Antenatal Care: Pregnancy Disorders Flashcards
Gestational Diabetes Anaemia
Define gestational diabetes
impaired glucose tolerance in pregnancy
What is the most common disorder in pregnancy
PIH
What is the second most common disorder in pregnancy
GDM
What are 6 RF for gestational diabetes
Asian FH BMI >30 Previous GDM Previous macrocosmic baby PCOS
How do the majority of women with gestational diabetes present
Asymptomatic
May have polyuria and polydipsia
Explain pathophysiology of gestational diabetes
During pregnancy insulin resistance increases. Meaning insulin demand increases by 30%. If an individual has a borderline pancreatic reserve, they will be unable to maintain insulin demand and hence experience transient hyperglycaemia.
Explain foetal consequences of gestational diabetes
Glucose crosses the placenta, but insulin does not. This causes foetal hyperglycaemia. Causing foetus to produce more insulin. When foetus is born hyperinsulinaemia, without high maternal glucose, causes hypoglycaemia.
What is the effect of insulin on foetal lungs
Decreases pulmonary surfactant production which can lead to transient tachypnoea newborn
What is first-line investigation for GDM
OGTT
What is performed with OGTT
Fasting glucose
What fasting glucose indicates GDM
> 5.6
What OGTT indicates GDM
> 7.8
When is OGTT offered if previous GDM
16W
When is OGTT offered if asian, FH or BMI >30
28W
When is OGTT offered if glycosuria
Anytime +2 glucose, offer OGTT
What are the 3 antenatal time periods OGTT offered
- 16W = previous GDM
- 28W = RFs
- Anytime glycosuria +2
What is first-line management for GDM
Lifestyle advice: try for 2W if fasting blood glucose <7
How often should someone with GDM measure their blood glucose
Measure QDS
What is second-line management for GDM
Metformin
When is metformin offered
If no improvement in blood glucose seen by lifestyle advice alone after 2W
What is third-line for GDM
Glibenclamide
When is glibenclamide only offered
If individual cannot tolerate metformin
When is insulin started for GDM
- Beginning if Blood glucose >7
2. Plasma glucose 6-6.9 and evidence foetal complications (macrosomia)
Explain scanning in child with GDM
Additional scans at 28, 32 and 36W
When should delivery be aimed for if on metformin
37W
When should delivery be aimed for if GDM managed by glucose alone
40+6
What is fasting blood-glucose target in GDM
5.3
Explain OGTT
Women is given 75g glucose and then blood glucose measured 2h later
How long post-delivery should diabetic medication be stopped
Immediately
What should be checked at 6-13W
Blood glucose
Explain post-natal screening after GDM
Check annually, due to increased risk T2DM
Explain further pregnancies following GDM
Screen at 16W with OGTT
What are two maternal risks of GDM
T2DM
Future GDM
What are 5 foetal complications of GDM
Macrosomia Organomegaly Polycythaemia Pre-maturity Polyhydramnios Hypoglycaemia Respiratory distress syndrome
What is the risk with macrosomia
Prolonged Labour
Instrumental delivery
Shoulder dystocia
What is anaemia
Deficiency in haemoglobin
What Hb defines anaemia in first trimester
<110
What Hb defines anaemia in second and third trimester
<105
What Hb defines anaemia post-natally
<100
Explain why anaemia is common in pregnancy
Increase in plasma volume causing physiological haemodiluation
What are 4 risk factors for anaemia in pregnancy
Age
Previous IDA in pregnancy
Haemaglobinopathies
Poor diet
What are 3 symptoms of anaemia in pregnancy
Breathlessness
Dizziness
Fatigue
What are 3 signs of anaemia
Pale
Kolonychia
Angular stomatitis
What is used to diagnose anaemia in pregnancy
FBC
How will Hb present in anaemia in first trimester
<110
How will Hb present in anaemia in second trimester
<105
How will Hb present in anaemia in third trimester
<105
How will Hb present in anaemia postnatally
<100
When should all women be screened for anaemia
12W and 28W
What is first line for anaemia in pregnancy
Oral Iron
What is second line for anaemia in pregnancy
Ferinject (Parental Iron)
How does obstetric cholestasis present
Pruritus soles and feet = worse at night
Jaundice (20%)
How will LFTs present in obstetric cholestasis
Raised ALT, AST
How is obstetric cholestasis managed
Ursodeoxycholic acid
If abnormal coagulation profile in obstetric cholestasis what should be given
Vitamin K (10mg PO) to mother IM vitamin K to foetus on delivery
What is main complication of obstetric cholestasis
Pre-maturity
What is another complication os obstetric cholestasis to the foetus
Meconium aspiration
