Chronic conditions in pregnancy

Question 1

Management of epilepsy in pregnancy

Answer 1

Specialist led care
Carmazepine first line
Folic acid 5mg for first 12 weeks of pregnancy
Screen for NTDs

Question 2

Management of baby after delivery in epilepsy

Answer 2

Vitamin K

Question 3

Complications of pregestational diabetes

Answer 3

Preeclampsia
Chronic hypertension
VTE
DKA
Retinopathy and nephropathy
Preterm labour
C/S
Polyhydramnios 
Miscarriage 
Congenital anomalies
Macrosomic
Neonatal hypoglycaemia (pancreatic insulin hypersecretion)

Question 4

Antenatal management for pregestational diabetes

Answer 4

Ideally counselled preconception about complications
Consultant led care
Continue insulin and metformin if already taking, stop all other oral hypoglycaemics
Blood glucose diary QDS
Check HbA1c every month
Serial fetal growth measurements
Consider C/S if large for date to avoid shoulder dystocia
Deliver at 38 weeks

Question 5

Management of pregestational diabetes in labour

Answer 5

Patient unlikely to be eating during labour:

• check blood glucose at least every 2 hours
• give IV dextrose

Contact neonatologist on call for review and check glucose levels of baby

Question 6

What is virchows triad

Answer 6

Venous stasis
Vessel wall damage
Hypercoagulable state

Question 7

Management of swollen leg

Answer 7

Wells score for DVT
Doppler ultrasound deep veins in leg
BP, O2 sats, RR
Blood test for d-dimers, fibrinogen
Unfractionated heparin therapy continued until 6-12 weeks postpartum
VTE prophylaxis dose for 6 weeks postpartum in future pregnancies

Question 8

Management of acute breathlessness

Answer 8

Wells score for PE
O2 sats, RR, BP, pulse, ECG
Bloods for d-dimer and fibrinogen
V/Q scan
If scan doesn’t confirm PE do pulmonary angiography
Unfractionated heparin therapy continued until 6-12 weeks postpartum
VTE therapeutic dose throughout pregnancy and for 6 weeks postpartum in future pregnancies

Question 9

Complications of maternal hyperthyroidism

Answer 9

Infertility
Recurrent miscarriage
Heart failure
Thyroid storm
Hyperemesis gravidarum 
Preterm labour
IUGR

Question 10

Management of hyperthyroidism

Answer 10

Switch carbimazole to PTU (propylthiouracil)
Avoid radioactive iodine therapy or thyroid surgery during pregnancy
Test fetus for hyperthyroidism by regular checks of HR (>160)

Question 11

Complications of maternal hypothyroidism

Answer 11

Placental abruption
IUGR
Development delay (congenital hypothyroidism)

Question 12

Management of hypothyroidism

Answer 12

Levothyroxine

Measure TSH levels every month to aid dose

Question 13

Management of gestational diabetes after delivery

Answer 13

Recheck oral glucose tolerance test at week 6 and 13 post partum
Annual HbA1c