Medical problems in pregnancy Flashcards
(42 cards)
What cutoffs are used to diagnose diabetes in pregnancy?
Fasting glucose >7 or >7.8 2h after 75g glucose.
Or fasting >5.1; >10 at 1h, >8.5 at 2h after 75g glucose.
What are the fetal complications of diabetes?
Congenital defects: neural tube and cardiac - related to perconception glucose control.
Preterm labour.
Decreased fetal lung maturity.
Increased birthweight: hyperinsunlinaemia and fat deposition.
Polyhydramnios.
Dystocia / birth trauma.
Fetal compromise / fetal distress / sudden fetal death: related to poor glucose control in 3rd trimester.
Severity correlates with sugar levels.
What are the maternal complications of diabetes in pregnancy?
Increased insulin requirement.
UTI, wound / endometrial infection after delivery.
Pre-eclampsia.
C-S or instrumental delivery more likely.
Retinopathy often deteriorates.
What is the optimum HbA1c in pregnancy?
<7
What blood glucose level should the pregnant lady be aiming for?
<6.
What monitoring would you do for a fetus in a diabetic pregnancy?
Fetal echo.
USS for growth and liquor volume.
How would you manage a pregnant diabetic woman?
Conception: optimise diabetic control, take 5mg folic acid, assess baseline diabetic complications.
During pregnancy: optimise diabetic control, give aspirin from 12wks to lower pre-eclampsia chances, monitor fetal echo and USS for growth.
Delivery: by 39wks.
What are the risk factors for GDM?
Previous GDM.
Previous large baby (>4.5kg).
Unexplained stillbirth.
First degree relative with DM.
BMI >30.
South asian, carribean, middle eastern origin.
How would you manage gestational diabetes?
Conservative: diet and exercise, twice weekly BMs.
Oral hypoglycaemics: metformin.
Insulin if required.
Repeat OGTT at 3/12 postpartum.
Can asthma treatment be continued in pregnancy?
Yes.
If on long term steroids, additional needed at labour.
What are the safest epileptic drugs in pregnancy?
Carbamazepine and lamotrigine.
What are the consequences of epileptic drugs during pregnancy?
Congenital abnormalitie (NTD), especially with multiple drugs, high doses or valproate.
What effects does hypothyroidism have in pregnancy?
Miscarriage.
Preterm delivery.
Intellectual impairment in childhood.
Increased pre-eclampsia risk.
How would you manage hypothyroidism in pregnancy?
6 weekly TSH levels.
What effects does hyperthyroidism have in pregnancy?
Increased perinatal mortality.
Risk of antithyroid Abs crossing the placenta and causing neonatal thyrotoxicosis and goitre.
What treatments are used for hyperthyroidism in pregnancy?
Propylthiouracil, not carbimazole. Give the lowest possible dose to minimise chances of neonatal hypothyroidism.
What is the aetiology of cholestasis in pregnancy?
Sensitivity to oestrogen causing cholestasis.
What are the main risks of cholestasis in pregnancy?
Stillbirth.
Preterm delivery.
How does cholestasis of pregnancy present?
Itching without a rash and abnormal LFTs.
How is cholestasis in pregnancy managed?
Vitamin K 10mg/day from 36 weeks (to minimise haemorrhage risk)
Ursodeoxycholic acid (to relieve itching).
Induction at 38wks.
What is the definition of antiphospholipid syndrome?
1 or more clinical criteria with positive lab criteria.
Clinically: vascular thrombosis, death of fetus >10wks, pre-eclampsia or IUGR requiring delivery <34wks, 3+ unexplained fetal losses <10wks.
Lab: Lupus anticoagulant, high anticardiolipin Ab, anti-beta2glycoprotein 1 Ab - each measured on two occasions >3mths apart.
What are the complications of antiphospholipid syndrome?
Placental thrombosis.
Recurrent miscarriage.
IUGR.
Pre-eclampsia.
Fetal loss.
What are the consequences of chronic renal disease in pregnancy?
Pre-eclampsia.
IUGR.
Polyhydramnios.
Pre-term delivery.
How do you manage the fetus in chronic renal disease?
USS to check growth.
Measurement of renal function.
Screening for UTI.
HTN control.
Vaginal delivery ok.
