Complications in Pregnancy/Post Partum Flashcards by Aaron Duff

What are booking bloods?

FBC and Blood Group &amp; Antibodies
Haemaglobinopathies
Infection screen
-Hepatitis B
-HIV
-Rubella
-VDRL
Random Blood Glucose

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When are monthly/fortnightly/weekly antenatal visits carried out?

Monthly till 28 wks
Fortnightly till 36 weeks
Weekly till delivery

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When is Anti D administered?

28 and 34weeks

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What is checked at each antenatal visit?

Accurately document gestation
BP
Urinalysis
SFH (FSH)
Fetal Heart/Kicks

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What is the incidence of hypertensive disorders in pregnancy?

HTN 10-15%
PET 3-5%
Severe PET 5/1000
Eclampsia 5/10000

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What is gestational hypertension?

New HT >20wks without significant proteinuria

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What renal disease can occur in pregnancy?

Decreased GFR
Proteinuria
Increased serum uric acid (also placental ischaemia)
Increased creatinine/K+/urea
Oliguria/anuria
Acute renal failure- ATN, renal cortical necrosis

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What liver disease can occur in pregnancy?

Epigastric/RUQ pain
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome (haemolysis, elevated liver enzyme, low platelets)

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What placental disease can occur in pregnancy?

IUGR
Placental abruption
Intrauterine death

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How should risk factors for preeclampsia be managed?

Aspirin

Surveillance

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What anti-hypertensive medications are used in pregnancy?

Labetalol
Methyldopa
Nifedipine (usually if monotherapy fails-top up)
Stop ACE & ARBS

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What can be used for severe hypertension e.g. 165/110?

Labetalol (oral or IV)
Hydralazine (IV)
Nifedipine (oral)

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What BP should be aimed for in pregnancy?

<150/80-100

If target organ damage, aim for <140/90 (if this consider reducing dose, if <130/90 reduce)

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What management should be carried out in diabetes-related pregnancies?

Screening
Detailed USS including extended cardiac views
Dietetic support
Diet, Metformin, Insulin
BM 4-6
HbA1C <6.0%
Retinal screening every trimester

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When should delivery be carried out in diabetes-related pregnancies?

37-38wks in pre-existing DM
38 wks in GDM on insulin
41 weeks if GDM on diet with normal BMs and fetal growth

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How should diabetes be managed in the post-natal mother?

Pre-existing: return to pregnancy regime

GDM: stop treatment and monitor BMs for 48 hrs to ensure normal and no persistence of IGT

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What is the incidence of VTE in pregnancy?

1/1000

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What is the main cause of maternal death?

VTE

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What is pregnancy in terms of coagulability?

A pro-coagulable state

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Why is pregnancy pro-coagulable?

To decrease risk of PPH

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What clotting cascade changes occur in pregnancy?

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Increased levels factor 7,8,9,10,12 and Fibrinogen and numbers of platelets
Decreased levels factor 11 and antithrombin 3

What percentage of early DVTs are asymptomatic?

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50%

What is the ratio of DVT starting in the left compared to the right leg?

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Left > Right 8:1

What investigations are used in DVT?

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D-dimer (not in pregnancy)

Duplex US on lower limb

What medication is given in DVT?

Heparin- treat then see

What overall haematology investigations occur in DVT?

``` Baseline investigations –FBC, clotting, Us & Es, LFTs AntiXa levels- Not routine. Platelet levels- Not routine Thrombophilia screen: Not routine Controversial Affected in pregnancy No influence to immediate management Interpretation usually by haematologists. ```

How are TEDs used in DVT?

Acute phase-2 years | Decrease thrombotic syndrome by 50%

Describe LMWH use in DVT?

Dalta-parin etc Longer duration of action so used 1x/daily Outside pregnancy 1.5mg/kg Therapeutic dose 1mg/kg/twice daily (or once) Continue 3 months post delivery, or 6 months after treatment onset Doesn't cross placenta-safe for fetus

What are the S/Es of heparin?

Haemorrhage Hypersensitivity Allergy at injection site Heparin induced thrombocytopenia- early in 5 days usually mild, late >5 days Osteopenia-osteoporosis on prolonged usage, less with unfractionated

What Ix is carried out in PE?

``` ABGs Chest x ray ECG Duplex ultrasound lower limbs Ventilation/perfusions scans CTPA ```

Should CXR be performed in all women with suspected PE?

Yes

What findings can CXR detect in PE?

``` Atelectasis Effusion Focal opacities Regional oligaemia Pulmonary oedema ```

What should be carried out if a CXR is -ve in PE?

Bilateral compression Duplex dopplers should be performed

Which has a lower risk of childhood cancer, CTPA or VQ scan?

CTPA

Should heparin be stopped in labour?

Yes

When should therapeutic and prophylactic heparin stopped pre-epidural?

24 and 12 hours before respectively

When should warfarin be stopped?

6 weeks before labour

Is warfarin okay in breast feeding?

Yes

How should levothyroxine be adjusted in pregnancy?

Increase by 25-50mcg in first trimester-repeat TFTs every trimester

How does hyperthyroidism change in pregnancy?

Gets worse due to HCG in first trimester Improves 2nd and 3rd Can cause IUGR, preterm labour, thyroid storm

What is the commonest chronic medical illness that complicates pregnancy?

Asthma

What is the asthma deterioration in the 3rd trimester usually due to?

Reduction or cessation of medications due to (unfounded) safety fears

What are some adverse effects in pregnancy due to asthma>

``` Hypoxaemia PIH/PET PTL/birth LBW IUGR Neonatal morbidity e.g. TTN, hypoglycaemia, seizures, NNU admission ```

Does asthma treatment change in pregnancy?

What should be taken for epilepsy during pregnancy

5mg folic acid from 12 weeks prior to conception | Vit K from 34-36 weeks if taking hepatic enzyme inducing anticonvulsants

What are the maternal effects of epilepsy on pregnancy?

25-30% increased seizure frequency 54% no change Poorly controlled (>1/month) likely to deteriorate in pregnancy Risk of seizures highest in peripartum period

What are some reasons for deterioration of control in epilepsy?

Pregnancy Poor compliance (fears of teratogenesis) Decreased drug levels due to nausea and vomiting Decreased drug levels due to increased volume of distribution and drug clearance Lack of sleep Lack of drug absorption Hyperventilation during labour

What are the fetal effects of epilepsy in pregnancy?

Fetus is relatively resistant to short term hypoxia during seizures Status epilepticus <1% pregnancies but dangerous Major risk of teratogenicity

Are all anticonvulsants teratogenic?

Yes- but never drugs are safe but now shown to have risks associated with use

What are the major malformations associated with anticonvulsants?

Neural tube defects Orofacial clefts Cardiac defects

What are the minor malformations associated with anticonvulsants?

Fetal anticonvulsant syndrome Dysmorphic features Hypertelorism Hypoplastic nails and distal digits

Complications in Pregnancy/Post Partum Flashcards

(51 cards)