Complications in pregnancy

Question 1

Aspirin

Answer 1

NICE recommend starting 75mg aspirin in women who are at risk of pre-eclampsia

Question 2

Anaemia

Answer 2

<110 in trimester 1, <105 in 2 and 3 , <100 postpartum

Advice on maximising oral intake
Trial of oral iron first line
Refer is severe (<70) / > 34 weeks / failure to respond to trial of oral iron

Continue for 3 months after normal levels and until at least 6 weeks postpartum

Question 3

Additional precautions

Answer 3

Hospital setting delivery
IV access
Group and save
Active management of 3rd stage
Plans for excess bleeding

Question 4

Pre-eclampsia

Answer 4

Incidence 3-5%

Dx:
BP >140/90 on 2 occasions at least 4 hours apart
Proteinuria > 300mg / 24hours or 30nmol on spot test protein creatinine ratio

Question 5

Pre-eclampsia RF

Answer 5

First pregnancy
Previous pre-eclampsia
> 40
BMI > 35
Multiple pregnancies
Pre-existing conditions

Question 6

Pre-eclampsia

Answer 6

ADMISSION REQUIRED

Monitor FBC, LFTs, U&Es, urate, USS (associated with FGR)

Only cure is delivery of placenta - balance of risks and benefits

Question 7

Management

Answer 7

Aim to keep BP < 160

Labetol (1st line), nifedipine (2nd line), hydralazine

Discharge when BP stabilised to < 140
2x weekly BP and urine, 1x weekly preeclampsia bloods, induction of labour arranged for 37 weeks

Fluid restrict due to risk of PO, magnesium sulphate infusions for seizure prevention

Question 8

HELPP

Answer 8

Haemolysis
Elevated liver enzymes
Low platelets

Management similar but more supported. Replacement of blood and platelets as needed.

Question 9

Fetal Growth Restriction

Answer 9

‘Constitutional’ or as part of spectrum of placental disease

Screening: customised SFH charts
RF: previous baby, pre-eclampsia / HTN, reduced fetal movements, maternal disease / smoking

Dx - USS (abdominal circumference, head measurements, femur length) - algorithm, assess placental function

Question 10

Management of FGR

Answer 10

Exclude underlying cause e.g. infection, congenital
Monitoring
Timing of delivery - steroids if prem, monitor HR, monitor blood flow, caesarean often needed

Question 11

APGAR Scoring

Answer 11

Appearance: blue / pale, acrocyanosis, pink
Pulse: absent, < 100, > 100
Grimace: absent, feeble, strong cry
Activity: none, some flexion, full movement
Respiration: absent, weak, strong

Take at 1 minute and 5 minutes
5 mins: >7 is normal and < 3 indicates neuro damage (NICU)