Medical disease in pregnancy

Question 1

How to diagnose thyroid disease in pregnancy

Answer 1

TSH + free T4
Ultrasound
NO RAIU!

Question 2

How to manage thyroid disease in pregnancy

Answer 2

Thyroid levels will change due to changes in blood -> Regular (4w) TSH monitoring.
Adjust thyroid meds
Consider surgery in 2nd trimester for hyperthyroidism

Question 3

How to manage epilepsy in pregnancy

Answer 3

Switch to least teratogenic meds(levetiracetam)
Switch to lowest theraputic dose
Ensure on folic acid
Offer abnormality screening with option to abort/plan

Question 4

How to manage UTIs in pregnancy

Answer 4

Treat even if asymtomatic. Usual meds: amoxicillin or nitrofurantion (bkp, ?tertatogenic) + rescreen after treatment
Do NOT use: TMP/SMX, ciprofloxacin

Question 5

What are the signs for pylonephritis

Answer 5

Fever, costophrenic angle tenderness, white cell casts in urine

Question 6

Safe hypertension meds in pregnancy

Answer 6

alpha-methyldopa, labetalol, hydralazine

STOP: ACEi, ARB, CCBs, diuretics

Question 7

How to manage DM in pregnancy

Answer 7

Move from orals to insulin (tighter control, reqs. will increase)
Monitor with postprandial glucose