Complications of Pregnancy

Question 1

What complications can happen in the first trimester?

Answer 1

miscarriage (15% of preggo)
ectopic pregnancy
hyperemesis gravidarum

Question 2

What is hyperemesis gravidarum?

Answer 2

severe vomiting

Question 3

What MATERNAL complications can occur in the second and third trimester?

Answer 3

UTI
anaemia
pre-eclampsia
gestational diabetes
antepartum haemorrhage

Question 4

What foetal complications can occur in the second and third trimester?

Answer 4

premature labour

macrosomia

Question 5

Why do mothers have high risk of UTI?

Answer 5

bc of urinary stasis

immune suppression during pregnancy

Question 6

Why can urine get static?

Answer 6

because of the progesterone causing smooth muscle to relax

and uterus pushes down on uterus

Question 7

Why is there immune suppression during pregnancy?

Answer 7

because the placenta is seen as a foreign object

Question 8

Why is Urine tested at every visit of the mother?

Answer 8

bc UTI are associated with obstetric problems especially pre-term delivery.

Question 9

What are the haemoglobin levels in pregnant and non-pregnant women?

Answer 9

non pregnant Hb is 12 - 16g/dl

pregnant Hb is 10.5 - 13g/dl

Question 10

Why is the Hb in women seen as less than a non-pregnant woman?

Answer 10

this is normal
bc the circulating blood volume in a pregnant woman increases from 4.5l to 6l.
the increase in plasma volume is more than the increase of red cells in the blood
so it is diluted
so ANAEMIA LOL

Question 11

How long does the dilutation last?

Answer 11

28 weeks- 30 weeks

Question 12

What are the main causes for having low Hb?

Answer 12

Fe deficiency (important in Hb synthesis)
sickle cell or thalassaemia
vitamin B12 and folate deficiency (both are important in Hb synthesis)
blood dyscrasias ie disorders of the blood

Question 13

How do you manage anaemia in pregnancy?

Answer 13

1. keep monitoring Hb levels INITIAL, 28 WEEKS AND at 36 weeks.
2. find the cause of the anaemia: serum ferritin, B12 levels,folate levels, and electrophoresis (to check for
   sickle cell and thalassaemia) is done
3. transfuse blood if Hb is less than 7

Question 14

What are the 2 types of diabetes in pregnancy?

Answer 14

gestational- diabetes FIRST seen between 20-40 weeks of pregnancy
pre-existing- diabetes before preggo or diagnosed before 20 weeks of pregnancy

Question 15

Why does gestational diabetes occur?

Answer 15

PLACENTA releases hormones:
human placental lactogen, cortisol, oestrogen, glucagon
all the hormones lead to insulin resistance in the mother
insulin resistance increases the ability of the mother to provide carbohydrates to the foetus (as less carbohydrates are taken into the tissue
as insulin does not work effectively)

Question 16

What is polycystic ovary syndrome?

Answer 16

cysts in ovary

produce more than normal levels of male androgens

Question 17

When are sugar levels of pregnant women checked?

Answer 17

Susceptible and show risk factors for diabetes: checked at booking INITIALLY when reported preggo, 28 weeks, 34 weeks, 40 weeks

Women not susceptible: 28 weeks and 40 weeks

Question 18

What is the normal risk of congenital malformation in a pregnant woman without diabetes?

Answer 18

2-3%

Question 19

How do HbA1 levels affect the risk of congenital malformation?

Answer 19

If HbA1c levels are 5-8% preconception then 4-5% risk
If HbA1c levels are 8-10% (periconceptually) then 9% risk
If HbA1c levels are over 10% (periconceptually), then 25% risk

Question 20

Does gestational diabetes pose a problem to the foetus?

Answer 20

no- only pre existing diabetes

Question 21

How does the baby get affected if the mother has diabetes?

Answer 21

mother diabetic so mother is hyperglycaemic

so the baby is hyperglycaemic

Question 22

What happens if the baby is hyperglycaemic?

Answer 22

1. foetus has excess insulin secreted
   so there will be abnormal growth of B cells in the pancreas which secrete insulin
2. this leads to macrosomia and hyperplacentation (both things bigger than normal)
3. inhibition of surfactant secretion in lungs
4. foetus has glucose in urine
5. can get hypoglycaemia

Question 23

What does macrosomia and hyperplacentation lead to?

Answer 23

• prolonged labour
• operative methods for delivery
• can get shoulder dystocia = shoulder gets stuck in cervix
• get pre-eclampsia
• antepartum haemorrhage (bleeding 20 weeks after pregnancy)
• postpartum haemorrhage (bleeding after delivery)

Question 24

What is surfactant secreted by?

Answer 24

Type II pulmonary cells

Question 25

What does hyperglycaemia in the foetus do to the lungs?

Answer 25

Inhibits surfactant secretion in the lungs

Question 26

Why can a baby develop hypoglycaemia from hyperglycaemia?

Answer 26

when baby is born
the cord is clamped
this cuts off glucose supply but the foestus has lots of insulin
so reduces glucose

Question 27

What is polycythemia?

Answer 27

when haematocrit is elevated

leads to jaundice which is yellow discolouration of the skin because of bilirubin build up.

Question 28

What condition can the foetus get if it has glycosuria?

Answer 28

polyhydramnios = high glucose in filtrate pulls water out of interstitium
baby pees alot
so lots of amniotic fluid

Question 29

What can happen because of polyhydramnios?

Answer 29

baby align itself in different way

can get cord prolapse= where umbilical cord comes our of cervix before baby does

Question 30

If a mother has pre-existing diabetes, what problems could this lead to (for the mother)?

Answer 30

high UTI risk
nephropathy
retinopathy
develop type II diabetes

Question 31

What does metformin do?

Answer 31

suppress glucose production in liver (gluconeogenesis)

Question 32

What symptoms defines pre-eclampsia?

Answer 32

1. BP higher than 140/90 on 2 separate readings
   (take 4-6 hours apart after 20 weeks gestation)
2. if lady already has hypertension, increase in systolic pressure of more than 30 and increase in diastolic pressure of more than 20
3. PROTEINURIA
4. severe oedema (in face lol)

Question 33

What are the theory causes of pre-eclampsia?

Answer 33

placentation disorder
vasospasm (arteries of mother constrict)
small vessel abnormalities
increased capillary permeability
mineral and vitamin deficiency e.g. selenium
immunological - wierd response to trophoblasts (placenta cells)
vasospastic substance- NO, TNF, free radicals

Question 34

What is IUGR?

Answer 34

Intrauterine growth restriction (IUGR) = unborn baby is not growing at the rate it should be in the womb.
can’t reach its growth potential= under 5th percentile and less than 2.5kg.

Question 35

Women with pre-existing hypertension need to consult physician before getting pregnant. Why?

Answer 35

Because Hyperglycaemia at conception is toxic for the foeture- can increase risk of sacral agenesis (Sacral doesnt form, CHD ans skeletal malformation.

Question 36

What are normal glucose levels?

Answer 36

fasting of less than 5mmol/l and 1hr post-prandial of less than 7-7.5mmol/l.

Question 37

How is the large placental flow accomodated for?

Answer 37

BP= CO X TPR
IN NORMAL PREGNANCY:
CO increases by 40% due to increased plasma volume! However TPR is reduced massively due to progesterone causing widespread vasodilatation and thus BP decreases. This helps accommodate the large placental flow.
Remember high volume low pressure!

IN PET:
Vasodilation doesnt happen so TPR increases