Flashcards in Complications in Pregnancy/Post Partum Deck (51):
What are booking bloods?
FBC and Blood Group & Antibodies
Random Blood Glucose
When are monthly/fortnightly/weekly antenatal visits carried out?
Monthly till 28 wks
Fortnightly till 36 weeks
Weekly till delivery
When is Anti D administered?
28 and 34weeks
What is checked at each antenatal visit?
Accurately document gestation
What is the incidence of hypertensive disorders in pregnancy?
Severe PET 5/1000
What is gestational hypertension?
New HT >20wks without significant proteinuria
What renal disease can occur in pregnancy?
Increased serum uric acid (also placental ischaemia)
Acute renal failure- ATN, renal cortical necrosis
What liver disease can occur in pregnancy?
Abnormal liver enzymes
Hepatic capsule rupture
HELLP syndrome (haemolysis, elevated liver enzyme, low platelets)
What placental disease can occur in pregnancy?
How should risk factors for preeclampsia be managed?
What anti-hypertensive medications are used in pregnancy?
Nifedipine (usually if monotherapy fails-top up)
Stop ACE & ARBS
What can be used for severe hypertension e.g. 165/110?
Labetalol (oral or IV)
What BP should be aimed for in pregnancy?
If target organ damage, aim for <140/90 (if this consider reducing dose, if <130/90 reduce)
What management should be carried out in diabetes-related pregnancies?
Detailed USS including extended cardiac views
Diet, Metformin, Insulin
Retinal screening every trimester
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
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
What is the incidence of VTE in pregnancy?
What is the main cause of maternal death?
What is pregnancy in terms of coagulability?
A pro-coagulable state
Why is pregnancy pro-coagulable?
To decrease risk of PPH
What clotting cascade changes occur in pregnancy?
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?
What is the ratio of DVT starting in the left compared to the right leg?
Left > Right 8:1
What investigations are used in DVT?
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?
–FBC, clotting, Us & Es, LFTs
AntiXa levels- Not routine.
Platelet levels- Not routine
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?
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?
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?
Chest x ray
Duplex ultrasound lower limbs
Should CXR be performed in all women with suspected PE?
What findings can CXR detect in PE?
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?
Should heparin be stopped in labour?
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?
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?
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>
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?
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