Medical Complications in Pregnancy

Question 1

Name seven types of cardiac disease that can present in pregnant women

Answer 1

• Congenital heart disease
• Acquired heart disease
• Pulmonary hypertension
• Cardiomyopathy
• Artificial heart valves
• Ischaemic heart disease
• Arrhythmias

Question 2

What cardiac diseases are classed as high risk?

Answer 2

Pulmonary Hypertension 
Presence of cyanosis 
TIA/arrhythmia
Heart failure 
Left heart obstruction 
Aortic root >45mm
Myocardial dysfunction

Question 3

Describe the NYHA classification

Answer 3

I - no limitation
II - mild symptoms during activity
III - marked symptoms during daily life
IV - symptoms at rest

Question 4

What cardiac symptoms are physiological in pregnancy?

Answer 4

Palpitations
Ectopic beats
Sinus tachycardia

Question 5

What conditions can cause cardiac symptoms in pregnancy?

Answer 5

Hyperthyroidism

Phaeochromocytoma

Question 6

What tests can investigate heart disease in pregnant women?

Answer 6

ECG
FBC
TFT
Echo
US

Question 7

Describe the effect of hyperventilation in a pregnant woman

Answer 7

PaO2 increases and PaCO2 falls causes a higher arterial pH and alkalosis

Question 8

Is breathlessness normal or abnormal in pregnancy?

Answer 8

Normal - improves on exertion

Question 9

What percentage of women will have an acute asthma exacerbation during pregnancy?

Answer 9

10%

Question 10

What can be given in asthmatic women to cover the stress of labour?

Answer 10

IV Hydrocortisone

Question 11

Where do most DVTs occur in pregnant women?

Answer 11

Ilio-femoral area

Question 12

State Virchow’s triad

Answer 12

Hypercoagulability
Venous stasis
Vascular damage

Question 13

What are the signs/symptoms of a DVT?

Answer 13

Swelling, oedema, leg pain/discomfort, tenderness, increased temperature, lower abdominal pain, increased WCC

Question 14

How is a suspected DVT investigated?

Answer 14

Compression duplex ultrasound

• normal - repeat in 7 days
• abnormal - MRI venography

Question 15

What are the signs/symptoms of PTE?

Answer 15

Dyspnoea, chest pain, faintness, collapse, haemoptysis, raised JVP, focal signs in chest, signs of DVT, ECG and CXR abnormalities

Question 16

Name two ways in which a PTE can be investigated

Answer 16

CTPA

V/Q scan

Question 17

What blood thinner is highly teratogenic?

Answer 17

Warfarin - causes scoliosis, short limbs, short phalanges, chondral calcification
Dose dependent - >5mg/day

Question 18

Describe post natal anticoagulation

Answer 18

Commence warfarin 5th post-natal day and continue for 6 weeks - 3 months post party

Question 19

Name four connective tissue diseases that can cause problems in pregnancy

Answer 19

Lupus - renal and haematological
Rheumatoid
Scleroderma - renal and pulmonary hypertension
ASP

Question 20

State the connective tissue treatments that are contraindicated in pregnancy

Answer 20

NSAID 
Cyclophosphamide 
Methotrexate 
Gold 
Penicillamine 
MMF 
Chlorambucil 
Leflunamide

Question 21

What is APS?

Answer 21

Anti-phospholipid syndrome - acquired thrombophilia where anti-phospholipid antibodies react with the phospholipid part of the cell membrane

Question 22

Name two antiphospholipid antibodies

Answer 22

Anticardiolipin

Lupus anticoagulant

Question 23

What are the clinical features of APS?

Answer 23

Thrombosis
Recurrent early pregnancy loss 
Late pregnancy loss 
Placental abruption 
Severe early onset pre-eclampsia 
Fetal growth restriction

Question 24

How is APS diagnosed?

Answer 24

Clinical feature + laboratory testing

Question 25

What clinical features are diagnostic of APS?

Answer 25

Pregnancy morbidity >3 miscarriages, >1 foetal loss, >1 preterm birth Vascular thrombosis

Question 26

What is the laboratory testing for APS?

Answer 26

Positive antibodies on two occasions more than 6 weeks apart

Question 27

How is APS managed?

Answer 27

No thrombosis - low dose aspirin + surveillance Previous thrombosis - LDA, treatment dose LMWH Recurrent early pregnancy loss - LDA + prophylaxis LMWH Late foetal loss = LDA + prophylaxis LMWH

Question 28

What is the risk to a baby if mum has a seizure?

Answer 28

Abdominal trauma - maternal fetal haemorrhage Premature pre-rupture membranes Preterm birth Hypoxic acidosis

Question 29

What is the risk to a baby if mum has epilepsy?

Answer 29

``` Malformations Adverse outcomes Developmental effects Haemorrhage disease Childhood epilepsy ```

Question 30

How is a seizure during labour treated?

Answer 30

Left lateral tilt, benzodiazepines/phenytoin, may require C-section Magnesium sulfate to cover eclamptic seizures

Question 31

State some ways to ensure baby safety when mum is epileptic

Answer 31

Not in a side room, change baby on the floor, safe feeding position, avoid triggers, special pram, bathing support

Question 32

What proportion of women are obese?

Answer 32

1/3

Question 33

What are obese women at more risk of?

Answer 33

``` Miscarriage VTE Infection Macrosomia Diabetes C-section Hypertension Haemorrhage Congenital abnormality ```

Question 34

How are obese women managed antenatally?

Answer 34

``` Low dose aspirin >12 weeks Thromboprophylaxis Detailed anomaly US OGTT Foetal growth scan Anaesthetic reveiw ```