5. Common medical problems in pregnancy Flashcards
What is gestational diabetes?
When does this develop?
‘Carbohydrate intolerance of variable severity with onset or first presentation in pregnancy’
This is the development of temporary diabetes once the woman falls pregnant - effects about 3% of the women in the UK
This tends to happen just slightly more than halfway through the pregnancy
What is the aetiology of gestational diabetes?
Pregnancy - intrinsically, this is a state of insulin resistance and glucose intolerance
This is thought to be due to the placental secretion of anti-insulin hormones e.g. HPL, cortisol, glucagon
Gestational diabetes can then occur as an exaggerated form of this physiological condition
What are the risk factors for gestational diabetes?
Previous GDM Family history of diabetes Previous macrosomic baby Previous unexplained stillbirth Obesity Glucosuria Polyhydramnios - excess amniotic fluid in the amniotic sac Large for gestational age in the current pregnancy
What are the maternal complications that arise as a result of gestational diabetes?
Generally, gestational diabetes does not cause massive problems for the mother but the following can occur: Hyperglycaemia/hypoglycaemia Pre-eclampsia - hypertension Infection Thromboembolic disease
What are the foetal complications that arise as a result of gestational diabetes?
Macrosomia - birth aphyxia and traumatic birth injury
Respiratory distress syndrome
Hypoglycaemia - when they’re born, they are used to having so much glucose so then enough is not provided in the breast or bottle milk
Hyperbilirubinaemia (jaundice)
What is the issue if a woman falls pregnant whilst she already has diabetes?
If you fall pregnant whilst you already have the disease, then the complications of the disease get worse quicker
What is the management for gestational diabetes?
Dietary modification including calorie reduction
Insulin provision if persistant fasting or postpradial hyperglycaemia despite adequate dietary modification
Intrapartum monitoring
Regular ultrasound scan every two weeks during pregnancy to monitor foetal growth and wellbeing
Glucose tolerance test 6 weeks following delivery
Why should a woman have a glucose tolerance test 6 weeks following delivery?
Because in some instances, some women have diabetes but they have no symptoms of this and are not aware of their disease
When they fall pregnant, the disease becomes evident and they then realise they require lifelong management
Why are non-viral infections an issue in pregnancy?
The vagina contains many bacteria which do not cause any harm in the vagina normally
BUT when the waters break, this results in access for the bacteria to go up through the cervix to infect the placenta and can then infect the baby itself
Therefore, there is an increased risk of non-viral infection in the baby once the waters break
What are the different non-viral infections that can occur in pregnancy?
Group B streptococcus Urinary tract infections Listeriosis Syphilis Chlamydia and Gonorrhoea
Why can a Group B streptococcus (GBS) infection easily occur in pregnancy?
How common in this?
25% of women contain Group B streptococcus bacteria within the normal flora of their vagina - this is normally harmless
BUT when their waters break, there is access and potential for an ascending movement and infection by these bacteria - can infect the placenta and then infect the baby
In most cases this does not occur but if it does take place and the baby is infected then this can prove to be life threatening
What can GBS Infection lead to?
Pneumonia
Meningitis
Non-focal sepsis
Death
How are GBS infections in the mother and baby prevented?
There may be opportunistic detection of the GBS antenatally via swabs or urine
Cannot treat during pregnancy as it will just return but can give benzylpenicillin whilst the woman is in labour
Why is there an increased risk of contracting a UTI during pregnancy?
There is increased pressure on the bladder, urethra, ureters during pregnancy and this can result in stasis of urine - stasis of bacteria within - more prone to infect
During pregnancy, there is an increased release of progesterone and relaxin - these act on smooth muscle via the bloodstream to ensure that it does not contract e.g. bladder, urethra, ureters, blood vessels
What is the treatment for a UTI in pregnancy?
Penicillins
Cephalosporins
Nitrofurantoin
NB. The normal first line treatment for a UTI is trimethoprim but this is teratogenic in the first trimester of pregnancy
What is listeriosis and how is it prevented?
Bacterial infection which is rare but fatal for the baby
This is gained via food poisoning so women should be wary of the foods they consume
This is asymptomatic and cannot be diagnosed during pregnancy - only after via placental investigations and post mortem
What is the risk and effect of syphilis on a foetus and new born?
If untreated in the mother, there is a 50% chance of congenital syphilis Primary - chancre Secondary - rash Latent - nothing Tertiary - neurosyphilis
What are the treatment and management options for syphilis?
Early routine screening during pregnancy
Treatment with penicillin
What is the effect of chlamydia and gonorrhoea on the mother and on the baby and how are these infections treated?
Mother: endometritis
Baby: Opthalmia neoatorum, pneumonia
Treatment: Azithromycin (tetracyclines are teratogenic)
What is the effect of iron deficiency anaemia on the mother and baby and what is the problem with diagnosing this?
There are no foetal complications linked to this but the maternal problems are linked to bleeding at the time of delivery
Symptoms paradox - the symptoms of iron deficiency anaemia are very similar to those of pregnancy so the history will not tell you whether iron deficiency anaemia is present or not
What is the treatment for iron deficiency anaemia during pregnancy?
Oral iron via tablets or syrup
Iron infusion
Blood transfusion
What is the effect of sickle cell anaemia on pregnancy?
More severe and more frequent pain crises
Hypertension leading to pre-eclampsia
Growth restriction, preterm birth
