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TAS Perinatal Medicine ✅ > Maternal Diseases ✅ > Flashcards

Maternal Diseases ✅ Flashcards

1
Q

Give 3 categories of maternal diseases that can affect a fetus?

A
  • Diabetes mellitus
  • Red blood cell alloimmunisation
  • Immune mediated disease
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2
Q

What is maternal diabetes mellitus associated with?

A

Increased perinatal morbidity and mortality

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3
Q

How can perinatal morbidity and mortality due to maternal diabetes mellitus be reduced?

A

Good blood glucose control from pre-conception

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4
Q

What fetal problems are associated with maternal diabetes mellitus?

A
  • Congenital malformations
  • Sudden intrauterine death
  • Macrosomia
  • Intrauterine growth restriction
  • Preterm labour
  • Hypoglycaemia
  • Hyperbilirubinaemia
  • Respiratory distress syndrome
  • Hypertrophic cardiomyopathy
  • Polycythemia
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5
Q

By how much is the risk of congenital malformations increased with maternal diabetes mellitus?

A

4x

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6
Q

What congenital malformations in particular is there an increased risk of with maternal diabetes mellitus?

A
  • Cardiac malformations

- Caudal regression syndrome (sarcral agenesis)

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7
Q

When does maternal diabetes mellitus the risk of sudden intrauterine death?

A

In the third trimester

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8
Q

What is macrosomia defined as?

A

LGA >90th centile

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9
Q

What causes macrosomia in maternal diabetes mellitus?

A

Maternal hyperglycaemia results in glucose crossing the placenta, which causes fetal hyperinsulinaemia, which promotes growth

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10
Q

How does the % of infants with a birthweight of >4kg compare between diabetic and non-diabetic mothers?

A

Up to 25% in diabetic mothers, compared to 8% in non-diabetic mothers

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11
Q

What complications are macrocosmic infants at higher risk of?

A

Cephalopelvic disproportion causing;

  • Obstructed labour
  • Shoulder dystocia
  • Birth trauma
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12
Q

How much is the risk of IUGR increased in diabetic mothers?

A

3x

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13
Q

What is the increased risk of IUGR in diabetic mothers associated with?

A

Maternal microvascular disease

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14
Q

What is the risk of preterm labour in diabetic mothers?

A

10% (either spontaneous or induced)

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15
Q

When is induction of labour usually planned in diabetic mothers?

A

38weeks

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16
Q

What are the neonatal problems associated with maternal diabetes mellitus?

A
  • Hypoglycaemia
  • Hyperbilirubinaemia
  • Respiratory distress syndrome
  • Hypertrophic cardiomyopathy
  • Polycythaemia
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17
Q

When is hypoglycaemia common in infants born to diabetic mothers?

A

First 48 hours after birth

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18
Q

Why is hypoglycaemia common in the first 48 hours of life for infants born to diabetic mothers?

A

Due to residual hyperinsulinism

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19
Q

What is hypoglycaemia often accompanied by in neonates born to diabetic mothers?

A
  • Hypocalcaemia

- Hypomagnesaemia

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20
Q

What can hyperbilirubinaemia in a child born to a diabetic mother be exacerbated by?

A

Polycythaemia

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21
Q

Why are infants born to diabetic mothers at a higher risk of respiratory distress syndrome?

A

Due to delayed maturation of surfactant

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22
Q

Is hypertrophic cardiomyopathy common in infants born to diabetic mothers?

A

No, is uncommon

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23
Q

What causes hypertrophic cardiomyopathy in infants born to diabetic mothers?

A

From fetal hyperinsulinism

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24
Q

What might hypertrophic cardiomyopathy cause in infants born to diabetic mothers?

A

Transient outflow obstruction

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25
Q

What causes polycythaemia in infants born to diabetic mothers?

A

Chronic fetal hypoxia

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26
Q

What does neonatal polycythaemia increase the risk of?

A
  • Stroke
  • Seizures
  • Necrotising enterocolitis
  • Renal vein thrombosis
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27
Q

What happens in maternal red blood cell alloimmunisation?

A

Maternal antibody is formed to fetal red blood cell antigens

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28
Q

What fetal red blood cell antigens might maternal antibody be produced against?

A
  • Rhesus D
  • Anti-Kell
  • Anti-c
29
Q

Give an example of a disease caused by maternal red blood cell alloimmunisation

A

Rhesus haemolytic disease

30
Q

What has happened to the incidence of rhesus haemolytic disease?

A

It has reduced

31
Q

Why has the incidence of rhesus haemolytic disease reduced?

A

Due to the introduction of anti-D prophylaxis

32
Q

What kind of antibodies can cross the placenta?

A

IgG

33
Q

Why can IgG cross the placenta?

A

Because they are small molecules

34
Q

What is the importance of IgG transfer across the placenta?

A

It confers passive immunity to the infant

35
Q

What it the problem with IgG transfer across the placenta?

