Antenatal Care: Pregnancy Disorders

Question 1

Define gestational diabetes

Answer 1

impaired glucose tolerance in pregnancy

Question 2

What is the most common disorder in pregnancy

Answer 2

PIH

Question 3

What is the second most common disorder in pregnancy

Answer 3

GDM

Question 4

What are 6 RF for gestational diabetes

Answer 4

Asian 
FH
BMI >30
Previous GDM 
Previous macrocosmic baby 
PCOS

Question 5

How do the majority of women with gestational diabetes present

Answer 5

Asymptomatic

May have polyuria and polydipsia

Question 6

Explain pathophysiology of gestational diabetes

Answer 6

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.

Question 7

Explain foetal consequences of gestational diabetes

Answer 7

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.

Question 8

What is the effect of insulin on foetal lungs

Answer 8

Decreases pulmonary surfactant production which can lead to transient tachypnoea newborn

Question 9

What is first-line investigation for GDM

Answer 9

OGTT

Question 10

What is performed with OGTT

Answer 10

Fasting glucose

Question 11

What fasting glucose indicates GDM

Answer 11

> 5.6

Question 12

What OGTT indicates GDM

Answer 12

> 7.8

Question 13

When is OGTT offered if previous GDM

Answer 13

16W

Question 14

When is OGTT offered if asian, FH or BMI >30

Answer 14

28W

Question 15

When is OGTT offered if glycosuria

Answer 15

Anytime +2 glucose, offer OGTT

Question 16

What are the 3 antenatal time periods OGTT offered

Answer 16

1. 16W = previous GDM
2. 28W = RFs
3. Anytime glycosuria +2

Question 17

What is first-line management for GDM

Answer 17

Lifestyle advice: try for 2W if fasting blood glucose <7

Question 18

How often should someone with GDM measure their blood glucose

Answer 18

Measure QDS

Question 19

What is second-line management for GDM

Answer 19

Metformin

Question 20

When is metformin offered

Answer 20

If no improvement in blood glucose seen by lifestyle advice alone after 2W

Question 21

What is third-line for GDM

Answer 21

Glibenclamide

Question 22

When is glibenclamide only offered

Answer 22

If individual cannot tolerate metformin

Question 23

When is insulin started for GDM

Answer 23

1. Beginning if Blood glucose >7

2. Plasma glucose 6-6.9 and evidence foetal complications (macrosomia)

Question 24

Explain scanning in child with GDM

Answer 24

Additional scans at 28, 32 and 36W

Question 25

When should delivery be aimed for if on metformin

Answer 25

37W

Question 26

When should delivery be aimed for if GDM managed by glucose alone

Answer 26

40+6

Question 27

What is fasting blood-glucose target in GDM

Answer 27

5.3

Question 28

Explain OGTT

Answer 28

Women is given 75g glucose and then blood glucose measured 2h later

Question 29

How long post-delivery should diabetic medication be stopped

Answer 29

Immediately

Question 30

What should be checked at 6-13W

Answer 30

Blood glucose

Question 31

Explain post-natal screening after GDM

Answer 31

Check annually, due to increased risk T2DM

Question 32

Explain further pregnancies following GDM

Answer 32

Screen at 16W with OGTT

Question 33

What are two maternal risks of GDM

Answer 33

T2DM | Future GDM

Question 34

What are 5 foetal complications of GDM

Answer 34

``` Macrosomia Organomegaly Polycythaemia Pre-maturity Polyhydramnios Hypoglycaemia Respiratory distress syndrome ```

Question 35

What is the risk with macrosomia

Answer 35

Prolonged Labour Instrumental delivery Shoulder dystocia

Question 36

What is anaemia

Answer 36

Deficiency in haemoglobin

Question 37

What Hb defines anaemia in first trimester

Answer 37

<110

Question 38

What Hb defines anaemia in second and third trimester

Answer 38

<105

Question 39

What Hb defines anaemia post-natally

Answer 39

<100

Question 40

Explain why anaemia is common in pregnancy

Answer 40

Increase in plasma volume causing physiological haemodiluation

Question 41

What are 4 risk factors for anaemia in pregnancy

Answer 41

Age Previous IDA in pregnancy Haemaglobinopathies Poor diet

Question 42

What are 3 symptoms of anaemia in pregnancy

Answer 42

Breathlessness Dizziness Fatigue

Question 43

What are 3 signs of anaemia

Answer 43

Pale Kolonychia Angular stomatitis

Question 44

What is used to diagnose anaemia in pregnancy

Answer 44

FBC

Question 45

How will Hb present in anaemia in first trimester

Answer 45

<110

Question 46

How will Hb present in anaemia in second trimester

Answer 46

<105

Question 47

How will Hb present in anaemia in third trimester

Answer 47

<105

Question 48

How will Hb present in anaemia postnatally

Answer 48

<100

Question 49

When should all women be screened for anaemia

Answer 49

12W and 28W

Question 50

What is first line for anaemia in pregnancy

Answer 50

Oral Iron

Question 51

What is second line for anaemia in pregnancy

Answer 51

Ferinject (Parental Iron)

Question 52

How does obstetric cholestasis present

Answer 52

Pruritus soles and feet = worse at night | Jaundice (20%)

Question 53

How will LFTs present in obstetric cholestasis

Answer 53

Raised ALT, AST

Question 54

How is obstetric cholestasis managed

Answer 54

Ursodeoxycholic acid

Question 55

If abnormal coagulation profile in obstetric cholestasis what should be given

Answer 55

``` Vitamin K (10mg PO) to mother IM vitamin K to foetus on delivery ```

Question 56

What is main complication of obstetric cholestasis

Answer 56

Pre-maturity

Question 57

What is another complication os obstetric cholestasis to the foetus

Answer 57

Meconium aspiration