Medical Disorders and Pregnancy Flashcards by Annie Caldwell

Can insulin cross the placenta?

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Can glucose cross the placenta?

Yes

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If the head is delivered but the shoulders aren’t, how quickly do you need to deliver the shoulders and what happens if this is not done?

5 minutes

Death due to hypoxia or brain damage due to hypoxia

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What can shoulder dystocia result in?

Stuck

Erb’s palsy

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Effects of T1DM in first trimester

Miscarriage
More prone to developing DKA
Congenital defects
- cardiac
- neural tube

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What is the risk of miscarriage in the general population?

6 - 8%

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What type of condition is pregnancy?

Diabetogenic

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Which weeks are the second trimester?

12 - 28 weeks

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Effects of T1DM in second trimester

Polyhydramnios

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What can be done after 28 weeks gestation to monitor growth?

Serial scans

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Management of a diabetic woman wanting to get pregnant

HbA1c < 48
Folic acid (5mg)
Make sure aware of hypo symptoms

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How much time before pregnancy should folic acid be taken?

3 months before

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Effects of T1DM in third trimester

Stillbirth (macrosomic babies)

Placental insufficiency

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When are scans done in a normal pregnancy?

12 - 14 weeks first scan
20 weeks anomaly scan
28 weeks onwards growth scans

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Effects of polyhydramnios

Pre term labour
Pre term rupture of membranes
PPH

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How does polyhydramnios cause its complications?

It stretches the uterus

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What can T1DM result in post delivery?

Neonatal hypoglycaemia
3 - 5% of the babies develop DM
Usually sugar levels of mum drop
Usually need pre pregnancy levels of insulin

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What is used to prevent respiratory distress syndrome of the neonate in DM?

Steriods

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Effects of DM in pregnancy to the mother

Increased insulin requirments 
Miscarriage 
Worsening of maternal DM 
Infections 
Jaundice

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Effects of DM on the foetus

Macrosomnia (foetal hypersinsulinaemia)
Neonatal hypoglycaemia
Resp distress 
Cardiac abnormalities 
Pre eclampsia 
Polyhydramnios 
Stillbirth 
Shoulder dystocia 
Impaired lung maturity of neonate

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What do steriods do to sugar levels?

Increase them and therefore need increased insulin dose

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How many doses of steriods are administered in DM and what steriods can be used?

2 doses

Bethamexasone or dexamethasone

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In T2DM, when do oral hypoglycaemics affect the foetus?

1st and 2nd trimester

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What is the only oral hypoglycaemic allowed in pregnancy? What has to be done if the diabetes is not well controlled on this?

