Pregnanncy

how would you test for pregnancy

human chorionic gonadotrophin. hCG doubles every 29-53hrs during the first 30 days, then declines after 8-10weeks

what is the all or nothing effect

first 2 weeks of pregnancy, if anything teratogenic is taken- embryo will abort itself

what is developing in weeks 3-8

major organ systems

what is developing in 4-6month

cerebellum + urogenital system forming

what happens if you give NSAIDS/B-blockers to a woman in 3rd trimester

pulmonary hypotension / hypoglycaemia

Almost all medications cross by ____

simple diffusion into the placenta

Drugs that have a ___ MW tend NOT to cross

high (more than 600-800Daltons) eg. heparin or insulin

Lipid/ Water soluble drugs have a higher affinity to cross the placenta

Lipid

Acidic / Basic drugs cross preferentially and why

Basic, because pH of placenta is less than pH of maternal blood eg. pethidine

Do we use newer medications or older in pregnancy?

older due to evidence

what are some problems with A-X categories

Implies hierarchy ‘C worse than B’, it does not consider clinical context eg. if someone is taking anti-epileptics vs if they don’t. another issue is that it assumes that all in the same category carry the same risk- but valproate carries higher risk than paroxetine but in same category. Once new drugs are rated, usually never changes and if it does change its usually down. No consideration of dose/route

what are the 3 vitamins and doses for pregnancy

Folic acid 500mcg daily, Iodine 150mcg daily, Vitamin D 400IU daily

when should you start taking folic acid before pregnancy

4 weeks before conception to end of first trimester

if someone has an increased risk of NTD when should they start taking folic acid and dose

3 months prior to conception, 5mg dose

why is iodine useful in pregnancy

required for healthy brain development in fetus

when to start taking iodine and what dose

150mcg before conception and throughout whole pregnancy + breastfeeding

are seaweed/kelp tablets useful in iodine deficiency

DO NOT TAKE- too much iodine foetal thyroid is very sensitive and they can be born with congenital hyperthyroidism

do exclusively breastfed babies need vit D supp?

Yes, 400IU daily for the first 6-12months

What puts a mum at higher risk of Vit D def

limited exposure to light, dark skin, BMI over 40kg/m

Do all pregnant women need iron supplementation

No, pregnant women have iron requirements 1.5 times greater than non-pregnant women. Routine supp not recommended- preferred to get it from diet

If ferritin levels are low in pregnancy- can you ‘eat’ your way out of anaemia?

no- supplementation needed

what is the dose of iron if pregnant women is deficient

100mg elemental iron alt daily up to bd. Infusion is an option if constipation/ GI upset NOT IN 1ST TRIMESTER

What conditions would you need routine vitamin B12 supp

Vegetarian/ vegan, coeliac disease, IBD, autoimmune diseases, prolonged use of PPI’s

what is the dose of B12 during pregnancy + breastfeeding

pregnancy: 2.6mcg/day, BF = 2.8mcg/day

Which vitamin in a high dose given during pregnancy can cause defects

Vitamin A- C/I in pregnancy

When do you take calcium during pregnancy ? and dose

Only if deficient. 14-18yrs: 1300mg daily. 18+yrs= 1000mg daily

Omega-3 fatty acids are needed ?

Sure why not- 1g day

What are some lifestyle changes to prevent morning sickness

Avoid an empty stomach-prevent a full stomach, avoid spicy/fatty foods, dry crackers before getting up in the morning, high protein snack before bed

what is a NOT GREAT treatment for morning sickness

ginger tablets 250mg q6h- caution if history of miscarriage… travel sickness bands are meh

What is severe N+V called

Hyperemesis gravidarum

When would you use pyridoxine in pregnancy and what dose, any special considerations

N+V. 25-50mg up to tds. Check that no other products contain Vit B6. TGA requires any product 10mg+ of B6 to have warning about peripheral neuropathy. TGA max = 100/day but some 200/day is still ok

When would you use doxylamine in pregnancy and what dose, any special considerations

N+V. 12.5mg mane, 12.5mg afternoon, 25mg nocte. Not licensed but is well established. Causes drowsiness

When would you use promethazine/ prochlorperazine

N+V but it is category C

When would you use metoclopramide, dose

N+V. Cat A. Dose = 5-10mg tds PO/IM/IV

Can you use ondansetron in pregnancy?

