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Obs and Gynae > Diabetes In Pregnancy > Flashcards

Diabetes In Pregnancy Flashcards

1
Q

Percentage of women with pre-existing or gestational diabetes in pregnancy?

A

5% (87.5% gestational, 7.5% type 1, 5% type 2)

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2
Q

Risks in pregnancy associated with pre-existing diabetes

A 
Higher risk of:
Miscarriage
Pre-eclampsia
Preterm labour (5x more likely)
Diabetic retinopathy can worsen rapidly
Congenital malformations 
Stillbirth
Macrosomia
Perinatal mortality 
Postnatal adaptation problems
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3
Q

How to diagnose gestational diabetes?

A

Fasting glucose >5.6 mol/litre

2 hour plasma glucose >7.8 mmol/litre

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4
Q

What is shoulder dystocia?

A

Vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the foetus after the head has delivered and gentle traction has failed
Anterior or posterior fetal shoulder impacts on maternal symphysis or sacral promontory, respectively

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5
Q

How should shoulder dystocia be managed?

A

McRoberts’ manoeuvre (flexion and abduction of the maternal hips)
Suprapubic pressure applied
Episiotomy is not always necessary

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6
Q

Reason for macrosomia

A

Maternal glucose high - enters baby’s blood stream, drives the release of insulin - stimulates fat storage, causes organ growth

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7
Q

What is hPL?

A

Human placental lactogen

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8
Q

What happens in gestational diabetes?

A

hPL, GH, cortisol, progesterone cause increased production of glucose
hormones also cause insulin resistance

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9
Q

Who should be screened for GDM

A 
>30 BMI
Previous baby >4.5kg
Previous GDM 
FH (first degree)
South Asian, black Caribbean or Middle Eastern.
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10
Q

Precautions in women with pre existing diabetes

A

Aspirin 75mg
Review every 2 weeks
Anomaly scan @ 20 weeks
Growth scan every 4 weeks from 28 weeks
Prophylactic LMWH antenatally and for 6 weeks postnatally
Blood sugar fasting <5.3, <7.8 1 hour post meal

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11
Q

Common drugs contraindicated in pregnancy

A

Contraindicated:
Ramipril
Isotretinoin
Sodium valproate

Caution:
Citalopram (1st trimester - congenital heart disease)
Trimethoprim (1st trimester - interferes with folic acid pathway)
Lamotrigine
Propylthiouracil (liver disease/failure in some pregnancies
Carbimazole (1st trimester - aplasia cutis)
Nitrofurantoin (>36 weeks - haemolytic anaemia)

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12
Q

Maximum dose of metformin?

A

2500mg OD

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13
Q

Risk factors that increase the chances of shoulder dystocia

A 
Macrosomia
Diabetes in pregnancy
Previous shoulder dystocia
Raised BMI
Induction of labour
Epidural
Instrumental delivery
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14
Q

Pathophysiology of diabetes in pregnancy

A

Increased insulin resistance
Reduced glucose tolerance
Reduced renal tubular threshold for glucose

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15
Q

Effect of pregnancy on diabetes

A

Increasing doses of insulin
Worsening retinopathy or nephropathy
Increased hypoglycaemic attacks

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16
Q

Diabetic drugs in pregnancy

A

Used
Metformin
Insulin

Avoided
Sulfonylureas (glibencamide)
Statins
ACE inhibitors

17
Q

Hypertension drugs in pregnancy

A

Used
Labetalol
Nifedipine
Doxasosin

Avoided
ACE inhibitors
Angiotensin II blockers
Diuretics

18
Q

Haematological drugs in pregnancy

A

Used
LMWH

Avoided
Warfarin

19
Q

Epilepsy drugs in pregnancy

A

Used
Lamotragine

Avoided
Sodium valproate
Phenytoin
Phenbarbitone

20
Q

Endocrine drugs in pregnancy

A

Used
Carbimazole
Propylthiouracil

Avoided
Radioactive iodine
Sex hormones

21
Q

Drugs used in inflammatory conditions in pregnancy

A

Used
Prednisolone
Sulfasalazine
Mesalazine (5mg folic acid)

Avoided
Methotrexate
Cyclophosphamide
NSAIDS

22
Q

Maternal effects of diabetes on pregnancy

A 
Increased risk of miscarriage
Increased PET
Worsening renal damage (hypoalbuminaemia, anaemia)
Infection 
Increased induction rate and LSCS rate
23
Q

Fatal effects of maternal diabetes on pregnancy

A

Increased risk of congenital malformations (skeletal, cardiac, NTD)
Unexplained stillbirth

24
Q

What is the Pederon hypothesis?

A

Maternal hyperglycaemia leads to foetal hyperglycaemia
Increased production of foetal insulin
Insulin = growth factor
Leads to:
- foetal hypoxia causing haemopoesis and thus polycythaemia and jaundice (splenomegaly)
-macrosomia which is associated with induction, dysfunctional labour, shoulder dystocia, PPH

Can lead to neonatal hypoglycaemia (feeding required 30mins post birth, blood sugars every 2-4 hours)

25
Q

When to refer to nephrologist?

A

Urine P/C Ratio >30mg/mmol

eGFR <45

26
Q

HbA1c, target and significant risk

A

Aim: <48

Significant risk: >86

27
Q

When should a baby be delivered (IOL or LSCS) in diabetes?

A

T1 or T2DM - 37-38+6
Offered prior to 37/40 if possible foetal or maternal complications
GDM - 40+6

28
Q

When is LSCS offered if shoulder dystocia is a concern?

A

In diabetes >4.5kg

Normal >5kg

Obs and Gynae (19 decks)

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