Medical disorders in pregnancy Flashcards by Aisha Mujahid

what are the booking bloods

FBC and blood group and ABs
harm-globulins
infection screen - hep B, HIV, rubella, VDRL
RBG

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when is the booking visit 
dating USS
anomaly scan 
monthly visits are till when
anti D (2)
fortnightly visits when
weekly visits till when

8-12 weeks
11-12 weeks
20 weeks
till 28 weeks
28 and 34 weeks
28-36 weeks
37 weeks - delivery

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what should be checked/asked at every antenatal visit

document gestation
BP
urinalysis 
SFH (FSH)
fetal kicks/heart

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incidence of hypertension in pregnancy
PET
severe PET
eclampsia

10-15%
3-5%
5/1000
5/10000

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what is chronic (essential) ht
what is gestational ht
what is pre eclampsia

HTN present at booking or <20 weeks

new HTN> 20 weeks with proteinuria

new htn >20 weeks and significant proteinuria

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what can lead to an increased risk inPET

chronic hypertension in mothers

or gestational hypertension

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hypertension has what effects on the kidneys during pregnancy

increased GFR
proteinuria 
serum uric acid
cr/k/urea
oliguria/anuria
acute renal failure

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hypertension has what effect on liver

epigastric/RUQ pain
abnormal liver enxymes
hepatic capsule rupture
HELP

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what is HELP synd

type of pre eclampsia - haemolytic, elevated liver enzymes, low platelets

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placental and hypertension

IUGR
placental abruption
intra uterine death

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investigations for htn

u&amp;es
serum urate
LFTs
FBC
coag screen
CTG
US

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management at booking

if there are risk factors for pre eclampsia -> put on aspirin

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management of htn

labetalol
methyldopa
nifedipine (if the other two fail)

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what should be stopped in preg

ACE and ARBs

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what should be used in severe hypertension

labetalol PO/IV
hydralzaine IV
nifedipine PO

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target BP

<150/80-100
organ damage <140-90
if <140/90 consider reducing dose
if <130/90 reduce dose

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effects of hypertension on pregnancy and management of that

gestational htn
PET
eclampsia

monster BP, bloods, protein

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planning of delivery in htn

vaginal

deliver at 37 weeks if PET

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effects of pregnancy on DM

poorer control
deterioration of renal function
deterioration of ophthalmic disease
gestational DM

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effects of medical condition on pregnancy

miscarriage 
fetal malformations cardiac/NTD/caudal regression syndrome
IUGR/macrosomia
unexplained IUD
PET

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medications in DM

diet
metaformin
insulin

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planning of delivery in DM

vaginal

induce labour at 37-38 weeks

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what does having diabetes lead to in the baby

fetal hyperinsulinaemia which leads to increased fetal growth

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what 4 things does increased fetal growth lead to and whats a risk for each one

fetal macrosomia - risk of birth injury/shoulder dystonia

polyuria/polyhydramnios - risk of preterm labour/malpresentation/cord prolapse

increased oxygen demands/polycytheamia - risk of unexplained term stillbirth

neonatal hypoglycaemia - risk of cerebral palsy

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risk factors for gestations DM

``` previous GDM FH - one first degree relative or two second degree relatives poor obstetric history significant glycosuria polyhydramnios macrocosmic infant in this pregnancy PCOS weight>100kn or BMI >30 south asian, muddle eastern or african origin ```

BM target HBA1C target retinal screening when

4-6 <5% every trimester

growth scans in DM monitoring for what elective delivery

serial growth scans at 28, 32, 36 weeks PET 37-38 weeks in pre existing DM 38 weeks in GDM on insulin, may be 41 weeks if GDM on diet with normal Bfs and fetal growth

neonatal in DM

surveillance at delivery monitor BMs to ensure no neonatal hypoglycaemia

post natal management for mum in DM

return to pre pregnancy insulin/oral HG regime | GDM: stop treatment and monitor BM for 48 hours to ensure return to normal and no persistence

macrosmonia can lead to what

increased risk of birth injury/shoulder dystocia obstetric litigation major cause LSCS recommended in DM where macrosomia and EFW>4000g

polycythaemia effects on baby

thrombotic effects | jaundice

effects of pregnancy on VTE/PE | medications

increased risk of it | LMWH

what is the main cause of maternal death

VTE

pregnancy is a what state in terms of coagulability

pro coagulable

what are there increased levels of and decreased levels of in terms of clotting factors

increased factor 7,8,9,10,12 and increase in fibrinogen and number of platelets decrease in factors 11 and antithrombin 3

what are the risk factors for VTE and what should be done if there are < or 3 or 4 present

