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21 Cards in this Set
- Front
- Back
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How can epilepsy affect fertility and contraception? |
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How does epilepsy and anti-epileptic medications affect pregnancy? |
Epilepsy seizures in pregnancy can result in the risk of fetal hypoxia and increased risk of stillbirth and small for gestational age AEDs are teratogenic and can cause major structural malformations (2-3 x population) and neurocognitive impairment. E.g. Sodium valproate can cause NTDs, hypospadias, heart defects, craniofacial anomalies, skeletal anomalies and developmental delay Additionally, AEDs decrease the availability of serum folate, so it is advised for women to take 5mg/day at least 1 month prior to conception. And even if there is no AEDs, there is higher risk of NTDs wth maternal epilepsy. So there is a fine balance between maintaining seizure control and minimising teratogenic risks and folic acid depletion. Remember, need to thus consider the effect of pregnancy on seizures, epilepsy on obstetric outcome, role of drug monitoring and screening for abnormalities, and the role of vitamin K |
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How does pregnancy affect epilepsy? |
Seizure activity doesn't always change in first trimester, but 16% improve and 17% deteriorate. There can be a decrease in compliance and absorption of drug (due to n&v), impaired sleep and reduced drug levels because of the increased volume of distribution and increased metabolism (lamotrigine). |
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What is the role of vitamin K in epilepsy and AED use in pregnancy? |
AEDs induce fetal hepatic enzyme activity and reduce vitamin K levels, causing neonatal bleeding. Antenatal administration of vitamin K is controversial, but the administration of konakion to the neonate is recommended for all.
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How should seizure risks be managed during intrapartum period/labour? |
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How can maternal chickenpox manifest in pregnancy? |
Pneumonia, hepatitis, encephalitis and mortality |
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How can VZV affect a fetus? |
Most high risk of maternal to fetal transmission is 13 to 20wks, and rarely it can cause Fetal varicella syndrome:
VZV transmission after 28wks and before 5 days of delivery is unlikely to cause severe disease because of the transfer of maternal IgG (90% seropositive mothers). However, VZV reactivation may result later in life/childhood. Important to measure maternal IgG. |
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How can VZV affect the newborn? |
Transmission of VZV to fetus between 5 days prior to labour and 2 days after labour can be dangerous because the maternal antibodies will not have had a chance to transfer to the fetus. It can cause neonatal varicella which is severe chickenpox and can result in death (31%), most commonly via varicella pneumonia. |
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What are the antenatal signs of haemolytic disease of the newborn? |
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What are the postnatal signs of haemolytic disease of he newborn |
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How can risk of Rhesus isoimmunisation be checked? |
Maternal blood group and Titres Fetal blood group amnio, free fetal DNA (paternal blood group) |
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What methods of rhesus isoimmunisation prevention are there? |
Blood transfusion vigilance and Anti-D prophylaxis. |
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What is the anti-D guidance in early pregnancy? |
Anti-D prophylaxis if
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What is the anti-D guidance in later pregnancy? |
Anti-D required if mother is Rh negative and:
Nb: anti-D confers passive immunity |
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What sorts of common skin problems are associated with pregnancy? |
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What are the common skin diseases in pregnancy? |
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What are the specific dermatoses of pregnancy? |
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What is atopic eruption of pregnancy? |
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What is the treatment for atopic eruption of pregnancy? |
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What is polymorphic eruption of pregnancy? |
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What is pemphigoid gestationis? |
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