Medical Problems in Pregnancy and Labour Flashcards
most common causes of maternal mortality in order?
cardiac disease
thrombosis/thromboembolism
other indirect cause
neurological
what medical problems are common in pregnancy?
diabetes and hypertension mainly cardiac disease resp disease - asthma venous thromboembolism connective tissue disease epilepsy obesity
what cardiac changes are seen in pregnancy?
blood volume increases by 30% plasma volume increases 45% CO increases 30-50% stroke volume increases 25% HR increases 15-25% peripheral vascular resistance decreases 15-20% CVP unchaged
what cardiac factors can predict ability to tolerate pregnancy and any adverse outcomes?
pulmonary hypertension NYHA heart failure classification presence of cyanosis TIA arhythmia heart failure left heart obstruction (MV <2cm, AV <1.5cm or >30mm) aortic root >45mm myocardial dysfunction (EF <40%)
what benign cardio symptoms are common in pregnancy?
palpitations
extra-systoles
systolic murmurs
what cardiac symptoms are more likely to be fatal in pregnancy?
pulmonary hypertension
fixed pulmonary vascular resistance
implications of anti-coagulation in women with valvular heart disease should be considered
what can cause palpitations in pregnancy?
physiological (common, occur at rest)
ectopic beats (common, thumping relieved by exercise)
sinus tachycardia (normal but should investigate to rule out pathology)
SVT (paroxysmal, usually predates pregnancy)
hyperthyroidism
phaeochromocytoma (rae, associated with headache, sweating and hypertension)
how are palpitations investigated in pregnancy?
ECG ECHO FBC TFT 24 hr ECG if SVT suspected free T4 if thyroid suspected 24hr catecholamines and US if phaeochromocytoma suspected
what lung functions increase in pregnancy?
O2 consumption (higher demand) metabolic rate resting minute ventilation tidal volume PaO2 arterial pH
what lung functions decrease in pregnancy?
functional residual capacity
PaCO2
what lung functions stay the same in pregnancy?
resp rate
vital capacity
FEV1 and PEFR
what ABG result is common to see in pregnancy?
compensated resp alkalosis
how does breathlessness commonly present in pregnancy?
seen in up to 75%
increased awareness of physiological hyperventilation
more common in 3rd trimester
often at rest or while talking
improves with exertion
shouldnt limit normal activities but can lead to indigiestion
commonest chronic medical disorder to complicate pregnancy?
asthma
how does pregnancy affect asthma?
may improve deteriorate or remain unchanged
clinical features same as non-pregnant
can deteriorate due to reduction or cessation of therapy due to safety concerns
those who improve may experience deterioration during puerperium
course of asthma similar in successive pregnancies
does asthma cause a risk in pregnancy?
well controlled asthma has no effect on pregnancy outcome
- can cause problems if severe or poorly controlled, poorly controlled is a bigger risk than the medications used to treat it
step up asthma treatment?
- SABA
- SABA + steroid
- add LABA
- increase steroid
- add 4th drug (LTRA, theophylline
- oral steroid
intra-partum care in asthma?
aim for vaginal birth
asthma attack during labour is rare due to endogenous steroids but should not stop inhalers anyway
IV hydrocortisone if oral steroids >2 weeks
VTE risk in pregnancy?
increased risk during pregnancy and in puerperium
what blood factors can cause hypercoagulability?
increased von willebrand factor increased factors 7, 9, 10 and 12 increased fibrinogen reduced protein S acquired aPC resistance impaired fibrinolytic activity
when is VTE prophylaxis given in pregnancy?
4+ risk factors = prophylaxis from 1st trimester 3 risk factors = prophylaxis from 28 weeks major risk factor = antenatal prophylaxis with LMWH high risk (previous VTE) = must give LMWH and refer to thrombosis in pregnancy team