``` obesity age >35 parity 3 smoker gross varicose veins current PET immobility FH of unprovoked or oestrogen provoked VTE in first degree relative low risk thrombophillia multiple preg ``` <3 - mobilisation and avoidance of dehydration 3 - prophylaxis from 28 weeks 4 or more - prophylaxis from first trimester

any previous VTE is managed how

antenatal prophylaxiss with LMWH

how many DVTs are asymp | which leg more common

50% | L>R

ix of DVT

D dimer not done in preg duplex US therapeutic heparin

management of DVT

FBC, clotting factos, Uns, LFTs antixa levels platelet levels thrombophilia screen - not routine and controversial TEDs

LMWH in DVT preg

once daily outside preg 1.5mg/kg therapeutic dose 1mg/kg twice or once daily continue till 3 months after delivery or 6 months after treatment

SE of heparin

``` haemorrhage hypersensitivity allergy at injection site HIT - heparin induced thrombocytopenia osteopenia - osteoperosis on prolonged use ```

HIT

1-30% early in 5 days, usually mild late >5 days with unfractionated heparin

PE ix

``` ABGs CXR ECG duplex US ventilation/perfusion scans CTPA ```

CXR - who should it be done on | of negative what should be done

all women | bilateral compression duplex dopplers

duplex of lower limbs - useful or no

indirect way limits further tests if negative - doesn't help much

CTPA

less childhood cancer risk compared to VQ | increased breast cancer risk

labour and delivery in VTE/PE

stop heparin in labour in vaginal delivery stop therapeutic anaesthesia 24 hours before planned surgery stop prophylactic 12 hours before

what should be given post natally in VTE/PE

6 weeks or for a total of 3 months warfarin or LMWH

what should warfarin be avoided in

avoided in pregnancy 6-12 weeks - teratogenic, miscarriage, neurological problems, stillbirth stop 6 weeks before labour

effects of pregnancy on hypothyroid women

increase levy by 25-5-mcg in first trimester and repeat TFTs every trimester

effects of pregnancy on hyperthyroid women

gets worse due to HCG in first trimester | improves in second and third trimester

effects of hyperthyroid on pregnancy

IUGR preterm labour thyroid storm

medications in hyperthyroid

carbimazole/PTU propanolol for IUGR growth scans

respiratory changes in pregnancy

increase resp rate which can cause respiratory alkalosis | changes in PFTs

``` what happens to the tidal volume the inspiratory capacity FEV1 and PEFR residual volume expiratory reserve functional residual capacity ```

``` increases increases stay the same decreases decreases reduction in it ```

effects of pregnancy on asthma

can improve, deteriorate or stay the same

management of asthma

same

how many women of child bearing age have epilepsy

0.5%

what seizure types may be affected by pregnancy

all

what is epilepsy associated with

risks for maternal death due to aspiration

epilepsy in preg management

5mg folic acid | vit k from 36 weeks if taking hepatic enzyme inducing anti convulsants

effects of pregnancy on epilepsy

increase seizure frequency in some

effects of epilepsy on pregnancy

fetus resistant to short term hypoxia during seizures no increased risk of miscarriage or obstetric cx teratogenicity of drugs

pre conceptually in seizures

take folic acid 5mg/day at least 12 weeks prior to conception

epilepsy during pregnancy

continue folic acid continue current drugs if well controlled - unless phenobarbitone detailed fetal scan at 18-20 weeks with fetal cardiac scan at 22 weeks vit k 10-20 mg orally from 34-36 weeks

post partum management in epilepsy

neonate should have 1mg IM vit K

Medical disorders in pregnancy Flashcards

(67 cards)