Maternal Medicine

Question 1

What is obstetric cholestasis

Answer 1

Also known as intra-hepatic cholestasis of pregnancy
Manifests after 24 weeks gestation

Hepato-biliary disorder characterised by :
impaired bile flow leading to the accumulation of bile acids.

Question 2

What are the causes of Obstetric Cholestasis

Answer 2

Genetic Association
Hormonal Association:
Oestrogen inhibits bile acid receptors in genetically susceptible women leading to impaired bile acid homeostasis

Question 3

Pathophysiology of Obstetric Cholestasis

Answer 3

Build of serum bile acid
= Increased deposition of bile salts in various tissues including skin and placenta

= SKIN PRURITUS & EXCORIATION

=PLACENTAL DEPOSISITON = RAISED FETOAL BILE ACID
= ACUTE FETOAL Deterioration (fetal arrythmias / cardiomyopathy / placental vasoconstriction

Question 4

Sx of Obstetric Cholestasis

Answer 4

Pruritus + Excoriations
General discomfort: fatigue or malaise.
Nausea and loss of appetite
Jaundice: Mild maternal jaundice (dark urine and pale stools)
RUQ pain

Question 5

How does obstetric cholestasis affect the fetus?

Answer 5

=PLACENTAL DEPOSISITON = RAISED FETOAL BILE ACID
= ACUTE FETOAL Deterioration (fetal arrythmias / cardiomyopathy / placental vasoconstriction

Question 6

Obstetric Cholestasis ivx

Answer 6

Serum Bile Acids >19mm/l
LFTs

Question 7

Obstetric Cholestasis Tx

Answer 7

1st - Emollient + Anti-Histamines (chlorphenamine )
2nd - Ursodeoxycholic acid

+ Vitamin K

if bile salt >100mm/l - expediated delievery

Question 8

What is GDM gestational diabetes mellitus

Answer 8

chronic hyperglycaemia and insulin resistance due to pregnancy

Question 9

What causes GDM?

Answer 9

In normal pregrnancy:

Local and placental hormones stimulates peripheral insulin resistance (spare j for delievery)

Question 10

How is GDM defined?

Answer 10

glucose intolerance with fasting blood glucose levels equal to or above 5.6 mmol/L

or

2-hour plasma glucose levels equal to or above 7.8 mmol/L on a 75g Oral Glucose Tolerance Test (OGTT).

Question 11

RF for GDM

Answer 11

Ethnic backgrounds with a high prevalence of type 2 diabetes (e.g., Middle Eastern, South Asian, and Afro-Caribbean)

Prior history of GDM

Prior delivery of macrosomic babies (>4.5kg)

History of stillbirth or perinatal death

Maternal obesity (BMI>30)

Diabetes in first-degree relatives

Question 12

GDM complications

Answer 12

maternal:
Pre-eclampsia
Chronic T2DM (60%)
Increased risk of CVS

Foetal
-Macrosomia -> shoulder dystocia
-Neonatal Hypoglycemia
-Childhood Obesity
-Increased risk of metbaolic syndrome

Question 13

When is GDM screened for?

Answer 13

if mother has any of rf they should be screen for GDM at 24-28 weeks

Question 14

Diagnosing gdm

Answer 14

5678
FPG EQUAL TO OR MORE THAN 5.6

ogtt 75G - >7.8MMOL/L

Question 15

Managing GDM

Answer 15

1st: 2 week diet, exercise and monitering glucose

2nd: Metformin

if FPG>7 - INSULIN

+ Growth scans at 28, 32, 36 weeks

Question 16

GDM sx

Answer 16

Polyuria
Thirst
Fatigue