Maternal Medicine (pre-existing illness) Flashcards
What anti-epileptics should pregnant ladies avoid?
Sodium valproate, carbamazepine, phenytoin - TERATOGENIC (neural tube defects), vitamin K deficiency
How much folic acid should diabetics and epileptics take?
5mg, for at least 12 weeks before conception and continue until delivery
Should a lady change her medication for epilepsy during pregnancy?
CASE BY CASE APPROACH - any change should be undertaken before conception, and given a trial run
How will a diabetic’s insulin requirement change during pregnancy?
The insulin dose should be increased to counteract diabetogenic hormones that are produced during pregnancy
What is the risk to the newborn infant, if the mother is diabetic?
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.
What BM levels should be targeted during pregnancy?
<5.5 pre-meal
<7.0 2 hours after a meal
What BM levels should be targeted in the puerperium?
4-9mmol/L
When should T1/2DM patients give birth?
Induction of labour at 38-39 weeks
Why is anaemia common in pregnancy?
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.
How can iron-deficiency anaemia be treated?
- Oral iron tablets
- Ferrous sulphate challenge
- Blood transfusion
When in pregnancy is haemoglobin checked?
Booking, 28, 34 weeks
What level should Hb be above ideally?
105
What are the risks of anaemia to pregnancy?
Preterm labour
PPH
What are the maternal risks of Diabetes in pregnancy?
- Pre-eclampsia
- Miscarriage
- Diabetic retinopathy
- Preterm labour
- Nephropathy
What are the foetal risks of Diabetes in pregnancy?
- Preterm labour/prematurity
- Macrosomia
- Congenital abnormalities
- Birth injury
- IUD
- Increased perinatal mortality
How should pre-existing diabetes be managed during the booking appointment?
- Additional U&E, LFT, TFT and HbA1c
- Review of current medication and advice on more frequent BM monitoring
- Counselling on increased risk of hypoglycaemia
How often should a pregnant Diabetic be reviewed?
Every 2 weeks
When should the screening for retinopathy occur, for a pregnant diabetic?
16 and 28 weeks
How can those at risk of GDM be screened for?
Oral glucose tolerance test (booking and/or 24-28 weeks)
GDM = fasting glucose >5.6mmols or 2 hour >7.8mmols
What are the risk factors for GDM?
- Pre-exisiting diabetes
- BMI > 30
- Family history
- Ethnicity
- Previous big baby
- Previous stillbirth
- Polyhydramnios
What should be done on diagnosis of GDM?
Bloods: U&E, LFT, Vit D, TSH, HbA1c Urine PCR Diabetic clinic review Lifestyle advice BM monitoring Treatment (metformin/insulin)
What additional scans do diabetics have?
14 - 16 weeks - Neural tube defect scan
26,30,34 weeks - Growth scans/AFI/Doppler
34 weeks + - CTG
Why should diabetic ladies be induced/offered c-section at 38 weeks?
Increased risk of stillbirth
When should diabetic ladies get a VARIABLE RATE IV INSULIN INFUSION?
- In labour
- NBM prior to c-section
- Maternal illness
- Use of corticosteroids
How should diabetics be managed during labour?
- Hourly BM checks
- Continuous CTG
- VRIII
What should be done 6 weeks after birth in a lady with GDM?
Fasting blood glucose
In what circumstances would you advice a diabetic to not become pregnant, and why?
HbA1c > 80 or 10% - high risk of miscarriage or congenital cardiac abnormalities
How is GDM usually picked up?
Urine dipstick:
Glucose + on two occasions
Glucose ++ on one occasion
