MATERNAL ILLNESS AND INFECTIONS DURING PREGNANCY Flashcards
Name 5 risk factors for gestational diabetes
Previous gestational diabetes
Family history of diabetes
Previous macrosomic baby
Previous unexplained stillbirth
Obesity
Glycosuria
Polyhydramnios
Large for gestational age in present pregnancy
Gestational diabetes has a 50% estimated liklihood of causing which disease to develop? [1]
DMT2
Explain pathophysiology of gestational diabetes
Pregnancy is a state of insulin resistance - gestational diabetes is an extreme of this
Foetus needs glucose to grow: gets from mother
Via the placenta: foetus puts out hormones HPL, cortisol and glucagon that makes the mother insulin resistant, so that she cannot use glucose as readily.
Mother will make more amino acids and fatty acids as a result of insulin resistance and some of these pass through to placenta too.
Glucose is transported to the foetus: causes the foetus to have hyperinsulinaemia
This increases growth of baby as glucose is turned into carbs / fats and birth weight goes up
Which hormones are secreted by the baby that causes insulin resistance in the mother? [4]
HPL (Human placental lactogen - causes insulin resistance), hPGF (human placental growth hormone) cortisol and glucagon
Name short term [4] and long term [3] potential consequences to the baby of having gestational diabetes
Short term:
* Macrosomia
* Neonatal hypoglycaemia
* Shoulder dystocia
* C section liklihood
Long term:
* Obesity
* DMT2
* CVD
* Respiratory distress syndrome
* Polyhydramnios
Why does baby go into state of hypoglycaemia after being born, if the mother has gestational diabetes? [1]
How do you treat? [1]
Used to be in a state of fetal hyperinsulinaemia.
Causes baby to go into hypoglycaemia because the placenta that was providing the glucose has not gone
GIve baby a glucose drip for first couple of days after birth
What are potential complications for mother of gestational diabetes? [5]
- Pre-eclampsia
- Infection
- Thromboembolic disease
Other potential complications:
* Nephropathy
* Retinopathy
* Coronary artery disease
* Poor wound healing
* DMT2 in the future
What is average weight of normal size baby boy & girl? [2]
3.5 kg: boy
3.4 kg: girl
How do you manage gestational diabetes? [4]
Dietary modification: calorie reduction
If not successful in reducing hyperglycemia: give insulin
Can also give metformin: crosses the placenta so also helps treat foetus
Regular ultrasound every 2 weeks to monitor fetal growth
The screening test of choice for gestational diabetes is? [1]
The screening test of choice for gestational diabetes is an oral glucose tolerance test (OGTT).
An OGTT is used in patients with risk factors for gestational diabetes, and also when there are features that suggest gestational diabetes:
What type of anaemia normally occurs during pregnancy? [1]
Explain physiology of why anemia occurs in pregnancy [1]
How do you treat? [1]
Usually IDA
Blood volume goes up but erythrocyte number doesn’t increase to same extent
Treatment: oral iron tablets
What is oligohydramnios? [1]
Give two reasons may occur? [2]
Defiency in amniotic fluid
Causes:
* Amniotic fluid leak
* Fetal kidney abnormality (amniotic fluid is produced in the kidneys)
What is the name of this consequence of oligohydramnios? [1]
Potters facies / sequence
How do you assess for depth of amniotic fluid? [1]
What are classifications for oligohydramnios or polyhydramnios? [2]
Assess using ultrasound the depth of amniotic fluid
Oligohydramnios: largest depth of amniotic fluid 2cm or less
Polyhydramnios: largest depth of amniotic fluid 8cm or more
What may cause polyhydramnios? [2]
Fetal GI blockage (not swallowing amniotic fluid)
Kidney anomlies
When is cytomegalovirus (CMV) the biggest risk for a baby? [1]
How does CMV appear histoligically
(CMV: 50% of adults are CMV IgG +ve)
Problematic if mother becomes infected during early pregnancy / first trimester
Histologically: owl eye in cells