Metformin

If cannot tolerate then need to be switched to insulin

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Risk factors for gestational DM

``` Multiple pregnancy Previous GDM in previous pregnancy FH of GDM FH of T2DM Obesity ```

What causes gestational DM?

The body cannot cope with the diabetogenic nature of the pregnancy

What 2 things are checked for every pregnant women?

BP | Urine dipstick

What things are checked for high risk women for GDM?

Bloods | OGTT

When is OGTT done in pregnant women?

28 weeks

Treatment of hyperthyroidism

PKU / Carbemazole RAI Surgery

Possible teratogenic effects of PKU? How common is this?

Failure to close scalp properly | Very rare

If the mother is on PKU as a treatment in pregnancy, what is usually done?

Change to carbemazole

Is a hyperthyroid mother in pregnancy high risk or low risk?

High

Effects of hyperthyroid in pregnancy

Hyperemesis more common (itself can also cause hyperthyroisim) Thyroid more stimulated in pregnancy If already on medication, requirements may increase Growth of baby altered Placental problems

What is a thyroid storm?

Once the baby is delivered, there can be drastic changes in hormones which can lead to MI etc

What needs to be done in a thyroid storm?

Antibodies need to be measured

Effects of hypothyroidism in pregnancy

Fertility problems | Neural tube problems (low IQ)

What is the most sensitive part of the babys body effected by the thyroid?

Brain tissue

What happens to the required dose of levothyroxine in the 1st trimester?

Increases

When do babies start producing their own thyroid hormones?

16 weeks

When is the skeletal form of the baby completed?

16 weeks

What is the risk of a controlled seziure free woman for 2 years during pregnancy and delivery?

Very low - 1 - 5% risk of seziure

What are all anti epileptic medications?

Teratogenic

How to change anti epileptic medications in pregnancy

Slowly Contraception until medication is sorted - do not rush pregnancy Need to have good control of epilepsy on new medication

What folic acid requirements do epileptic women trying to get pregnant need?

Very high dose

What can epilepsy itself increase the risk of?

NT defects

Effects of epilepsy in the 1st trimester

Miscarriage Foetal abnormalities Hyperemesis

Seizure frequency changes in pregnancy

60% remain the same 10% decrease 30% increase

Effects of epilepsy in the 2nd trimester

Growth restriction | Placenta affected

Effects of epilepsy in the 3rd trimester

Pre term labour | Placental abruption

Is epilepsy an indication for a C section?

What are women with epilepsy more prone to and why?

PPH | Can affect vitamin K factors etc

Is epileptic medication safe in breast feeding?

Yes (benefits > risks)

What type of medication can reduce the effectiveness of anti epileptic drugs?

COCP

What can sodium valproate reduce the effectiveness of?

COCP

What are the best contraceptive methods for a women with epilepsy?

Barrier methods | Coil

Post partum thyroiditis can be definitively diagnosed based on what 3 criteria?

1. Patient is within 12 months of giving birth 2. Clinical manifestations are suggestive of hypothyroidism 3. TFTs support the diagnosis

What is found in 90% of the patients with post partum thyroiditis?

Thyroid peroxidase antibodies

What are the 3 stages of post partum thyroiditis?

1. Thyrotoxicosis 2. Hypothyroidism 3. Normal thyroid function (but high recurrence rate in future pregnancies)

Treatment of post partum thyroiditis

Thyrotoxic phase - propanolol for symptom control | Hypothyroid phase - levothyroxine

What is the main presenting feature of obstetric cholestasis?

An intense itch

What is the most sensitive marker for obstetric cholestasis?

A rise in serum bile acids

What is the commonest cause of cardiac abnormality in pregnant women?

Mitral valve stenosis

What trimester of pregnancy is aortic dissection assosiated with?

3rd

Differential diagnosis of chest pain in pregnancy

Mitral stenosis Pulmonary embolism Aortic dissection

Most cases of MVS in pregnancy are assosiated with what?

Rheumatic heart disease

Predisposing factors in pregnancy for aortic dissection

HTN Congenital heart disease Marfans syndrome

What is the first line antihypertensive treatment for pregnant women with severe asthma?

Nifedipine

Which particular drug to treat UTI is contraindicated in the first trimester of pregnancy?

Trimethoprim

Treatment for obstetric cholestasis

Ursodeoxycholic acid Vit K supplementation Induction of labour at 37 weeks

When should anti-Xa activity be measured if a pregnant woman is on LWMH due to suspected DVT or PE?

Extremes of body weight Complicating factors e.g. - renal impairment - recurrent VTE

What does obstetric cholestasis increase the risk of?

Stillbirth

Another name for obstetric cholestasis

Intrahepatic cholestasis

Presentation of obstetric cholestasis

``` Pruritis - may be intense - typically on palms, soles and abdomen Jaundice (20%) Raised bilirubin (90%) ```

Effects of HTN in the eye

Diabetic retinopathy | Papilloedema in severe

What drugs are used to treat HTN in pregnancy?

Labetolol Nifedipine Methydopa

Contraindications to labetolol

Diabetes | Asthma

Why is labetolol contraindicated in DM?

It masks hypos

Why is labetolol contraindicated in asthma?

Causes wheeze

S/E of methyldopa

Depression

Side effects of nifedipine

Headaches | Oedema

Effects of mag sulphate in babies

Cerebral protective of the babies

How to monitor the treatment of VTE in pregnant women on LWMH if they are at extremes of body weight or have complicating factors (e.g. renal failure, recurrent VTE)?

Measurement of peak anti-Xa activity

When do pregnancy induced BP problems NOT occur before?

20 weeks

What should be done if a pregnant women is exposed to chickenpox in pregnancy?

Check VZV Antibodies

If VZV Abs are -ve during pregnancy, what must be done and in what time frame?

Give VZIGs | Only effective up to 10 days post exposure

Criteria for post partum thyroiditis

1. Within 12 months of giving birth 2. Clinical manifestation of hypothyroid 3. TFTs support diagnosis

Medical Disorders and Pregnancy Flashcards

(87 cards)