Flashcards in Week 4 part 2 Deck (90)
What are the effects of diabetes on pregnancy?
2. Fetal malformations cardiac, neural tube, caudal regression syndrome
4. Unexplained IUD
mEDICATIONS for diabetse in pregnancy>
Diet, metformin, insulin
When should labour be induced with diabetes?
At 37-38 weeks
Diabetes causes fetal macrosomia - what risk does this have?
Diabetes causes polyuria, polyhydramnios - what risk does this have?
Preterm labout/malpesntation/cord prolase
Diabetes causes increased O2 demands and polycythaemia - what risk does this have?
Risk of unexplained term still birth
Diabetes causes neonatal hypoglycaemia - what risk does this have?
Risk of cerebral palsy
Is PCOS a risk factor for gestational diabetes mellitus?
In pregnancy with pre-existing DM when should labour be induced?
At 37-38 weeks
Major cause of obsetric litigation?
What is LSCS recommended in DM where macrosomia and EFW greatr than 4000g?
What fetal effect of DM causes fetal malpresentations and possible increased risk preterm labouir?
What does hyperinsulinaema in fetus cause risk of?
wHAT IS THE leading cause of maternal death?
VTE - venous thromboembolism
wHAT ARE medications for VTE in pregnancy?
Is pregnancy pro-thrombotic?
Virchows triad in preganncy
Stasis - secondar to venous compression by pregnant uterus
Hypercoagulability - effects of pregnancy
Vascular damage - varicose veins
Evolutionary - why is pregnancy a pro-coaguable state?
To decrease risk of post partum haemorrhage
Pregnancy is a pro coaguable state - what factors are increased?
7,8,9,10,12 and fibrinogen, increased platelets
Pregnancy is a pro coguable state - what factors are decreased?
Factor 11 and antithrombin 3
Three risk factors for VTE (preexisting)?
greater than 35 years of age
also parity >3, elective CS, FH, varicose veins, systemic infection, immoblity, PET, twins
In pregnancy, if four or more risk factors for VTE?
Prophylaxis in first trimester
3 risk factors for VTE in pregnancy?
Prophylaxis from 28 weeks
Postnatally, if any previous VTE, anyone requiring antenatal LMWH, high risk thrombophilia, low risk thrombophilia + FH - what is managed?
High riSK - at least 6 weeks [pstnatal prophylactic LMWH
With DVT - what investigation is NOT done in pregnancy?
D-dimer - do ultrasound instead and give therapeutic heparin - treat then see!
What is the therapeutic dose of LMWH in pregnancy?
1mg twice daily OR once daily - continue until 3 months after delibery ot 6 months after treatment
Why is heparin safe in pregnancy?
Doesnt cross placenta - no anticoagulation effect on fetus
Side effects of heparin in pregnancy?
HIT - heparin induced thrombocytopenia
In PE in pregnancy what do u give before investigating?