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

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