Common Medical Problems Of Pregnancy Including Infections Flashcards
What ethnic origins incr gestational diabetes risk
Asian
Indigenous
Pacific Islander
Hispanic
African
Gestational diabetes risk factors
Previous GD
family history of diabetes
Previous macrosomic baby
Previous unexplained stilbirth
Obesity
Glycosuria
Polyhydramnios
Large for gestational age
What causes foetal hyperinsulinaemia in GD and why
Incr maternal blood glucose
Ensure foetus gets enough glucose
Gestational diabetes
An exaggerated form of Carbohydrate intolerance of variable sensitivity with onset or first presentation in pregnancy
What causes a state of insulin resistance and glucose intolerance in normal pregnancy
Placental secretion of anti insulin hormones - HPL cortisol glucagon
What causes a mother with GD to return to pre pregnancy metabolic state
Birth (placenta delivered)
Pre pregnancy Determinants of insulin resistance
Ethnicity
Physical inactivity
Obesity
Dietary composition
PCOS
hypertension
Maternal Complications of GD
Hyper/hypoglycaemia
Pre eclampsia
Infection
Thromboembolic disease
Nephropathy
Retinopathy
Coronary artery disease
Poor wound healing
GD fetal complications
Macrosomia
Respiratory distress syndrome
Hypoglycaemia immediately after birth
Jaundice
Congenital abnormalities
What are fetal risks of macrosomia
Birth asphyxia
Traumatic birth injury
Shoulder dystocia
Normal birth weight
3.5 kg male
3.4 kg female
Why can babies of mothers with GD have hypoglycaemia immediately after birth
fetal hyperinsulinaemia due to hyperglycaemia in uterus from placenta delivering glucose, after birth glucose drops but insulin remains
GD management
Dietary modification
Calories reduction
Insulin
Mother with T2 switch from oral meds to insulin
Intrapartum monitoring
Ultrasound every 2 wks
Glucose tolerance testing 6-12 wks after delivery
What causes anaemia in pregnancy
Haemodilution
What is the main cause of maternal problems linked to anaemia in pregnancy
Bleeding at delivery
Anaemia treatment
Iron tablets or syrup
Iron infusion
Blood transfusion
What week of gestation is amniotic fluid highest
28th wk
Oligohydramnios
Deficiency in amniotic fluid
3rd trimester vol <300ml
Largest depth 2cm or less
What can cause oligohydramnios
Amniotic fluid leak
Fetal kidney abnormalities
Polyhydramnios
Excess amniotic fluid
>2000ml
Largest depth 8cm+
Causes of Polyhydramnios
Fetal GI or kidney abnormalities
Is Polyhydramnios or oligohydramnios easier to treat
Polyhydramnios
Potters facies/sequence
Flattened profile and badly developed hand muscles due to oligohydramnios
Which infections are included in TORCH
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes simplex, HIV, hepatitis
When is cytomegalovirus infection most likely to lead to congenital cytomegalovirus in a foetus
Primary infection during 1st trimester
Congenital cytomegalovirus symptoms
Severe intrauterine growth retardation
Hepatosplemomegaly
Microcephaly
Sensorineural deafness
Most common effect of congenital cytomegalovirus
Hearing problems - may not develop until childhood
Why is rubella prevalence increasing
Decr MMR uptake
How does rubella infection during pregnancy effect the fetus
Eye abnormalities - cataracts, glaucoma, strabismus, nystagmus, microphthalmia, iris dysplasia
Heart disease
PetechiaE and purpura
Microcephaly
When can congenital toxoplasmosis occur
Mother newly infected during or just before pregnancy
Congenital toxoplasmosis symptoms
Choriorentitis ———————\
Hydrocephalus ———————— classic triad
Intracranial atherosclerosis —/
IUGR
Microcephaly
Hepatolsplemomegaly
How is congenital toxoplasmosis diagnosed
Maternal serology
Amniotic fluid PCR
How is congenital toxoplasmosis treated
Pyrimethamine, sulfadiazine, and folic acid for mother and baby
Symptoms of perinatal herpes infection
Skin lesions
65% mortality if untreated
How is congenital CMV and congenital herpes treated
Antivirals(CMV) Antiretrovirals(HSV)
Effects of neonatal group B streptococcus infection
Pneumonia
Meningitis
Non focal sepsis
Death
Prevention of neonatal group B streptococcus infection
Antenatal detection - swabs and urine
Risk profiling
Benzylpenicillin during labour
Maternal and fetal complications of UTIs in pregnancy
Maternal - pyelonephritis
Fetal - growth restriction, pre term labour
UTI treatments
Penicillin
Cephalosporins
Nitrofurantoin
What foods should pregnant women avoid to prevent listeriosis infection
Unpasteurised milk products
Undercooked meat
Unwashed vegetables
Listeriosis symptoms in mother
Asymptomatic or indistinct virus symptoms
Symptoms of congenital syphilis in under 2s
Rash
Rhinorrhoea
Osteochondritis
Perioral fissures
Lymphadenopathy
Pemphigus syphiliticus
Congenital syphilis symptoms in over 2s
Hutchinson’s teeth
Clutton’s joints
Saber shins
High arched palate
Deafness
Saddle nose deformity
Frontal bossing
opthalmia neonatorum
Watery eye discharge that can become copious and purulent, caused by congenital chlamydia or gonorrhoea infection
Effects of chlamydia and gonorrhoea on fetus
Ophthalmia neonatorum
Pneumonia
Congenital Chlamydia and gonorrhoea treatment
Azithromycin
What cells are targeted by parvovirus B19
Erythrocytes
Why is parvovirus B19 infection more serious before 20 weeks
Hemopoetic system in liver so easier to be infected
After 20 wks haemopoesis moves to bones so very little infection risk
Congenital parvovirus B19 infection effect
Erythropoiesis arrested
RBC, lymphocyte, granulocyte, and platelet count decr
Hydrops fetalis
Fetal loss
How can fetus be effected by Covid 19 infection in mother
Vertical transmission
Pro inflammatory cytokines can effect development
