complications in pregnancy Flashcards
(44 cards)
what is pre-eclampsia
hypertension + end-organ dysfunction +/- proteinuria in pregnancy
why does pre-eclampsia happen
spiral arteries of placenta form abnormally and the resistance in them increases
when can pre-eclampsia occur
20+ weeks gestation
what is chronic hypertension
hypertension that existed before 20 weeks gestation
what is gestational hypertension
hypertension occurring after 20wks gestation
what are lacunae
pools of blood
formed when spiral arteries break down and maternal blood flows into the pools of blood and out though uterine veins
form at about 20wks
what are risk factors for pre-eclampsia
hypertension previous hypertension in pregnancy autoimmune conditions diabetes CKD 40+ BMI > 35 over 10 years since last pregnancy multiple pregnancy first pregnancy FH
what is the prophylaxis for pre-eclampsia
aspirin from 12 weeks if the patient has a high risk factor or more than one moderate risk factor
how does pre-eclampsia present
triad of hypertension, proteinuria, oedema
headache visual disturbances nausea vomiting reduced urine output brisk reflexes
what investigations could you do in pre-eclampsia
blood pressure urine dipstick - proteinuria 1+ LFTs - raised liver enzymes protein : creatinine >30mg/mmol albumin : creatinine >8mg/mmol FBC low platelets, low Hb, raised bilirubin, raised urea, raised creatinine, raised urate coagulation tests CTG for fetus
how do you manage pre-eclampsia
routinelly monitor BP, symptoms, proteinuria
labetolol is first line
nifedipine is second line
methyldopa is third line
IV hydralazine if severe
IV magnesium sulphate in labour to prevent seizures
fluid restriction
give steroids if the baby needs to be delivered <36wks
how do you manage gestational hypertension
aim for 135/85
urine dipstick weekly
bloods weekly
what is HELLP syndrome
complication of severe pre-eclampsia/eclampsia
haemolysis
elevated liver enzymes
low platelets
what is eclampsia
onset of seizures (tonic clonic) in pregnancy or within 10 days of delivery
what are features of eclampsia
hypertension
proteinuria
thrombocytopenia
raised AST
how do you manage eclampsia
medical emergency
IV magnesium sulphate
what is gestational diabetes
carbohydrate intolerance that first comes on in pregnancy
reverts back to normal after delivery
what is a normal OGTT result
fasting < 5.6mmol/l
at 2 hours <7.8mmol/l
what are risk factors for gestational diabetes
history of GD previous macrosomic baby >4.5kgs BMI>3 family history polyhydramnios
what is the screening test for gestational diabetes and when would you do it
oral glucose tolerance test
for patients with risk factors
what effect can diabetes have in each trimester, labour and in baby
1st - malformations
3rd - intrauterine death
labour - obstruction
neonatal - baby will be hypoglycaemic
how do you manage gestational diabetes
28-36wks 4x US scans per week to monitor fetal growth
insulin +/- metformin
glibenclamide if insulin or metformin can’t be used
if a patient has pre-existing diabetes and gets pregnant what should the management be
5mg folic acid daily from pre-conception to 12wks
retinal and renal assessment
induce labour at 38-40wks
maintain BG in labour with IV dextrose insulin infusion
what are complications of diabetes in pregnancy
baby - hypoglycaemia, shoulder dystocia, respiratory distress, still birth, jaundice
patient - pre-eclampsia, worsening of nephropathy, retinopathy, hypoglycaemia, infections
