Week 4 part 2 Flashcards
What are the effects of diabetes on pregnancy?
- Miscarriage
- Fetal malformations cardiac, neural tube, caudal regression syndrome
- IUGR/macrosomia
- Unexplained IUD
- PET
mEDICATIONS for diabetse in pregnancy>
Diet, metformin, insulin
When should labour be induced with diabetes?
At 37-38 weeks
Diabetes causes fetal macrosomia - what risk does this have?
Shoulder dystocia
Diabetes causes polyuria, polyhydramnios - what risk does this have?
Preterm labout/malpesntation/cord prolase
Diabetes causes increased O2 demands and polycythaemia - what risk does this have?
Risk of unexplained term still birth
Diabetes causes neonatal hypoglycaemia - what risk does this have?
Risk of cerebral palsy
Is PCOS a risk factor for gestational diabetes mellitus?
Yes
In pregnancy with pre-existing DM when should labour be induced?
At 37-38 weeks
Major cause of obsetric litigation?
Macrosomia
What is LSCS recommended in DM where macrosomia and EFW greatr than 4000g?
Macrosomia
What fetal effect of DM causes fetal malpresentations and possible increased risk preterm labouir?
Polyhydramnios
What does hyperinsulinaema in fetus cause risk of?
CP
wHAT IS THE leading cause of maternal death?
VTE - venous thromboembolism
wHAT ARE medications for VTE in pregnancy?
LMWH
Is pregnancy pro-thrombotic?
Yes
Virchows triad in preganncy
Stasis - secondar to venous compression by pregnant uterus
Hypercoagulability - effects of pregnancy
Vascular damage - varicose veins
Evolutionary - why is pregnancy a pro-coaguable state?
To decrease risk of post partum haemorrhage
Pregnancy is a pro coaguable state - what factors are increased?
7,8,9,10,12 and fibrinogen, increased platelets
Pregnancy is a pro coguable state - what factors are decreased?
Factor 11 and antithrombin 3
Three risk factors for VTE (preexisting)?
Obesoty
greater than 35 years of age
Smoker
also parity >3, elective CS, FH, varicose veins, systemic infection, immoblity, PET, twins
In pregnancy, if four or more risk factors for VTE?
Prophylaxis in first trimester
3 risk factors for VTE in pregnancy?
Prophylaxis from 28 weeks
Postnatally, if any previous VTE, anyone requiring antenatal LMWH, high risk thrombophilia, low risk thrombophilia + FH - what is managed?
High riSK - at least 6 weeks [pstnatal prophylactic LMWH
With DVT - what investigation is NOT done in pregnancy?
D-dimer - do ultrasound instead and give therapeutic heparin - treat then see!
What is the therapeutic dose of LMWH in pregnancy?
1mg twice daily OR once daily - continue until 3 months after delibery ot 6 months after treatment
Why is heparin safe in pregnancy?
Doesnt cross placenta - no anticoagulation effect on fetus
Side effects of heparin in pregnancy?
Haemorrhage
Hypersensitiity
HIT - heparin induced thrombocytopenia
Osteopenia
In PE in pregnancy what do u give before investigating?
Heparin
What mght PE cause on CXR in pregnancy?1.
- Atelectasis - collapse of lung
- Effusion
- Focal opacities
- Regional oligaemia
- Pulmonary oedema
In poregnancy, if PE CXR is abnormal and high clinical suspicion what is done?
CTPA
In pregnancy, if CXR for PE is negative what is done?
Bilateal compression duplex dopplers
What is a risk factor in pregnancy when fetting CTPA done for potential PE?
History of breast cancer
With VTE for pregnancy - when is heaprin stopped?
Whwen in labour
If using warfarin in pregnancy for VTE when is it stopped?
6 weeks before labour start D2/3 - avoid in pregnancy 6-12 weeks teratogenic, miscarriage, neurological problems, still borth
Is warfarin ok with breast feeding?
YES
How is the dose of levothyroxine changed in pregnnacy for hypothyroid women?
Increased by 25-50mcg in first trimester
TFT every trimester
What are the effect of hyperthyroid on pregnancy?
- IUGR
2, Preterm labour - Thyroid storm
What medications are used for hyperthyroid in pregnancy?
Carbimazole and propothyouracil
Beta-blockers (propanalol) - IUGR
What is the commonest chronic medical illness to complicate pregnancy?
Asthma
What does the increased resp rate in pregnancy cause?
Resp alkalosis
Resp changes in pregnancy
Inceased O2 emand Tital volume increase Inspiratory capacity increases Residual volume decreases Expiratory reserve decreases Reduction in functional residual capacity (diaphragmatic elevation, increase in subcostal angle)
What respiratory related things are unchanged in pregnancy?
FEV1 and PEFR
What are the major malformations with epilepsy in pregnancy?
- NTD
- orofacial
- Heart defects
Why is there an increaesd chance of seizure in first trimester
?
Hyperemesis and haemodilution
When might yo take vitamin K in epilepsy in pregnanyc/
If taking hepatic enxyme inducing anticonvulsants
In epilepsy in pregnanhcy - when are seizures highest risk?
