Medical Problems in Pregnancy

Question 1

What is gestational diabetes?

Answer 1

Any degree of glucose intolerance with onset during pregnancy

Question 2

By approx. how much do insulin requirements go up in pregnancy?

Answer 2

30%

Question 3

What are the risk factors for a poor pancreatic reserve?

Answer 3

BMI >30
Asian 
Prev gest diabetes
PCOS
Prev macrosomic baby

Question 4

How does gestational diabetes present?

Answer 4

Polyuria
Polydipsia
Fatigue

Question 5

What may gestational diabetes cause in the foetus?

Answer 5

Hyperinsulinaemia

Question 6

What does hyperinsulinaemia in the foetus lead to?

Answer 6

Macrosomia
Organomegaly 
Erythropoiesis
Polyhydramnios
(Basically everything grows too much)
And pre-term delivery

Question 7

What advice should be given to mothers whose babies have hyperinsulinaemia?

Answer 7

Regular feeding to preventhypoglycaemia

Question 8

How may high insulin effect the lungs?

Answer 8

Reduces pulmonary phospholipids which reduces the amount of surfactant present

Question 9

What is the main test for gestational diabetes?

Answer 9

OGTT

Question 10

What result on OGTT would indicate gestational diabetes?

Answer 10

Fasting glucose >5.6

2hrs post prandial glucose >7.8

Question 11

How is gestational diabetes managed?

Answer 11

Lifestyle advice
Metformin
Glibenclamide (if metformin not tolerated)
Insulin (if fasting glucose >7)

Question 12

When should additional growth scans be performed with gestational diabetes?

Answer 12

28, 32 and 36 weeks

Question 13

When should patients with gestational diabetes deliver by?

Answer 13

38 weeks

40 weeks 6 days if controlled through diet

Question 14

What is the post-natal follow up to gestational diabetes?

Answer 14

Stop meds

Measure glucose at discharge and at 6-13 weeks post partum

Question 15

When are pregnant women screened for anaemia?

Answer 15

28 weks

Question 16

What is livedo reticularis?

Answer 16

Red/blue reticular pattern on the skin of the arms, trunk or legs

Question 17

What is catastrophic antiphospholipid syndrome?

Answer 17

Acute formation of microthromboses

Causes infarction of multiple organs

Question 18

What is the clinical criteria for antiphospholipid syndrome?

Answer 18

VT or AT

Recurrent miscarriage OR premature birth

Question 19

What are the lab criteria for antiphospholipid syndrome?

Answer 19

Lupus anticoag
Anticardiolipin
Anti-beta2-glycoprotein I
On 2+ occasions, twelve weeks apart

Question 20

Give pregnancy specific risk factors for VTE?

Answer 20

Parity >3
Multiple preg
Pre-ec
C-sec
PPS
Still birth

Question 21

What should be given in pregnancy in VTE?

Answer 21

LMWH

Question 22

Warfarin is the first line treatment for VTE in second trimester
True/false

Answer 22

False

Warfarin is teratogenic and should be avoided

Question 23

What is hyperemesis gravidarum?

Answer 23

Persistent and severe vomiting during pregnancy

Question 24

When does nausea and vomiting of pregnancy normally begin?

Answer 24

4-7th week

Question 25

What is the criteria for hyperemesis gravidarum diagnosis?

Answer 25

More than 5% pre-preg weight loss Dehydration Electrolyte imbalance Prolonged n&v

Question 26

How does beta-hCG contribute to n&v in pregnancy?

Answer 26

Stimulates the chemoreceptor trigger zone in the brainstem (area postrema) This feeds into vomiting centre of brain (nucleus tractus solitarius)

Question 27

What are the risk factors for hyperemesis gravidarum?

Answer 27

``` First preg Prev HG Raised BMI Multiple preg Hydatidiform mole ```

Question 28

How is mild hyperemesis gravidarum treated?

Answer 28

Oral antiemetics Hydration Dietary advice

Question 29

How is moderate hyperemesis gravidarum treated?

Answer 29

IV fluids Parenteral antiemetics Thiamine

Question 30

Why is thiamine given in hyperemesis gravidarum?

Answer 30

To prevent Wernicke's encephalopathy

Question 31

What anti-emetics can be given first line in hyperemesis gravidarum?

Answer 31

Cylcizine Prochloperazine Promethazine Chlorpromazine