Medical Complications of Pregnancy

15th Jan 2009 Rob Bradley

Medical complications in Pregnancy

Medical complications in Pregnancy

• Pregnancy effect on disease • Disease effect on pregnancy

Medical complications in Pregnancy
• • • • • • • Diabetes Thyroid Asthma Epilepsy Renal Cardiac Obstetric cholestasis

Medical complications in Pregnancy
• • Diagnosis Pregnancy specific issues
– Effect of pregnancy on disease – Effect of disease on pregnancy

Management
– Prevention of complications – Monitoring

Post natal issues

Medical complications in Pregnancy

Diabetes in pregnancy
• Glycaemic control
– insulin – diet

Diabetes

Monitor complications
– retinopathy – nephropathy

Preventative advice for GDM

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Medical Complications of Pregnancy

15th Jan 2009 Rob Bradley

Diabetes in pregnancy

Diabetes in pregnancy
• • Screening for GDM Glycaemic control – pre-conception – during pregnancy Anomaly screening Fetal growth assessment Delivery planning – gestation – mode

• Fetal malformation • Fetal macrosomia • Intrauterine death

• • •

Medical complications in Pregnancy

Thyroid in pregnancy
Hypothyroid Pregnancy has little effect on disease
– no monitoring if good control prepregnancy

Thyroid

Severe untreated hypothyroidism
– infertility, menstrual disturbance – miscarriage, PET, LBW

Thyroid in pregnancy
Hyperthyroid • • • 95% Graves
– TSH stimulating antibodies

Thyroid in pregnancy
Hyperthyroid • Treat with PTU or carbimazole
– PTU for new cases – lowest effective dose

May improve with pregnancy Severe untreated hyperthyroidism
– infertility, menstrual disturbance – miscarriage, IUGR, preterm labour

• • •

Thyroid stimulating Ab measurement
– neonatal observation for up to a week

• •

Poor control may result in thyroid crisis Good outcome with adequate control

Beta blockers for severe symptoms Neonatal TFTs
– cord and at 2 weeks

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Medical Complications of Pregnancy

15th Jan 2009 Rob Bradley

Medical complications in Pregnancy

Asthma in pregnancy
Usually no significant change Continue medication – reassure re safety

Asthma

Medical complications in Pregnancy
• •

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

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 in Pregnancy

Renal

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Medical Complications of Pregnancy

15th Jan 2009 Rob Bradley

Renal disease in pregnancy
• • • • UTI more common Chronic renal disease may get worse
– more BP, more proteinuria – pregnancy loss, IUGR, pre-term delivery

Renal disease in pregnancy
• • • • Pre-conception counselling Joint care Option of ToP Timing of delivery

CRF on dialysis bad outcome
– only 20-30% successful

Renal transplant
– little effect on kidney in most cases – generally good outcome if good renal function

Medical complications in Pregnancy

Heart disease in pregnancy
• Worse outcome with:
– cyanosis – pulmonary hypertension – degree of dyspnoea

Heart disease

• • • • •

Discuss ToP if appropriate Fetal congenital heart defect Joint care including anaesthetist Time and mode of delivery Antibiotic prophylaxis (SBE)

Medical complications in Pregnancy
• • • • • •

Obstetric cholestasis
rcog.org.uk – green top guidelines 2006

Obstetric cholestasis

Itching, raised ALT & bile salts SB rate similar to general population SB not related to level of ALT or bile salts No tests predict SB Symptomatic relief for itching Vitamin K orally to reduce PPH

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