Obstetrics

Question 1

Whats the most common inherited risk factor for VTE in pregnancy?

Answer 1

Factor V Leiden Mutation (Factor V Leiden mutation is the most common hereditary hypercoagulability disorder in european caucasians).

Question 2

What is factor V Leiden mutation?

Answer 2

Factor V Leiden mutation is a genetically inherited disorder of blood clotting. In this disorder, the Leiden variant of factor V cannot be inactivated by activated protein C, and so clotting is encouraged.

Question 3

What causes the decrease in glucose tolerance during pregnancy?

Answer 3

Glucose tolerance decreases in pregnancy due to altered carbohydrate metabolism and the antagonistic effects of human placental lactogen, progesterone and cortisol.

Question 4

At what blood glucose level do the kidneys begin to excrete glucose in:

a) Non-pregnant women?
b) Pregnant women?

Answer 4

a) 11 mmol/L
b) This varies in pregnant women but most often it decreases thus glycosuria may occur at physiological blood glucose concentrations

Question 5

What happens to the fetus in the presence of raised blood glucose levels?

Answer 5

The fetus responds by producing more insulin (hyperinsulinemia) to reduce the blood glucose level. This causes fat deposition and excessive growth - macrosomia.

Question 6

What are the risk factors for gestational diabetes? (x5)

Answer 6

1) BMI >30
2) Previous macrosomic baby (4.5kg or more)
3) Previous gestational diabetes
4) 1st degree relative with diabetes
5) Minority ethnic family origin with a high prevalence of diabetes e.g. South Asian, Black Caribbean and Middle Eastern.