Antenatal Care and Complications (1) Flashcards
Anaemia:
What is the normal range?
Why does this occur during pregnancy?
What is it commonly caused by?
What should a B12 deficiency be tested for?
→ How is this treated?
➊ 12-16g/dL (Non-pregnant), and 10.5-13g/dL (Pregnant)
➋ Normal increase in Plasma volume, Red cell mass, and Haemodilution (lower Hb concentration)
➌ Iron deficiency, Vitamin B12/Folate deficiency, Sickle cell/Thalassaemia, Blood disorders
➍ Pernicious anaemia by checking for IF Abs
→ Hydroxocobalamin or Cyanocobalamin
Pre-existing Diabetes:
What is an ↑HBa1c associated with?
What does the Maternal hyperglycaemia lead to?
→ What does this lead to in the foetus?
→ What does this increase the risk of?
What occurs shortly after birth in these cases?
→ What can it lead to if severe?
How is this managed?
➊ Congenital malformations - Sacral agenesis, Skeletal and Neural Tube Defects, CHD
➋ Foetal hyperinsulinaemia
→ B-cell Hyperplasia leads to Macrosomia
→ Shoulder dystocia, Birth injuries, and Emergency c-section
➌ Neonatal Hypoglycaemia due to sustained high foetal insulin levels
→ Seizures
➍ • Better pre-gestational diabetic control
• Ultrasound – Detect congenital abnormalities and assess foetal growth
• Timing of delivery - Evaluating risk between Intrauterine death and Respiratory distress, as well as between Macrosomia, Shoulder dystocia and Caesarean delivery
• Retinopathy Screening – Very important to screen for this during pregnancy!
• Screening for Pre-eclampsia
Gestational Diabetes (GDM):
What is it?
What is its pathophysiology?
What are its risk factors?
How is it investigated?
How is it managed?
➊ DM diagnosed for the first time after 20 wks
➋ Placental steroids (hPL, cortisol, oestradiol, glucagon) lead to insulin resistance, which increases glucose for placental transfer
➌ Obese, Family Hx, Previous hx of macrosomia, PCOS, Older age
➍ * Screen high-risk groups at Booking, Screen everyone at 28 weeks
* OGTT - Diagnosed if fasting > 5.6 and/or 2hr glucose > 7.8
N.B. Remember the diagnostic criteria of GDM by 5678! - 5.6mmol/L fasting, 7.8mmol/L 2 hr plasma glucose.
N.B. All patients with a risk factor for GDM should be offered an OGTT at 24-28 wks.
➎ * Fasting glucose < 7 - trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin
* Fasting glucose > 7 - start insulin ± metformin
* Fasting glucose > 6 plus macrosomia (or other complications) - start insulin ± metformin
N.B. These pts shouldn’t give birth any later than 40+6 wks.
Pre-existing Hypertension:
Which anti-hypertensives have to be stopped in pregnancy?
→ Why is this?
Which safer options should they be switched to?
➊ ACEi, ARB
→ Both affect the RAAS, therefore affecting foetal kidneys and their production of urine → Oligohydramnios – Hypocalvaria (incomplete formation of the skull bones)
➋ Labetalol (1st line) or Nifedipine
Pregnancy-induced Hypertension:
What is it?
→ What is the severe form of this?
What are its complications?
How is it managed?
➊ HTN after 20 wks w/o proteinuria - Differentiating feature from PET
→ Pre-eclampsia, where there’s end-organ damage and proteinuria
➋ Pre-eclampsia, Eclampsia, Stroke, Placental abruption, Intrauterine Growth Restriction, Stillbirth, Preterm delivery (induced if foetal distress)
➌ • Labetalol
• BP monitoring, and looking out for symptoms of any complications e.g. regular urine dips, screens, and check-ups
UTI:
What is the most common cause?
How is it managed?
What should be avoided in the 1st trimester?
→ Why?
➊ E.coli
➋ 7-day course of:
• Nitrofurantoin 100mg BD - Avoid in 3rd trimester/at term - 1st line
• Amoxicillin/Cefalexin – 2nd line
➌ Trimethoprim
→ It’s a folate antagonist, therefore avoided as folate is important for normal foetal development – Can cause congenital malformations (particularly NTD)
Epilepsy:
Why is this a concern in pregnancy?
Which anti-epileptics should be avoided?
What are the safer anti-epileptics options?
➊ • The physiological changes during pregnancy can lower the seizure threshold and increase the frequency of them – Prolonged seizures can increase the risk of foetal hypoxia
• Maternal use of anti-epileptics can increase the risk of NTDs
➋ • Sodium valproate is avoided as it causes NTDs and developmental delay
• Phenytoin is avoided as it causes cleft lip and palate
➌ Levetiracetam, Lamotrigine
Substance-use:
What can alcohol use lead to?
What can opioid use lead to?
What can tobacco use lead to?
➊ Miscarriage, stillbirth, birth defects, and Foetal Alcohol Syndrome (FAS)
➋ Poor foetal growth, premature delivery, stillbirth, birth defects, and Neonatal Abstinence Syndrome (NAS) where the baby experiences withdrawal symptoms (irritability, tachypnoea, fever, poor feeding)
➌ Premature delivery, low birth weight, cleft lip and palate, Sudden Infant Death Syndrome (SIDS)
