Maternal Medical Flashcards
BSL targets for GDM
Fasting 5 or less
1h post- prandial 7.4 or less
2h post- prandial 6.7 or less
Distinguish between Graves flare vs postpartum thyroiditis (with hyperthyroidism)
TSI positive with Graves
Radioactive iodine will show increased uptake with Graves
Diagnosis of AFLP
Swansea criteria: at least 6 of the following:
Hypoglycaemia
Hyperuricaemia
Coagulopathy in the absence of thrombocytopenia
Vomiting
Abdo pain
Diabetes insipidus
Raised ammonia
AKI
raised transaminases
Leucocytosis
Encephalopathy
Diagnosis of Hep B
Screen with Hep B surface antigen- if positive,
Perform Hep B e antigen OR Hep B DNA; + LFTs
Vertical transmission:
95% if both HBsAg + HBeAg +ve
2- 15% if HBsAg +ve but HBeAg -ve
Higher vertical transmission with higher viral load
When to initiate treatment of Hep B and how
If viral load >100 000 000- treat with tenofovir from 30 weeks
Monitor ALT q4weeks, for 2-3 months
Give HBIG + birth dose HBV vaccine to infant
If viral load less than that above, no treatment for mother but give same to infant
Clinical features of TTP
Classic pentad: haemolytic anaemia, thrombocytopenia, fever, neurological manifestations, AKI
Clinical features of HUS
Classic Triad- thrombocytopenia, haemolytic anaemia, renal episode (AKI post- partum usually)
Alpha thalassaemia
4 copies of alpha gene (2 from each parent) which code for alpha globulin chain.
Leads to reduction in synthesis of alpha globulin chains.
3 copies- asymptomatic
2 copies- asymptomatic but May become anaemic in pregnancy
Haemoglobin H (1 copy)- mild- mod anaemia in childhood. In adulthood, can be asymptomatic anaemia to transfusion dependent
Alpha thalassaemia major/ Bart’s hydrops- incompatible with life
Beta thalassaemia
2 copies of beta globulin gene
Trait (one normal gene)- asymptomatic but maybe become anaemic with infection or pregnancy
Major (no normal gene)- lack of beta chain so Hb ends up consisting of an alpha tetramer which results in chronic dysfunction of erythropoiesis ( splenomegaly, infections, long bone deformity, osteoporosis, skull bone expansion, short stature). Patient is transfusion- dependent with endocrine abnormalities
Diagnosis of thalassaemia
Hallmark is very low MCV and MCH.
Consider if normal Hb + above
Offer haemoglobinopathy screening to all women antenatally
Haemoglobin electrophoresis
Screening for thalassaemia
Offer haemoglobinopathy screening to all women antenatally:
- if positive, offer partner screening
- if both partners positive, offer prenatal diagnosis (PCR or southern Blot)
- if affected- involve paeds
Von Willebrand disease (VWD) pathogenesis
vWF is an adhesive protein that has a special role in platelet function and stability of factor VIII.
vWF is required for the binding of platelets to the sub- endothelium after vessel injury.
vWD is a deficiency in vWF
Diagnosis:
- low vWF and factor VIII
- prolonged APTT
3 types:
Type 1- mild
Type 2- qualitative defect
Type 3- severe deficiency
Mx of vWD in pregnancy
Avoid aspirin and NSAIDs (PP)
Type 1- DDAVP IV infusion prior to procedures/ surgery/ regional
Type 2- give FFP prior to procedure
Type 3- FFP prior to procedure
Haemophilia A
X- linked recessive
Low factor VIII levels- improves in pregnancy
Diagnosis:
- prolonged APTT
- low factor VIII levels
Haemophilia B
X- linked recessive
Low factor IX levels
Diagnosis:
- prolonged APTT
- low factor IX levels
