34. Common Medical Problems in Pregnancy Flashcards
What is gestational diabetes?
Why does it occur?
What are some risk factors?
Carbohydrate intolerance of variable severity with onset or first presentation in pregnancy. 50% develop diabetes outside pregnancy in the following 10-15yrs.
Pregnancy is a state of insulin resistance and glucose intolerence, thought to be due to placental secretion of HLP, cortisol and glucagon. GDM = exaggerated form of this physiologic condition.
Previous GDM, family history of diabetes, previous macrosomic baby/unexplained stillbirth, obesity, glycosuria, polyhydramnios, large for gestational age in pregnancy.
Who, when and how is gestational diabetes screened?
What are some maternal complications?
What are some foetal complications?
Who: depends on location e.g. everybody/presence or absence of clinical features. When: 12w midwife appointment. If high risk, tested again at 28w. How: different protocols based on differnt areas based on risk factors. Screen with oral glucose tolerence test (fasting BG, given sugary drink and BG tested 2h later).
Hyperglycaemia/hypoglycaemia, pre-eclampsia, infection, thromboembolic disease. NB: women with GDM never get nephropathy, retinopathy, coronary artery disease and poor wound healing, but woman with T2DM who fall pregnant do.
Macrosomia (birth asphyxia and traumatic birth injury), respiratory distress syndrome, hypoglycaemia, hyperbilirubinaemia (jaundice). Brachial plexus injury during birth -> permanent Erb’s palsy. If pregnant and already have T2DM = congnital abnormalities.
How is gestational diabetes managed?
How does group B streptococcus affect birth and the baby?
How can group B streptococcus be prevented?
Dietary modification incl. calorie reduction. Insulin if presistent fasting or postprandial hyperglycaemia despite adequate dietary modification. Intrapartum monitoring. Regular USS every 2w to monitor foetal growth. Glucose tolerence test 6w after birth.
Normal in 50% women vaginal tract. Harmless until labour, most carriers don’t pass infection but if passed can be life threatening: pneumonia, meningitis, non-focal sepsis, death.
Opportunistic swabs, urine. Risk profiling (preterm/prolonged ruptured membranes, previous GBS infection, intrapartum fever etc.), benzylpenicillin in labour.
Why are UTIs and varicose veins more common in pregnancy?
What are some risks to the mum and foetus of UTIs?
How are UTIs treated?
Uterus sits atop the bladder. As it grows, its increased weight can block the drainage of urine from the bladder, causing an infection (E.coli main cause). Uterus also puts pressure on the inferior vena cava which increases pressure in leg veins causing varicose veins.
Mum - pyelonephritis. Foetus - growth restriction, preterm labour.
Penicillins, cephalosporins, nitrofurantoin. AVOID teratogenic drugs e.g. trimethoprim.
What is listeriosis?
What happens to a foetus if the mum has syphilis?
How is syphilis prevented and treated?
What can chlamydia and gonorrhoea cause for the mum and baby? How is it treated?
Rare but can be fatal for baby, often asymptomatic or viral symptoms, no routine screening but advice given (avoid unpasteurised milk/cheese).
50% risk of congenital syphilis, the earlier the disease stage the worse the prognosis (10 = chancre, 20 = rash, 30 = GPI (mental disorder), tabes dorsalis, neurosyphilis, latent = nothing).
Early routine screening, Tx: penicillin.
Mum: endometritis. Baby: ophthalmia neonatorum, pneumonia. Tx: azithromycin (tetracyclines are teratogenic).
What are the physiological consequences of anaemia?
How does iron deficiency anaemia affect pregnancy?
How is it treated?
Aside from iron deficiency anaemia, what other types need to be detected during pregnancy?
Blood volume increases, physiological haemodilution, physiological reduction in Hb level as pregnancy goes on so different normal ranges (>11 at first, >10.5 by 3rd trimester).
Common, not much foetal complication, maternal problems linked to bleeding at birth. Symptoms (breathless, tiredness and palpitations) same as normal pregnancy so might not be detected, so screen everyone at 12 and 28w.
Oral iron tablets/syrup, iron infusion, blood transfusion. Main SE: constipation.
Sickle cell and thalassaemia.
How does sickle cell affect pregnancy?
How does pregnancy affect sickle cell?
Uterine spiral arteries -> spiral arteriole -> v small BVs. These can get clogged which may cause vasoactive cytokine release from the foetus -> pre-eclampsia. There will be high peripheral resistance in the small BVs, baby will be small with IUGR, therefore baby may need to be delivered early: iatrogenic preterm birth.
More severe and frequent crises. Can screen parents (autosomal recessive inheritance) and work out if foetus has sickle cell via CVS/prenatal diagnosis -> make decision about having baby.
