Antental complications Flashcards
What are the common pregnancy complications ?
- Bleeding during pregnancy
- Gestational diabetes ( GDM )
- Pregnancy-induced hypertension ( PIH )
What are the first trimester complications? ( common causes of bleeding )
Spontaneous abortion / miscarriage
- Threatened
- Inevitable
- Complete
- Missed
- Incomplete
Ectopic pregnancy
Abdominal pregnancy
What are the second trimester complications? ( common causes of bleeding )
Gestational trophoblastic disease ( Hydatidiform mole )
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
Premature cervical dilatation
Disseminated intravascular coagulation ( DIC )
What are the third trimester complications ? ( common causes of bleeding )
- Placenta previa
- Abruptio placenta
- Preterm labour
What to do if there is spontaneous abortion ( threatened ) ?
- avoid strenous activity / bed rest, avoid coitus for 2 weeks
- medication : progesterone if inadequate luteal function
What to do if there is spontaneous abortion ( Inevitable / incomplete ) ?
- misoprostol orally to induce contractions
- suction curettage / dilation and curettage / dilation & evacuation
What to do if there is spontaneous abortion ( missed ) ?
- < 14 weeks : dilation and curettage
- . 14 weels : prostaglandin suppository or oral misoprostol to dialte the cervix, then oxytocin infusion or administration of mifepristone.
what is GDM?
gestational diabetes mellitus
- a chronic disease in which glucose metabolism is impaired by a lack of insulin or by ineffective insulin utilization
what are the types of pre-gestational diabetes?
Type 1 and Type 2 ( pre-gestational diabetes )
What are the effects of GDM on pregnant mother?
- Increase spontaneous miscarriage : 15-30%
- Pregnancy induced hypertension ( 3-5 times )
- Increased rate of CS and postpartum hemorrhage : macrosomic baby
- UTIs increase
- Polyhydramnios ( > 2000ml )
What is the effect of GDM on fetus?
- Fetal death
- Congenital anomalies
- Macrosomia ( > 4,500g )
- Fetal growth restriction
Assessment of GDM
- Health history ; physical examination
- Risk factors.
- Maternal surveillance
- Fetal surveillance
- GDM screening test ; glucose challenge test
- GDM diagnostic test : 2-hour oral glucose tolerance test
What are the risk factors?
Personal/ family history of GDM, previous unexplained stillbirth, marked obesity and glycosuria
What is maternal surveillance ?
The screening at first prenatal visit ; additional screening at 24 to 28 weeks for women considered at risk
urine for protein, ketones, nitrates and leukocyte esterase ; evaluation function/ trimester ; eye exam in first trimester ; hbA1c
what is fetal surveillance?
ultrasound ; alpha-fetoprotein levels ; amniocentesis
What is glucose challenge test?
sample drawn 1 hour after a 50g glucose drink : 7.2 mmol/L and over : abnormal
What is 2 hour oral glucose tolerance test?
samples drawn after 75g glucose drink
Less than 140mg/dL ( 7.8 mmol / L )
Normal glucose tolerance
From 140 to 199 mg/dL ( 7.8 to 11.1 mmol/L )
Prediabetes ( impaired glucose tolerance )
= / > 200mg/dL ( 11.1 mmol/L ) on more than one testing occasion
Diabetes
What is the medical management for GDM ?
It would maintain blood glucose level in the normal range and prevent ketoacidosis
What is pre-pregnancy care?
- Normal blood glucose level : several months before pregnancy
- Daily multivitamin supplement e.g. folic acid
Blood glucose monitoring
Blood glucose level during pregnant : 7 point blood sugar profile , 95 mg/dL ( fasting )
Blood glucose level control : HbA1c < 7%
Close maternal and fetal surveillance
- Nutritional management
- Hypoglycemic agents
