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3RD YEAR - Women's Health > Maternal Medicine (pre-existing illness) > Flashcards

Maternal Medicine (pre-existing illness) Flashcards

1
Q

What anti-epileptics should pregnant ladies avoid?

A

Sodium valproate, carbamazepine, phenytoin - TERATOGENIC (neural tube defects), vitamin K deficiency

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2
Q

How much folic acid should diabetics and epileptics take?

A

5mg, for at least 12 weeks before conception and continue until delivery

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3
Q

Should a lady change her medication for epilepsy during pregnancy?

A

CASE BY CASE APPROACH - any change should be undertaken before conception, and given a trial run

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4
Q

How will a diabetic’s insulin requirement change during pregnancy?

A

The insulin dose should be increased to counteract diabetogenic hormones that are produced during pregnancy

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5
Q

What is the risk to the newborn infant, if the mother is diabetic?

A

Neonatal hypoglycaemia - early feeding and regular blood glucose monitoring should be preformed to minimise this risk, as it can lead to cerebral damage if left untreated.

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6
Q

What BM levels should be targeted during pregnancy?

A

<5.5 pre-meal

<7.0 2 hours after a meal

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7
Q

What BM levels should be targeted in the puerperium?

A

4-9mmol/L

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8
Q

When should T1/2DM patients give birth?

A

Induction of labour at 38-39 weeks

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9
Q

Why is anaemia common in pregnancy?

A

There is an increase in blood volume during pregnancy, which is higher than the increase in red cell mass, causing a subsequent decrease in haemoglobin concentrations. Iron and folic acid requirements increase.

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10
Q

How can iron-deficiency anaemia be treated?

A
  • Oral iron tablets
  • Ferrous sulphate challenge
  • Blood transfusion
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11
Q

When in pregnancy is haemoglobin checked?

A

Booking, 28, 34 weeks

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12
Q

What level should Hb be above ideally?

A

105

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13
Q

What are the risks of anaemia to pregnancy?

A

Preterm labour

PPH

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14
Q

What are the maternal risks of Diabetes in pregnancy?

A
  • Pre-eclampsia
  • Miscarriage
  • Diabetic retinopathy
  • Preterm labour
  • Nephropathy
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15
Q

What are the foetal risks of Diabetes in pregnancy?

A
  • Preterm labour/prematurity
  • Macrosomia
  • Congenital abnormalities
  • Birth injury
  • IUD
  • Increased perinatal mortality
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16
Q

How should pre-existing diabetes be managed during the booking appointment?

A
  • Additional U&E, LFT, TFT and HbA1c
  • Review of current medication and advice on more frequent BM monitoring
  • Counselling on increased risk of hypoglycaemia
17
Q

How often should a pregnant Diabetic be reviewed?

A

Every 2 weeks

18
Q

When should the screening for retinopathy occur, for a pregnant diabetic?

A

16 and 28 weeks

19
Q

How can those at risk of GDM be screened for?

A

Oral glucose tolerance test (booking and/or 24-28 weeks)

GDM = fasting glucose >5.6mmols or 2 hour >7.8mmols

20
Q

What are the risk factors for GDM?

A
  • Pre-exisiting diabetes
  • BMI > 30
  • Family history
  • Ethnicity
  • Previous big baby
  • Previous stillbirth
  • Polyhydramnios
21
Q

What should be done on diagnosis of GDM?

A 
Bloods: U&amp;E, LFT, Vit D, TSH, HbA1c
Urine PCR
Diabetic clinic review
Lifestyle advice
BM monitoring
Treatment (metformin/insulin)
22
Q

What additional scans do diabetics have?

A

14 - 16 weeks - Neural tube defect scan
26,30,34 weeks - Growth scans/AFI/Doppler
34 weeks + - CTG

23
Q

Why should diabetic ladies be induced/offered c-section at 38 weeks?

A

Increased risk of stillbirth

24
Q

When should diabetic ladies get a VARIABLE RATE IV INSULIN INFUSION?

A
  • In labour
  • NBM prior to c-section
  • Maternal illness
  • Use of corticosteroids
25
Q

How should diabetics be managed during labour?

A
  • Hourly BM checks
  • Continuous CTG
  • VRIII
26
Q

What should be done 6 weeks after birth in a lady with GDM?

A

Fasting blood glucose

27
Q

In what circumstances would you advice a diabetic to not become pregnant, and why?

A

HbA1c > 80 or 10% - high risk of miscarriage or congenital cardiac abnormalities

28
Q

How is GDM usually picked up?

A

Urine dipstick:
Glucose + on two occasions
Glucose ++ on one occasion

3RD YEAR - Women's Health (24 decks)

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