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Reproductive > Complications of pregnancy 2 > Flashcards

Complications of pregnancy 2 Flashcards

1
Q

What are the complications of hypertensive disorders during pregnancy?

A

Maternal:

  • Eclampsia seizures
  • Cerebral haemorrhage or stroke
  • Haemolysis
  • Elevated liver enzymes
  • Low platelets
  • Renal failure
  • Pulmonary oedema

Fetal:

  • Impaired placental perfusion leading to fetal distress or prematurity
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2
Q

What are the complications associated with diabetes in pregnancy?

A
  • Macrosomia & polyhydramnios
  • Miscarriage
  • Shoulder dystocia
  • Stillbirth
  • Pre-eclampsia
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3
Q

When should thrombosis in pregnancy be suspected?

A

1) Older mothers
2) Increased BMI and a smoker
3) Pre-eclampsia
4) Decreased mobility

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4
Q

What is chronic hypertension in pregnancy?

A

Hypertension pre-pregnancy or at booking (<21 weeks gestation)

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5
Q

What is the systolic pressure for mild hypertension?

A

140-149

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6
Q

What is the systolic pressure for moderate hypertension?

A

150-159

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7
Q

What is the systolic pressure for severe hypertension?

A

> 160

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8
Q

How is gestational hypertension defined?

A

Hypertension which develops after 20 weeks gestation

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9
Q

What is the definition of pre-eclampsia?

A

New hypertension after 20 weeks associated with proteinuria

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10
Q

In which population of mothers is chronic hypertension most common?

A

Older mothers

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11
Q

If a pregnant woman is identified as having chronic hypertension what medication should she be started on?

A

Labetolol - 1st

Nifedipine - 2nd

Methyldopa

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12
Q

What is the target blood pressure for pregnant woman?

A

< 150/100

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13
Q

What antihypertensive medications should not be used during pregnancy?

A

ACE-inhibitors

ARB’s

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14
Q

What other steps can mothers take to lower their BP, apart from medication?

A

Lower dietary Sodium

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15
Q

How much protein must be detected in urine for pre-eclampsia to be diagnosed?

A

300mgs in 24 hours

Protein/creatinine ratio > 0.3

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16
Q

What is the pathophysiological process involved in pre-eclampsia?

A

1 - Secondary invasion of maternal spiral arterioles by trophoblasts resulting in reduced placental perfusion

2 - Imbalance between vasodilators and vasoconstrictors

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17
Q

What are the risk factors for pre-eclampsia?

A

1 - 1st pregnancy

2 - Extremes of maternal age

3 - >10 years between pregnancies

4 - BMI > 35

5 - +ve FH for pre-eclampsia

18
Q

Which organs are affected by pre-eclampsia?

A

Kidneys

Liver

Brain

Eyes

Vascular

19
Q

What are the complications of pre-eclampsia in the mother?

A

1 - Seizures

2 - Stroke

3 - HELLP

4 - DIC

5 - Renal failure

20
Q

What does HELLP stand for in terms of complications of pre-eclampsia?

A

H - Haemolysis

EL - Elevated Liver enzymes

LP - Low platelets

21
Q

What are the complications of pre-eclampsia for the fetus?

A

Intra-uterine growth restriction (IUGR)

Prematurity

Fetal distress

22
Q

What are the symptoms of severe PET?

A

1 - Heache

2 - Blurred vision

3 - Pain below ribs

4 - Oedema of hands, face and legs

5 - Seizures

23
Q

How is pre-eclmapsia seizures treated?

A

Magneisum sulphate bolus + IV infusion

24
Q

What is the prophylactic treatment for pre-eclampsia?

A

Low dose aspirin

25
Q

What happens to insulin requirements of mother during pregnancy?

A

Increase

26
Q

Why do insulin requirements of the mother increase throughout pregnancy?

A

Pregnancy hormones (hCG, progesterone etc.) have an anti-insulin effect

27
Q

What are the implications for the fetus when a mother has poorly controlled blood glucose?

A

Macrosomia

28
Q

Increases in which hormones cause macrosomia in the fetus?

A

Glucose

Insulin

29
Q

What are the effects of diabetes on the mother and fetus?

A
  • Fetal congenital abnormalities
  • Miscarriage
  • Macrosomia
  • Shoulder dystocia
  • Increased risk of pre-eclampsia
30
Q

How is diabetes managed during pregnancy?

A

1 - Optimise glucose control

2 - Retinal & renal assessment

3 - Observe for pre-eclampsia

4 - Labour induced 38-40 weeks

31
Q

What are the risk factors for gestational diabetes?

A

1 - BMI > 30

2 - FH of diabetes

3 - Previous macrosomic baby

32
Q

How is gestational diabetes screened for during pregnancy?

A

1 - Risk factor present

2 - HbA1C levels checked

3 - If HbA1C > 6% then OGTT

33
Q

How is gestational diabetes managed during pregnancy?

A

1) Control blood sugars via diet

34
Q

What are the components of Virchows triad?

A

Stasis

Hypercoaguability

Damage to vessel wall

35
Q

How are each of the components of Virchows triad affected by pregnancy?

A

Stasis - Progesterone & growing fetus

Hypercoaguability - Increased levels of fibrinogen, Factor VIII, VW Factor, platelets

Vessel wall damage - Can occur during delivery or C-section

36
Q

As a result of significant changes to the components of Virchow’s triad, what is the mother at increased risk of?

A

Venous-thrombo embolism

37
Q

What are the risk factors for venous-thromboembolism during and after pregnancy?

A
  • Older mothers
  • Increased BMI
  • Smokers
  • Pre-eclampsia
  • Sickle cell disease
38
Q

What are prophylactic measures that can be taken to reduce the risk of VTE’s during pregnancy?

A

1 - TED stockings

2 - Increase mobility

3 - Stay hydrated

39
Q

What are the signs of VTE?

A

1 -Pain in calf

2 - Swollen leg

3 - Breathless

40
Q

What investigations can be performed to diagnose a VTE?

A

Doppler of leg

V/Q scan

Reproductive (27 decks)

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