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Medical Complications of Pregnancy

Medical Complications of Pregnancy

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An overview of the more common medical complications of pregnancy.
An overview of the more common medical complications of pregnancy.

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Published by: MemMed Administrator on Jan 16, 2009
Copyright:Attribution Non-commercial

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09/29/2012

 
Medical Complications of Pregnancy15
th
Jan 2009Rob Bradley1
 
Medical complications inPregnancy
 
 
Medical complications inPregnancy
Pregnancy effect on disease
Disease effect on pregnancy
 
 
Medical complications inPregnancy
Diabetes
Thyroid
 Asthma
Epilepsy
Renal
Cardiac
Obstetric cholestasis
 
 
Medical complications inPregnancy
Diagnosis
Pregnancy specific issues
 – 
Effect of pregnancy on disease
 – 
Effect of disease on pregnancy
Management
 – 
Prevention of complications
 – 
Monitoring
Post natal issues
 
 
Medical complications inPregnancyDiabetes
 
 
Diabetes in pregnancy
Glycaemic control
 – 
insulin
 – 
diet
Monitor complications
 – 
retinopathy
 – 
nephropathy
Preventative advice for GDM
 
Medical Complications of Pregnancy15
th
Jan 2009Rob Bradley2
 
Diabetes in pregnancy
Fetal malformation
Fetal macrosomia
Intrauterine death
 
 
Diabetes in pregnancy
Screening for GDM
Glycaemic control
 – 
pre-conception
 – 
during pregnancy
 Anomaly screening
Fetal growth assessment
Delivery planning
 – 
gestation
 – 
mode
 
 
Medical complications inPregnancyThyroid
 
 
Thyroid in pregnancy
Hypothyroid
Pregnancy has little effect on disease
 – 
no monitoring if good control pre-pregnancy
Severe untreated hypothyroidism
 – 
infertility, menstrual disturbance
 – 
miscarriage, PET, LBW
 
 
Thyroid in pregnancy
Hyperthyroid
95% Graves
 – 
TSH stimulating antibodies
May improve with pregnancy
Severe untreated hyperthyroidism
 – 
infertility, menstrual disturbance
 – 
miscarriage, IUGR, preterm labour
Poor control may result in thyroid crisis
Good outcome with adequate control
 
 
Thyroid in pregnancy
Hyperthyroid
Treat with PTU or carbimazole
 – 
PTU for new cases
 – 
lowest effective dose
Thyroid stimulating Ab measurement
 – 
neonatal observation for up to a week 
Beta blockers for severe symptoms
Neonatal TFTs
 – 
cord and at 2 weeks
 
Medical Complications of Pregnancy15
th
Jan 2009Rob Bradley3
 
Medical complications inPregnancy Asthma
 
 
 Asthma in pregnancy
Usually no significant change
Continue medication
 – 
reassure re safety
 
 
Medical complications inPregnancyEpilepsy
 
 
Epilepsy in pregnancy
Some worsen, most stable
Teratogenesis
(background 2-3%)
 – 
National Teratology Unit 0191 232 1525
 – 
6% one drug, 15% two, 50% three
 – 
NTDs (valproate & carbamazepine)
 – 
orofacial clefts (phenytoin)
 – 
heart defects (phenytoin & valproate)
 
 
Epilepsy in pregnancy
Folic acid 5mg -conception +/-12 wks
Rationalise drug therapy
 Anomaly scans (NB heart)
Drug levels if control worsens
 Vitamin K (10mg po od) from 36/40
Neonatal vitamin K 
 
 
Medical complications inPregnancyRenal

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