In peripartum period
Effects of epilepsy on pregnancy: status epilepticus?
Less than 1% pregnancies but dangerous for mother and baby - treat vigourously
What epileptic drug has major malformation of fetus like orofacial clefts?
Phenytoin
What two epileptic drugs cause cardiac defects in fetus?
Phenytoin and valproate
In fetus: v-shaped eyebrows, lowset ears, broad nasal bridge, irregular teeth, hypertelorism, hypoplastic nails + distal digits
fetal anticonvulsant syndrome
if taking phenytoin, valproate nd carbamazepine - what is risk to fetus?
50%
are benzodiazepines teratogenic?
no
with anticonvulsants what is the mechanism of teratogenesis thought to be?
folate deficiency
Preconceptually - what is management of epilespy in pregnancy?
TRake folic acid 5mg a day for at least 12 weeks prior to conception
What scans are done for management of epilepsy in pregnancy?
Detailed fetal scan at 18-20 weeks with detailed fetal cardiac scan at 22 weeks
If on enzyme inducers in pregnancy what drug should be given orally from 34-36 weeks?
Vit K 10-20mg
In epilepdy in pregnancy what should neonate have 1mg of postpartum?
IM vit K
What percentage of women conceive?
80%
Who is the patient referred to if in pregnanyc: psychosis, severe anxiety, depression, suicidal, self-neglect, symptoms interfering with AOLs, history of bipolar or schizophrenia, history of puerperl psychosis, psycotropic meds?
Psychiatry team for psychotherapy
Pervasive or episodic fearfulness, avoidance and autonomic arousal
Often concurrent depression
Phobias, obsessive compulsive, post traumatic stress
Anxiety disorders
What do anxiety disorders predict?
Post natal depression
What drug should be avoided when treatint anxiety disorders in pregnancy and why?
Benzos - cleft and neonatal withdrawal
What do 50% of bipolar women go on to develop postnatally if it isnt getting treatd?
Episode of bipolar and risk of suicide
Baby can be affected by bipolar 1 in 7
Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of valproate?
- NTD
- craniofacial defects
- CV abnormality
- IUGR
- Reduced IQ
- Cleft
Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of carbamazapine?
Facial dysmorphism
Cardiac abnormalities
Fingernail hypoplasia
NTD
Bipolar affective disorder in pregnnayc can be treated with anticonvulsants - mood stabilisers - give some complications of lamotrigine?
Cleft
Steveen Johnson syndrome to baby if breastfed
What mood stabiliser for bipolar in pregannncy can cause vit k deficiency and haemorrhagic disease of newborn?
Carbamazepine
What anomalies can lithium cause to newborn?
Cardiac abnormalities, risk maternal toxicity, Ebsteins anomaly
Nenoatal hypotonia, hypothyroidism, hypoglycaemia
Is lithium used for BPAD in pregnanyc allowed for breastfeeding?
NO it is contraindicated
What is risk of schizophrenai to child?
10%
For treating schizoprenia in pregnancy what can atypicals such as clozapine, olanzapine, risperidone and quetiapine cause?
Gestational diabetes
IUGR
For treating schizoprenia in pregnancy: are tpyical antipsychotics safe?
Yes
For treating schizoprenia in pregnancy: which atypical is contraindicated in breast feeding?
Clozapine
What condition in pregnancy causes this: IUGR, prematurity, hypokalaemia, hyponatraemia, metabolic alkalosis, miscarriage, premature delivery
Eating disorders - bulimia nervosa, anoerxia
Who is mikld-moderate depression in pregnancy treated by?
GP
Who is severe depression in pregnancy treated by?
Psychiatry
What two drugs are not used to treat depression in pregnancy and why?
Venlafaxine - hypertension
Paroxetitine - cardiac abnormalities
What two antidepressants have high levels in breast mild?
Citalopram and fluoxetine SSRIs
Which antidepressant SSRI is ok for breastfeeding?
Sertraline
Are antidepressants amitriptyline and nortryptiline safe in pregancy and okay for breast feeding?
Yes
What condition do 10% of women get after pregnancy and the onset is 2-6 weeks?
Postnatal depression
What condition do 50% of women get after pregnancy?
Baby blues
Brief period of emotional instability, tearful, irritable, anxiety and poor sleep?
Baby blues - 3-10 days self-loimiting
Usually presents within 2 weeks of delivery
Early symptoms are sleep disturbance and confusion, irrational ideas
Mania, delusions, hallucinations, confusion
Puerperal psychosis
Name some risk factors for puerperal psychosis? (0/1% of women)
- Bipolar 50%
2. 1st degree relative with history
Management of puerperal psychosis?
An emergnency - admit toi specialist mother-baby unit, antidepressantsm antipsychotics, mood stabilisers and ECT
facial deformities, lower IQ, neurodevelopmental delay, epilepsy, hearing, heart and kidney defects
Faetal alcohol sybdrome
Are cocaine, amphetamine and ecstasy teratogenic?
Yes
Should you be breastfeeding if alcohol greaster than 8, HIV or cocaine?
No
