Medical Problems in Pregnancy and Labour Flashcards

1
Q

maternal mortality is highest in what geographical region?

A

central africa

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2
Q

what are the most common causes of maternal death in the UK?

A

cardiac causes

VTE

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3
Q

what factors increase the risk of maternal mortality in pregnancy?

A

multiple health problems

vulnerabilities (children in social services, drug/alcohol abuse)

ethnicity

age

medication

overweight / obese

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4
Q

what are the most common medical problems (both direct and indirect) in pregnancy?

A
diabetes 
hypertension 
cardiac disease
respiratory disease
asthma 
VTE
connective tissue - APS / SLE
epilepsy
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5
Q

why is heart disease a common complication of pregnancy?

A

heart works around 40% harder during pregnancy - increased CO

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6
Q

if patients have a known congenital cardiac condition, how should they be managed in pregnancy?

A

pre-pregnancy counselling (esp on medication)

maximise scans (regular ECHO)

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7
Q

why do acquired heart conditions obviously start in pregnancy?

A

heart is asked to work a lot harder so disease traits may start to show

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8
Q

when is peri-partum cardiomyopathy usually diagnosed?

A

at time of birth

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9
Q

what symptoms are common with peri-partum cardiomyopathy?

A

orthopnoea (breathless when lying down)

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10
Q

how is continuity of care across different specialities managed in pregnant women with underlying conditions?

A

hand held / one track records

*these can be accessed by any clinician the pregnant patient sees

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11
Q

by how much does pregnancy increase the risk of MI and how is this prevented?

A

3-4x increased risk

check ECG (+CT) if required

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12
Q

the presence of what cardiac features would predict poor outcomes in pregnancy?

A
pulmonary hypertension 
cyanosis 
TIA
arrhythmia 
heart failure 
left heart obstruction 
aortic dissection 
MI
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13
Q

if patients have valvular heart disease or arrhythmias increasing risk of stroke, how should they be anticoagulated in pregnancy?

A

LMWH (does not cross placenta)

stop before delivery due to haemorrhage risk

warfarin can be recommenced 5 days post natal and is safe in breastfeeding

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14
Q

what palpitations can occur in pregnancy?

A

physiological (at rest / lying down)

ectopic beats (relieved by exercise)

sinus tachycardia (normal in pregnancy)

SVT (usually predates pregnancy)

hyperthyroidism

phaeochromocytoma (rare, associated with headache, sweating, HT)

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15
Q

describe the main respiratory changes that occur during pregnancy?

A

less residual capacity

increased O2 capacity to take in enough O2 for mother and foetus

SOB is common in 3rd trimester

SOB often improves with exertion (walking along corridor)

asthma = common in pregnancy

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16
Q

how is asthma normally treated in pregnancy?

A

treated as if patient is not pregnant

steroids safe for use in pregnancy

minimise asthma attacks as this can affect mother, placenta and thus foetal development

17
Q

acute asthma during labour is unlikely - true or false?

A

true - due to endogenous steroids

18
Q

what vascular factors cause increased risk of VTE in pregnancy?

A

virchow’s triad

  • hyper coagulability
  • venous stasis
  • vascular damage
19
Q

how should VTE be screened for?

A

DVT - look for symptoms / signs (swollen, hot, red limb)
PE - pleuritic pain, SOB etc

if suspicious of DVT

  • whole leg doppler (inc groin)
  • if negative, repeat in 1 week
20
Q

how is a suspected DVT managed?

A

LMWH (weight based) taken twice daily

- enoxaparin / dalteparin

21
Q

what investigations can be used to investigate a PE, and which of these may be avoided in pregnant women?

A

CTPA
- not used in pregnancy due to increased breast tissue and vasculature that can take up radiation (risk of breast cancer)

V/Q scan

22
Q

what teratogenic effects can warfarin cause?

A
midface hypoplasia 
stippled chondral calcification 
short proximal limbs 
short phalanges 
scoliosis
23
Q

for how long should anticoagulation be continued after pregnancy?

A

until at least 6 weeks post-natal AND at least 3 months post-partum

24
Q

connective tissue diseases such as APS and SLE can cause what complications to the actual pregnancy?

A
miscarriage 
pre eclampsia 
abruption 
growth restriction (due to small vessel disease affecting placenta)
still or preterm birth
25
Q

what complications can connective tissue disease drug treatments cause?

A
teratogenic 
fetotoxic 
sepsis 
diabetes 
osteoporosis
26
Q

what drugs that may be used in connective tissue disease are not safe in pregnancy?

A

NSAIDs
cyclophosphamide
methotrexate
penicillamine

27
Q

how are patients normally diagnosed with APS?

A

antiphospholipid autoantibodies - positive on 2 tests >6 weeks apart

clinical disease picture (ie recurrent miscarriage / clotting, severe pre-eclampsia etc)

28
Q

what pregnancy outcomes are common for patients with APS?

A

early pregnancy loss
T2/T3 IUD
preterm birth
foetal growth restriction

29
Q

how are patients with APS normally managed in pregnancy?

A

if no previous complications = foetal and maternal surveillance

others = low dose aspirin and LMWH during pregnancy

*consider prophylaxis also

30
Q

what is the most important risk factor for determining seizure deterioration in pregnancy?

A

seizure free period

no seizure in 9 months prior to pregnancy, up to 92% of mothers will remain seizure free

31
Q

what obstetric complications can occur as a result of a woman having epilepsy during pregnancy?

A
miscarriage 
antepartum haemorrhage 
pre-eclampsia 
IOL/C-section 
PPH
32
Q

what are the largest risk to the foetus if a mother has a seizure during pregnancy?

A

maternal abdominal trauma - foetal-maternal haemorrhage

preterm birth

hypoxia / acidosis

33
Q

by how much do AEDs increase the risk of teratogenicity in a foetus and how can this be minimised?

A

2-3x increased risk for any AED

reduce polytherapy as this increases risk
use lowest effective dose where possible
avoid valproate
counsel epileptic patients on contraception

34
Q

give examples of foetal malformations from AEDs which can be visualised on a 20 week anomaly scan?

A

spina bifida

heart defects (eg septal)

lip defects (cleft-lip palate)

35
Q

seizure risk is higher during labour - true or false?

A

true

stress, pain, sleep deprivation, over-breathing and dehydration increase the risk of intra-partum seizures

36
Q

if status epilepticus occurs during labour, what procedure is carried out?

A

left lateral tilt - takes pressure of uterus off of aortic / caval vessels

37
Q

what “baby-safety” measures have been put in place for mothers with epilepsy?

A
avoid excessive fatigue 
safe feeding position 
lowest setting for high chairs 
dress baby on the floor 
using padded sling / carry cot
38
Q

what perinatal outcomes are common in pregnant mothers who are obese?

A

congenital abnormalities
macrosomia
shoulder dystocia
stillbirth

39
Q

how should pregnant mothers who are obese be managed during pregnancy?

A

check BMI at booking appointment

PET prophylaxis - aspirin

thromboprophylaxis

OFTT at 26-28 weeks

anaesthetic review at 34 weeks

MDT plan for labour and birth