Conditions In Pregnancy

Question 0

Diabetes (before pregnancy)

Answer 0

Aim for HbA1c of less than or equal to 6.1% and avoid if over 10%

5mg folic acid

Stop all oral hypoglycaemics (except metformin), statins, ACE inhibitors

Treat retinopathy pre-pregnancy. Nephropathy may worsen.

Elective delivery at 38wks. Use glucose and insulin via pump during delivery

Complications:

• hypoglycaemia unawareness - esp trimester 1
• hydramnios - fetal polyuria
• pre-term labour
• stillbirth
• malformation rates (x3) - sacral agenesis, CNS, CVS malformations
• macrosomic
• growth restriction
• neo-natal hypoglycaemia, low Ca, low Mg
• neo-natal RDS
• polycythaemia

Question 1

Hyperemesis gravidarum

Answer 1

Persistent vomiting which causes weight loss (>5% of pre-pregnancy weight) and ketosis.

Effects 1%, recurrence rate 15%

High HCG level may be the cause - therefore likely with multiple or molar pregnancy. (Do ultrasound to exclude)

(Steeply rising estrogens may cause morning sickness)

Can cause abnormal TFTs.

Correct dehydration, can use cyclizine or other anti-emetics, occasionally steroids.

Question 2

Gestational diabetes

Answer 2

OGTT > 7.8

3% incidents

Treat with diet, exercise, metformin, glibenclamide, insulin

50% get full diabetes long term

Question 3

Hypertension

Answer 3

Chronic hypertension is hypertension predating pregnancy or developing before 20wks

Gestational hypertension is hypertension without proteinuria which develops after 20wks

Pre-clampsia is hypertension with proteinuria developing after 20wks

Anti-hypertensives licensed for use in pregnancy:

• atenolol
• labetalol
• metoprolol
• methyldopa

Aim for BP < 150/90

Give aspirin from 12wks until delivery

Question 4

Pre-eclampsia

Answer 4

Pregnancy induced hypertension with proteinuria +/- oedema,

develops after 20wks, resolves within 10 days after delivery

Failure of trophoblastic invasion of spiral arteries leaving them vasoactive (usually do not respond to vasoconstrictors, protecting placental flow). Maternal BP increases, partially compensating for this.

If high risk take aspirin from week 12 until delivery

Propholactic magnesium sulphate halves risk of eclampsia and may reduce maternal deaths

Usually asymptomatic but can get headache, chest or epigastric pain, vomiting, increased pulse, visual disturbance, shaking, hyperreflexia, irritability.

Danger of generalised seizures (eclampsia). Death may be imminent from stroke (commonest), hepatic, renal or heart failure.

Admit if BP rises by > 30/20 over booking BP, if BP > 160/100, if BP > 140/90 + proteinuria! or if growth restriction.