GDM, Thyroid d/o in preg

Question 1

DM in pregnancy c/f

Answer 1

Effects on fetus
1. Macrosomia
2. Congenital abn- neural tube, vertebra, cardiac, renal
3. IUGR, IUFD
4. Malpresentation
5. Miscarriage
6. Preterm delivery

Effects on mother:
1. Pre-eclampsia
2. Diabetic ketoacidosis
3. Polyhydramnios
4. Placenta abruption
5. Shoulder dystocia while delivery

Question 2

Mx of DM1 in preg

Answer 2

1. Early referral to diabetician, obs
2. Basic parameters - HbA1c, BP, renal
3. Reassess need of insulin (increases in preg)
4. ===Screening USG - 18wks, then monthly
   CTG - 32wks till delivery===
5. Aim delivery at term, NVD if possible

Question 3

*Gestational diabetes

Answer 3

DM during preg
1. In GDM/strong fam h/o
Dxt: OGTT in T1 done (normally at 26-28wks)
Dxt with OGTT (75g)
●FBS >5.1mmol/L
(OR)
●1hr level >10mmol/L
2hr level >8.5mmol/L

Question 4

Mx of GDM

Answer 4

1. Refer
2. Life style modification - chart RBS
3. Insulin next
   High FBS - intermediate/long acting
   High PLBS - short acting
4. Delivery at term
5. *F/U OGTT at 6 wks post-partum and
   every 5 yrs after that (30% risk)

●Metformin given if RBS not too high
C/I in fetal growth restriction, pre-eclampsia

●Fetal growth scan at 28-32 wks for macrosomia

Question 5

Hypothyroidism in preg

Answer 5

1. Rare
2. A/w fetal loss, IUFD, miscarriage, fetal abnormalities
3. TSH at first visit, 36wks
4. Rx: throxine replacement

Question 6

Hyperthyroid in preg

Answer 6

1. Graves disease
2. Mx: PTU upto 12wks(T1) … change to carbimazole
3. C/I:
   Carbimazole in T1
   Radio iodine ablation
   Sx