Complications of Pregnancy Flashcards
What complications can happen in the first trimester?
miscarriage (15% of preggo)
ectopic pregnancy
hyperemesis gravidarum
What is hyperemesis gravidarum?
severe vomiting
What MATERNAL complications can occur in the second and third trimester?
UTI anaemia pre-eclampsia gestational diabetes antepartum haemorrhage
What foetal complications can occur in the second and third trimester?
premature labour
macrosomia
Why do mothers have high risk of UTI?
bc of urinary stasis
immune suppression during pregnancy
Why can urine get static?
because of the progesterone causing smooth muscle to relax
and uterus pushes down on uterus
Why is there immune suppression during pregnancy?
because the placenta is seen as a foreign object
Why is Urine tested at every visit of the mother?
bc UTI are associated with obstetric problems especially pre-term delivery.
What are the haemoglobin levels in pregnant and non-pregnant women?
non pregnant Hb is 12 - 16g/dl
pregnant Hb is 10.5 - 13g/dl
Why is the Hb in women seen as less than a non-pregnant woman?
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
How long does the dilutation last?
28 weeks- 30 weeks
What are the main causes for having low Hb?
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
How do you manage anaemia in pregnancy?
- keep monitoring Hb levels INITIAL, 28 WEEKS AND at 36 weeks.
- find the cause of the anaemia: serum ferritin, B12 levels,folate levels, and electrophoresis (to check for
sickle cell and thalassaemia) is done - transfuse blood if Hb is less than 7
What are the 2 types of diabetes in pregnancy?
gestational- diabetes FIRST seen between 20-40 weeks of pregnancy
pre-existing- diabetes before preggo or diagnosed before 20 weeks of pregnancy
Why does gestational diabetes occur?
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)
What is polycystic ovary syndrome?
cysts in ovary
produce more than normal levels of male androgens
When are sugar levels of pregnant women checked?
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
What is the normal risk of congenital malformation in a pregnant woman without diabetes?
2-3%
How do HbA1 levels affect the risk of congenital malformation?
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
Does gestational diabetes pose a problem to the foetus?
no- only pre existing diabetes
How does the baby get affected if the mother has diabetes?
mother diabetic so mother is hyperglycaemic
so the baby is hyperglycaemic
What happens if the baby is hyperglycaemic?
- foetus has excess insulin secreted
so there will be abnormal growth of B cells in the pancreas which secrete insulin - this leads to macrosomia and hyperplacentation (both things bigger than normal)
- inhibition of surfactant secretion in lungs
- foetus has glucose in urine
- can get hypoglycaemia
What does macrosomia and hyperplacentation lead to?
- 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)
What is surfactant secreted by?
Type II pulmonary cells
