shown to have worsening rates during pregnancy?

Answer 72

Seizure rates worsen in women having >1 seizure/month during pregnancy

Question 73

There is a likely deterioration in control of epilepsy duing pregnancy due to fear of teratogenesis ALL anti-convulsants are thought to be teratogenic Status elipticus is rare in pregnancy but treatment is the same as non-pregnant women and monitor foetus What is the status elipticus treatment? (include ROA) State the treatment steps if the condition fails to improve

Answer 73

* Lorazepam IV or buccal midazolam if unable to access IV (rectal route diazepam is alternative if both of these routes are unable) * Repeat lorazepam after 10 minutes if it fails to work and call for senior help * Prepare phenytoin IV * GIVE GENERAL ANAESTHETIC *

Question 74

If a parent has epilepsy, what is the risk of the child developing it? What si the risk if both parents have epilepsy?

Answer 74

5% if one parent has epilepsy 15-20% if both parents have epilepsy

Question 75

Foetal teratogenicity due to anticonvulsants Which two main anti-convulsants cause neural tube defects? Which is the main causing of orofacial celft? What is the main causing of cardiac defects?

Answer 75

* Sodium valproate mainly and carbazapine - neural tube defects * Phenyotin - orofacial cleft * Phenyotin and sodium valproate - cardiac defects

Question 76

The risk of the different anti-convulsants during pregnancy for causing teratogenicity is very little Which drug may however be the drug of choice? The risk greatly increases if taking 2 or more anti-convulsants What is the risk of teratogenicity to the foetus if taking carmazepine, sodium valproate and phenytoijn?

Answer 76

Drug of choice in pregnancy may be carbamezapine If take phenytion, valproate AND carbamazepine, risk to fetus is up to 50%

Question 77

Mechanism of teratogenesis though to be folate deficiency What is the folate dose for the mother during pregnancy? Why is it continued after 12 weeks of pregnancy?

Answer 77

Folate dose is 5mg/day preconceptually and throughout the whole of pregnancy (will prevent folate deficiency anaemia in the mother)

Question 78

When is the detailed foetal anomaly scan carried out? When is the foetal cardiac scan carried out?

Answer 78

Detailed fetal scan at 18-20 weeks with detailed fetal cardiac scan at 22 weeks

Question 79

When is Vitamin K given to the mother and why in epilepsy management?

Answer 79

Given to the mother at 36 weeks to reduce risk of foetal vit K deficiency and hemorrhagic disease of the newborn

Question 80

Most mothers have normal deliveries –LSCS only if recurrent generalised seizures in late pregnancy/labour What is the baby given at birth?

Answer 80

The baby is given 1mg IM vitK at birth and the mother is encouraged to breastfeed

Question 81

What is advised for bath taking for the mother when pregnant and she has epilepsy?

Answer 81

Advised to have shallow baths with the door unlocked to decrease the risk of drowning

Question 82

What is there an increased risk of in pregnancy and postnatal period for the mother? it is the sudden death

Answer 82

SUDEP Sudden Unexplained Death in EPilsepy the sudden, unexpected, witnessed or unwitnessed, non-traumatic, and non-drowning death in patients with epilepsy with or without evidence for a seizure, and excluding documented status epilepticus, in which postmortem examination does not reveal a structural or toxicological cause for death.