Make your own free website on Tripod.com

Pre-conception advice


The obese patient

  • F - foetal monitoring is difficult

  • A - abdominal delivery is difficult

  • T - thromboembolic disease is more common

Deaths in early pregnancy

  • Maternal death rate 1:3000

  • Complications of termination of pregnancy

  • Thromboembolism

    • risk increase in Caesarean section

    • haematological conditions - antiphospholipid syndrome, protein C/ Protein S / Factor V Leiden deficiencies

Drugs

  • 1st trimester is usually best to avoid
  • Lithium can lead to cardiac abnormalities
  • Tricyclic antidepressants, Prozac
  • sodium valproate - can lead to neurodevelopmental abnormalities, change to phenobarbitone
  • warfarin
  • thalidomide
    • effects on angiogenesis
    • leads to phocomelia

Neural tube defects

  • so take folic acid before conception

Diabetes

  • Macrosomia
  • increased risk of foetal abnormalities expecially sacral agenesis
  • increased risk of intrauterine death

Infections

  • Rubella
    • in 1st 4 weeks leads to CVS, eye abnormalities
    • in 2nd 4 weeks leads to eye and brain abnormalities
    • in 3rd 4 weeks leads to brain and hearing abnormalities
  • Varicella-Zoster
    • encephalitis, hepatitis
    • 1st 12 weeks -  not such a big risk
    • 12-24 weeks - risk scarring, blindness, distortion of limbs
    • treat mother with acyclovir
    • if exposure of mother then VZV-Ig
  • HIV
  • Toxoplasmosis
    • retinitis, cerebral calcifications, hydrocephalus
    • from cat faeces
  • Malaria
    • cause of maternal death
    • chronic anaemia
    • haemolysis

Maternal Medical conditions

  • Worsening of asthma, epilepsy

Cardiac abnormalities

  • previous congenital abnormality
  • rheumatic fever leading to valvular disease
    • may need antibiotic cover during delivery
  • Ischaemic heart disease

Cancer

  • breast
  • melanomas
  • colon
  • brain

Pre-eclampsia


Home ] Up ]