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Repro > Complications in Pregnancy 2 > Flashcards

Complications in Pregnancy 2 Flashcards

1
Q

What is gestational hypertension?

A

Hypertension that develops after 20 weeks gestation

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2
Q

What is pre-eclampsia?

A

Hypertension that develops after 20 weeks gestation that is associated with significant proteinuria

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3
Q

What is significant proteinuria defined as?

A

Automated reagent strip urine protein estimation of > 1

Urinary protein : Creatinine ratio > 30mg/mmol

24 hour urine protein collection of > 300mg/day

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4
Q

What steps need to be taken in a mother with chronic hypertension?

A
  • Change current BP medications (No ACE-i, ARB’s. Anti-diuretics)
  • Aim to keep BP < 150/100
  • Monitor for superimposed pre-eclampsia
  • Monitor fetal growth
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5
Q

What constitutes pre-eclampsia?

A
  • Systolic blood pressure above 140 mmHg
    Diastolic blood pressure above 90 mmHg

+

Proteinuria of more than 300mgms/24 hours (protein:creatinine ratio > 30mg/mmol)

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6
Q

Describe the pathophysiology of pre-eclampsia?

A
  • spiral arterioles invaded by trophoblasts, become fibrous and narrow. Leads to poor placental perfusion
  • Hypo-perfused placenta releases pro-inflammatory proteins, these cause dysfunction in the endothelial cells of the mother which results in vasoconstriction
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7
Q

What are some risk factors for developing pre-eclampsia?

A
  • First pregnancy
  • Advanced age of mother
  • Previous pre-eclampsia
  • Pregnancy interval > 10yrs
  • BMI > 35
  • Family history
  • Multiple pregnancy
  • Hypertension / renal disease / diabetes
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8
Q

What are some of the symptoms of pre-eclampsia?

A
  • Headache
  • Blurred vision
  • Epigastric pain (RUQ)
  • Oedema
  • Brisk reflexes
  • Nausea and vomiting
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9
Q

What are some biochemical and haematological abnormalities that may be seen in pre-eclampsia?

A
  • Raised liver enzymes
  • Raised urea and creatinine
  • Low platelets
  • Low Hb, signs of haemolysis
  • Signs of Disseminated intravascular coagulation
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10
Q

Management of pre-eclampsia?

A

Only cure is the delivery of baby and placenta, conservative management while waiting for fetal maturity:

  • Close observations of signs + ongoing investigations
  • Anti-hypertensives
  • Steroids for fetal lung maturity if premature

Consider induction of labour if threat to maternal / fetal wellbeing

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11
Q

What are some potential complications of pre-eclampsia?

A
  • Eclampsia
  • Severe hypertension (stroke)
  • Renal failure
  • Pulmonary oedema / cardiac failure
  • HELLP syndrome
  • Fetal distress / prematurity / death
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12
Q

What is HELLP syndrome?

A

Combination of features that occurs with pre-eclampsia:

  • Haemolysis
  • Elevated Liver enzymes
  • Low Platelets
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13
Q

What is eclampsia?

A

Pre-eclampsia + seizures

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14
Q

How is eclampsia treated?

A

IV Magnesium Sulphate for the seizures

Anti-hypertensives

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15
Q

in a woman with previous Pre-eclampsia what is recommended?

A

Prophylactic low dose aspirin from 12 weeks until delivery

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16
Q

What is gestational diabetes?

A

Reduced insulin sensitivity during pregnancy

Abnormally high glucose reverts to normal after pregnancy

baby is more likely to be large

Mother more at risk of type 2 diabetes later in life

17
Q

How do maternal insulin requirements change during pregnancy?

A

They increase

Human placental lacotgen, progesterone, HCG and cortisol from the placenta have anti-insulin action

18
Q

What is fetal hyper-insulinaemia? What is it caused by?

A

Increased insulin secretion by the fetus

Caused by maternal diabetes, fetus needs to secrete increased insulin as excessive glucose crosses the placenta

19
Q

What are some possible complications of diabetes on the fetus?

A
  • Congenital abnormalities (cardiac abnormalities / sacral agenesis)
  • Miscarriage
  • Macrosomia
  • Polyhydramnios
  • Shoulder dystocia (ant. shoulder gets caught under pubic bone)
  • Stillbirth / perinatal mortality
  • Neonatal hypoglycaemia
  • Jaundice
20
Q

What are some possible complications of diabetes during pregnancy for the mother?

A
  • Increased risk of pre-eclampsia
  • Worsening of nephropathy, retinopathy, hypoglycaemia
  • Infections
21
Q

What are the preconception management options for diabetic women of reproductive age?

A
  • Better glycaemic control (glc. 4-7mmol/mol, HbA1c < 48mmol/mol)

Folic acid 5 mg

Dietary advice

Retinal and renal screening

22
Q

What management is necessary for diabetic mothers during pregnancy?

A
  • optimise glucose control with increased glucose requirements
  • Can sometimes continue metformin but may need to switch to insulin for tighter control
  • Retinal assessments at 28 & 34 weeks

Watch for ketonuria / infections / appropriate fetal growth

23
Q

What are some considerations to keep in mind for the delivery of a baby with a diabetic mother?

A

Labour usually induced at 38-40 weeks

Consider caesarean if significant macrosomia

CTG monitoring during labour

24
Q

how does the risk of maternal & fetal complications increase in type 1&2 vs gestational diabetes?

A

Gestational Diabetes Mellitus associated with some increase in maternal complications (eg pre-eclampsia) and fetal complications (macrosomia) but much less than with type I or II diabetes

25
Q

What are some risk factors for gestational diabetes mellitus?

A 
BMI > 30 
Previous macrosomic baby 
Previous GDM
Family history of diabetes
Ethnicity (asian / black)
Polyhydramnios in current pregnancy
26
Q

If a risk factor for gestational diabetes is present, such as previous GDM, what screening can be done?

A

Offer HbA1c test at booking, as well as OGTT

Repeat OGTT at 24-28 weeks

Can also OGTT at 16 weeks and 26 weeks if high suspicion

27
Q

How is gestational diabetes managed?

A

Control blood sugars - diet & metformin/insulin if needed

OGTT 6-8 weeks post delivery

Yearly check of HbA1c / blood sugar as mother is at higher risk of developing diabetes

28
Q

What is virchow’s triad regarding blood clotting?

A
  • Stasis
  • hypercoagulability
  • Vessel wall injury
29
Q

Why does pregnancy predispose women to venous thrombosis?

A

because it is a hypercoagulable state:

  • increased fibrinogen. factor VII, VW factor, platelets
  • Decrease in natural anticoagulants (antithrombin III)
  • Increase in fibrinolysis
  • Increased stasis (progesterone, large uterus)
30
Q

What are some risk factors for venous thromboembolism during pregnancy?

A
  • Age
  • High BMI, dehydration & smoking
  • Pre-eclampsia
  • Decreased mobility
  • Infections
  • Operative delivery / haemorrhage
  • Previous VTE
  • Sickle cell disease
31
Q

What are some options for VTE prophylaxis during pregnancy?

A
  • TED stockings
  • Advise increased mobility / hydration
  • Prophylactic anticoagulation with risk factors
32
Q

What are some signs / symptoms of VTE??

A

Pain / tenderness in calf

Increased girth of affected leg

Breathlessness

Cough, tachycardia, pleural rub

33
Q

Investigations for suspected VTE?

A

ECG
Blood gases
Ventilation perfusion
CTPA (CT pulmonary angiogram)

34
Q

management of VTE?

A

Anti-coagulation (thrombolysis)

Repro (21 decks)

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