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Medical Problems in Pregnancy


Drugs

  • Pharmacokinetics

  • Drugs which cross placenta

  • teratogenicity

  • drugs which enter breast milk

Diabetes in pregnancy

  • gestational diabetes

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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