Medical Disorders of Pregnancy

Question 1

What is the definition of gestational diabetes?

Answer 1

Any degree of glucose intolerance with onset or first recognition during pregnancy

Question 2

Give some risk factors for developing gestational diabetes?

Answer 2

• Obesity
• Asian ethnicity
• GDM in previous pregnancy

Question 3

What are the clinical features of gestational diabetes?

Answer 3

• Polyuria
• Polydipsia
• Fatigue

Question 4

What are some of the possible fetal complications of gestational diabetes?

Answer 4

• Macrosomia

- Preterm birth

Question 5

How is gestational diabetes investigated and diagnosed?

Answer 5

Oral glucose tolerance test (OGTT)

Diagnosis:

• Fasting glucose > or equal to 5.6 mmol/L
• 2 hour postprandial glucose > or equal to 7.8 mmol/L
• Remember this as ‘5678’

Question 6

Describe the management of gestational diabetes

Answer 6

If fasting plasma glucose < 7 mmol/L at diagnosis:

1. Lifestyle advice (diet, exercise)
2. Metformin
3. Insulin

If fasting plasma glucose > 7 mmol/L at diagnosis:
- Start insulin

Question 7

What is the prognosis for patients with gestational diabetes?

Answer 7

• Increased risk of developing type 2 diabetes

- Increased risk of gestational diabetes in further pregnancies

Question 8

Describe the classification of hypertensive disorders of pregnancy

Answer 8

Hypertension during pregnancy is either:

• Pre-existing (chronic/essential HTN)
• Pregnancy-induced

Question 9

What is the definition of pregnancy-induced hypertension?

What is the definition of pre-eclampsia?

Answer 9

A rise in blood pressure above 140/90 mmHg after 20 weeks gestation

Pregnancy-induced hypertension associated with organ damage (proteinuria)

Question 10

Give 2 examples of risk factors for pre-eclampsia?

If a woman is considered at risk of developing pre-eclampsia, is there any prophylactic treatment which can be given? When is this treatment given?

Answer 10

Pre-existing HTN
Previous HTN in pregnancy

75mg aspirin daily (from 12 weeks gestation until birth)

Question 11

Are there any symptoms associated with pre-eclampsia?

Answer 11

Many patients may be asymptomatic

If symptomatic:

• Headaches
• Visual disturbance
• Epigastric pain

Question 12

Give 3 potential complications of pre-eclampsia

Answer 12

• HELLP syndrome (severe form of pre-eclampsia)
• Eclampsia (the onset of seizures)
• Placental abruption

Question 13

1) Describe the medical and definitive management of pre-eclampsia
2) What is the first line treatment in eclampsia?

Answer 13

1) Medical = antihypertensives e.g. labetalol (or nifedipine)
Definitive = Delivery (after 34 weeks, once a course of corticosteroids has been completed)

2) Magnesium sulphate (treat the seizure)

Question 14

Is there an increased risk of developing pre-eclampsia in future pregnancies in affected women?

Answer 14

Yes

Question 15

During pregnancy, when is the risk for VTE highest?

Answer 15

Postpartum (up to 6 weeks PP)

Question 16

Which type of anticoagulation is used in pregnant women to prevent/treat VTE?

Answer 16

LMWH

Question 17

What are the clinical features of intrahepatic cholestasis of pregnancy? (also known as obstetric cholestasis)

Answer 17

• Pruritus

- Jaundice

Question 18

Intrahepatic cholestasis of pregnancy is associated with an increased risk of…

Answer 18

Premature birth

Question 19

Describe the medical and definitive management of intrahepatic cholestasis of pregnancy

Answer 19

• Medical: ursodeoxycholic acid

- Definitive = induction of labour at 37 weeks

Question 20

What is HELLP syndrome?

Answer 20

• HELLP syndrome is a severe form of pre-eclampsia

- Features: Haemolysis, Elevated Liver enzymes, Low Platelets