A

When maternal IgG is part of a disease state, transplacental passage may result in damage to the fetal tissues or cause transient disease in the infant

36
Q

Give 5 examples of maternal immune mediated diseases that can affect a foetus?

A
  • Hyperthyroidism (Grave’s disease)
  • Hypothyroidism
  • Autoimmune thrombocytopenia
  • SLE
  • Myasthenia
37
Q

When is a fetus/infant rarely affected by maternal hyperthyroidism?

A

If the mother is on treatment

38
Q

What can happen in foetuses of mothers with untreated hyperthyroidism?

A

Transient neonatal thyrotoxicosis

39
Q

What causes transient neonatal thyrotoxicosis?

A

Transplacental transfer of TSH receptor antibodies (TRAbs)

40
Q

How does transient neonatal thyrotoxicosis present?

A

Tachycardia and features of neonatal hyperthyroidism

41
Q

How long does transient neonatal thyrotoxicosis need treatment for?

A

Several months

42
Q

What might occur in infants of mothers who are on anti-thyroid drug therapy?

A

Transient hypothyroidism

43
Q

Can maternal hypothyroidism cause problems in the neonate if it is treated?

A

It is rare

44
Q

What is the global importance of maternal hypothyroidism?

A

It is an important cause of congenital hypothyroidism secondary to maternal iodine deficiency

45
Q

How can maternal autoimmune thrombocytopenia affect the foetus?

A

Antiplatelet IgG autoantibodies in maternal thrombocytopenia can cross the placenta causing fetal thrombocytopenia

46
Q

Does maternal immune mediated fetal thrombocytopenia always require treatment?

A

No, rarely does

47
Q

What can maternal immune mediated fetal thrombocytopenia cause if severe?

A

Cerebral haemorrhage before birth or from birth trauma

48
Q

What is required in severe cases of maternal immune mediated fetal thrombocytopenia?

A

Intrauterine IV platelet transfusions

49
Q

What should be given if there is severe thrombocytopenia or petechiae at birth in maternal immune mediated fetal thrombocytopenia?

A

IV immunoglobulins

50
Q

When will IV platelets be given in the neonatal period for maternal immune mediated thrombocytopenia?

A

Only for extremely low platelet counts or active bleeding

51
Q

Why are IV platelets only given in the neonatal period for maternal immune mediated thrombocytopenia if there is extremely low platelet counts or active bleeding?

A

Because of the anti platelet antibodies

52
Q

How can maternal SLE affect pregnancy?

A
  • Increased risk of recurrent miscarriage

- Increased chance of congenital heart block

53
Q

Why are mothers with SLE at increased risk of recurrent miscarriage?

A

Due to vasculopathy associated with SLE

54
Q

What is the chance of a mother with SLE having a baby with congenital heart block?

A

0.5-2%

55
Q

Why is there an increased chance of complete heart block in babies of mothers with SLE?

A

Due to the presence of anti-Ro and anti-La autoantibodies, which may damage the conduction system in the fetal heart

56
Q

What may be needed in babies with congenital heart block?

A

Pacemaker insertion

57
Q

How can maternal myasthenia affect the foetus?

A

Maternal acetylcholine receptor (AChR) IgG antibodies can cross the placenta

58
Q

What is it produced when maternal AChR IgG cross the placenta?

A

Transient neonatal myasthenia

59
Q

How does transient neonatal myasthenia present?

A

Hypotonia after delivery, causing problems with feeding and sometimes respiration

60
Q

How is transient neonatal myasthenia diagnosed?

A

Administration of anti-cholinesterase (neostigmine)

61
Q

What happens when neostigmine is given in transient neonatal myasthenia?

A

Rapid improvement

62
Q

How long does transient neonatal myasthenia last for?

A

2 months

63
Q

In what situation can perinatal alloimmune thrombocytopenia develop?

A

When fetal platelets contain an antigen which the mother lacks

64
Q

What are the most common antigens implicated in perinatal alloimmune thrombocytopenia?

A

HPA-1a or 5b

65
Q

What is the pathological process in perinatal alloimmune thrombocytopenia?

A

The mother develops antibodies which cross the placenta and bind to fetal platelets

66
Q

What is perinatal alloimmune thrombocytopenia analogous to?

A

Rhesus D alloimmunisation

67
Q

In what respects does perinatal alloimmune thrombocytopenia differ from rhesus D alloimmunisation?

A
  • Often affects first pregnancy

- Maternal antiplatelet antibody titres are not predictive of severity of the fetal thrombocytopenia

68
Q

What can be done if perinatal alloimmune thrombocytopenia is identified from a previously affected infant?

A

Can be treated with IVIG and platelets if necessary

69
Q

How is severe thrombocytopenia after birth treated in perinatal alloimmune thrombocytopenia?

A

Platelet transfusions negative for the platelet antigen

TAS Perinatal Medicine ✅ (16 decks)

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