Medical Problems in Pregnancy
Drugs
Diabetes in pregnancy
Thyroid disease and pregnancy
- hypothyroidism
- hyperthyroidism
- anti-thyroid drugs cross placenta (propylthiouracil, carbimazole)
- thyroxine does not cross placenta
- thyroid stimulating hormone (TSH) and thyrotrophin releasing hormone (TRH)
do not cross placenta
- radioactive iodine should not be used
Epilepsy in pregnancy
- differential diagnosis with eclampsia
- anticonvulsant drugs
- teratogenicity
- pharmacokinetics
- folic acid
- oral contraceptive pills
- practical concerns of epileptic women
Anaemia in pregnancy
- definition - 11g / 100ml or more
Haemoglobinopathies in pregnancy
- sickle cell disease
- sickle cell trait
- haemoglobin C disease
- alpha-thalassaemia
- beta-thalassaemia trait
- beta-thalassaemia major
Cardiac disease in pregnancy
Normal changes
- plasma volume increases by 50%
- red cell volume increases by 20-30%
- total blood volume increases by 40%
- decrease in peripheral resistance, reduced blood viscosity
- increase in cardiac stroke volume and stroke rate
- cardiac output increases by 20%
Congenital cardiac anomalies (in mother)
- pulmonary hypertension
- potential for shunt reversal
- Marfan's syndrome
- aortic stenosis
- control hypertension
- avoid anaemia and respiratory infection
- avoid beta-sympathomimetics, ergometrine
Rheumatic heart disease
Ischaemic heart disease
Cardiomyopathy
Renal Disease in pregnancy
Normal Physiological changes
- Renal plasma flow and GFR increased by 40%
- Increased creatinine and urea clearance
- renal tubular reabsorption often exceeded for
- glucose
- amino acids
- folic acid
- water soluble vitamins
- iodine
- significant dilatation of renal pelvices and ureters
Urinary infection
- associated risks
- miscarriage
- hypertension
- anaemia
- premature labour
- chronic pyelonephritis
Polycystic renal disease
Chronic renal impairment with diabetes, systemic lupus erythematosus (SLE)
Renal transplant
- immunosuppressants teratogenic
- increased risk
- miscarriage
- hypertension
- severe pre-eclampsia
- foetal growth restriction
- urinary tract infection
- premature labour
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