Flashcards in Medical problems in pregnancy Deck (35):
What are the 3 types of liver disease in pregnancy? (3)
Acute fatty liver of pregnancy (severe fulminating illness)
Haemolysis (in pre-eclamptic toxaemia)
What physiological change in pregnancy puts increased risk on women with pre-existing heart disease? (1)
40% increase in blood volume in pregnancy, women with heart disease are unable to adequately increase cardiac output.
This increases risk of uterine hypo perfusion and pulmonary oedema.
What is chronic hypertension in pregnancy? (2)
Hypertension that is either present before conception or detected before 20/40.
Name 3 drugs that are acceptable for treatment of hypertension during pregnancy. (3)
Methyldopa, nifedipine, labetalol
NB ACEi are teratogenic
Define eclampsia. (1)
Name 2 symptoms of impending eclampsia. (2)
Tonic-Clonic seizures on a background of pre-eclampsia.
Severe headaches, vomiting, pain just below the ribs, visual disturbance, sudden swelling of face, hands or feet.
What is the management for a mother presenting with eclampsia? (3)
A/B: oxygen, maintain patency, ventilate if necessary
C: Left tilt, large-bore IV access, evaluate pulse and bp
Meds: IV magnesium sulphate 4g
Post-seizure: control BP, strict fluid management, may require CVP monitoring, deliver baby once stabilised, consider ITU
What is HELLP syndrome? (1)
HELLP syndrome is haemolysis, elevated liver enzymes and low platelet count.
What is gestational hypertension? (1)
Gestational hypertension is new hypertension presenting after 20 weeks without significant proteinuria.
What is pre-eclampsia? (1)
Pre-eclampsia is new hypertension presenting after 20 weeks with significant proteinuria.
What is severe pre-eclampsia? (1)
Severe pre-eclampsia is pre-eclampsia with severe hypertension and/or with symptoms, and/or biochemical and/or haematological impairment.
Define mild, moderate and severe hypertension. (3)
Mild hypertension 140-149 / 90–99 mmHg
Moderate hypertension 150-159 / 100-109
Severe hypertension 160+ / 110+ mmHg
Name any 2 of the features that would put a woman at high risk of developing pre-eclampsia. (2)
How should she be managed? (1)
CKD, chronic hypertension, previous gestational hypertension in previous pregnancy, Type 1 or 2 DM, SLE or phospholipid syndrome.
If any of high risk factors give aspirin 75mg after 12 weeks gestation until birth.
Name any 2 moderate risk factors for developing pre-eclampsia. (2)
When should these women be treated? (2)
More than 10 years since previous pregnancy
BMI >35 at booking
FH of pre-eclampsia
If more than 1 moderate risk factor give aspirin 75mg daily from 12 weeks until birth.
What should the target blood pressure be for hypertension in an uncomplicated chronic hypertensive lady? (1)
What should the target blood pressure be for hypertension in chronic hypertensive lady with evidence of end-organ damage? (1)
Keep lower than 150/100
Keep lower than 140/90
What gestation should birth be offered to women with chronic or gestational hypertension with bp less than 160/110? (1)
After 37 weeks
What is significant proteinuria? (2)
Diagnose significant proteinuria if the
- urinary protein:creatinine ratio is greater than 30 mg/mmol or
- a validated 24-hour urine collection result shows greater than 300 mg protein.
What is the first line treatment for gestational hypertension? (1)
Once 150/110 treat with labetalol daily.
Aim for < 150/100
What fetal monitoring should occur in a chronically hypertensive mother? (2)
1. US assessment of fetal growth and amniotic fluid
2. Umbilical artery doppler velocimetry
At 28-30 weeks and at 32-34 weeks.
CTG only if fetal activity abnormal.
If a mother has been diagnosed with severe gestational hypertension, or has pre-eclampsia, what fetal monitoring should be undertaken? (2)
At diagnosis: CTG, US assessment of fetal growth and amniotic fluid, Doppler of umbilical artery.
If normal repeat CTG no more than weekly and the US and doppler no more than fortnightly.
Name 2 indications for repeating CTG? (2)
Reported change in fetal movements
Deterioration in maternal condition
Give 2 factors that would place a woman at high risk of developing pre-eclampsia. (2)
Previous severe pre-eclampsia
Previous pre-eclampsia resulting in birth at <10th centile
Previous Intrauterine death
Previous placental abruption
How should a women who has been assessed as at high risk of developing pre-eclampsia be managed? (2)
US assessment of fetal growth and amniotic fluid assessment and umbilical artery doppler velocimetry from 28 weeks and repeated 4 weekly.
When should external cephalic version be offered? (1)
If uncomplicated singleton breech presentation at 36 weeks.
What gestation should women be routinely offered induction of labour? (1)
When should symphysis-fundal height be measured? (1)
From 24 weeks.
name 2 risk factors for development of gestational diabetes mellitus. (2)
Previous macrocosmic baby >4.5 kg
Family history of DM in first degree relative
South Asian or black caribbean or middle eastern
Sarah has type 2 diabetes mellitus, and wishes to conceive a child.
What HbA1c should she be aiming for? (1)
Good control of diabetes reduces the risk of miscarriage, congenital malformations, stillbirths and neonatal death.
When is testing done for gestational diabetes mellitus in at risk patients? (2)
If previous GDM at booking and at 24-28 weeks if negative
Other risk factors at 24-28 weeks, OGTT.
What is the pathophysiology of GDM? (2)
Pregnancy increases peripheral insulin resistance.
(increased secretion of insulin antagonists including hPL, cortisol, glucagon)
What are the management options for gestational diabetes mellitus? (2)
Diet and exercise (30mins walk after eating)
Medical: metformin, then insulin
(glibenclamide can be used if metformin unsuitable)
How can the risk of hypoglycaemia be reduced in women on insulin or glibenclamide? (1)
Aim for blood sugars over 4.0
Name 2 consequences of subclinical hypothyroidism in pregnancy? (2)
Intellectual impairment in childhood
Name 2 drugs that can be used to treat cholestasis in pregnancy. (2)
In diabete mellitus in pregnancy, when should delivery be performed? (1)