Yes. Cat B1 so not really well established

What are some dietary modifications for GORD

Reduce meal sizes, Avoid gastric irritants eg. chocolate, coffee, citrus juices, fizzy drinks, greasy/spicy/acidic foods. drink water at least half an hour before a meal. chewing gum stimulates salivary glands and may neutralize acid.

what are some positioning modifications for GORD

sleep elevated, lying on left side may cause less frequent reflux, avoid lying down immediately after eating

when dietary mods fail, what pharmacotherapy would you add for GORD

1. Calcium/ Mg based antacids (Liquid > solids) + Aluminium containing antacids cause constipation = avoid.

2. H2 receptor antagonists eg. famotidine 20mg bd or ranitidine 150mg bd

3. Metoclopramide

4. Omeprazole 20-40mg od if unresponsive

Diet and lifestyle points for someone who is constipated (4)

increase fibre, adequate fluid intake, increased activity, response to defecation urge

name some bulk forming laxatives and how they work

psyllium husk. absorb water in the bowel and increase faecal bulk and stimulate perstaltic activity

Name some osmotic/iso-osmotic laxatives and how they work

lactulose, glycerol, macrogols. draw water into the bowel and allow for stimulation of peristaltic acitivty

Name some stool softeners and how they work

docusate, liquid paraffin, poloxamer. soften stool and increase ability to pass faeces

Which stimulant laxative do we avoid in pregnancy

castor oil- may induce premature labour

What is leucorrhoea and why is it occuring during pregnancy

thick white vaginal discharge. due to high levels of oestrogen and marked shedding of superficial mucosal cells in the vagina. Increases your risk of thrush, investigate for itch. Tx with clotrimazole, miconazole

what is 1st line for pre-existing diabetes for birth parent

Insulin - bolus/basal

why might metformin be used during pregnancy

uncontrolled patients and to assist with weight loss/maintenance and decreased incidence of hypertension

what is pre-eclampsia and how is it diagnosed

raised blood pressure after 20 weeks gestation, accompanied by other organs such as: renal, haematological, liver, neurological, pulmonary oedema, fetal growth restriction, proteinuria. slow or quick deterioration- headache.

Can you use ARB’s/ ACEi’s in pregnancy

NO- renal complications / fetal death

Is HTN a concern in pregnancy?

Yes

what are some fetal complications associated with pre-eclampsia

fetal growth restriction, fetal death in utero, perinatal death, neonatal complications asso with preterm birth, hypoxic / neurological injury

what is first line antihypertensive therapy

Methyldopa or Labetalol (avoid in women with asthma)

what is 2nd line antihypertensive therapy

Nifedipine (ADR: severe headache in first 24h, flushing, tachycardia), Prazosin (Orthostatic hypotension) or Hydralazine (Flushing, headache, nausea, lupus like syndrome)

List some treatments for SEVERE HTN

IV Labetalol, IV Hydralazine, Oral Nifedipine

Why do we give Magnesium Sulphate IV

neuroprotection of preterm baby before 30 weeks, halves the risk for progression to eclampsia, first line seizure for ANY seizure in pregnancy

what is the thought MOA of MgSO IV

Neuromuscular blocking action: relaxes smooth muscles including vasculature and reduces cerebral ischaemia

which + why would we give corticosteroids to mother if baby needs to be delivery preterm

betamethasone/ dexamthasone (usually never see this tho). helps with fetal lung maturation when at risk of preterm birth. Monitor BSL until 48hrs after last dose.