medical complications of pregnancy

Question 1

diagnosis for GDM

Answer 1

Slightly different than normal
random >5.6
2 hour OGTT >7.8

Question 2

antenatal mx of GDM (including targets)

Answer 2

diabetic-obstetric clinic every 2 weeks
monitor BM 7x a day - target <5.3 fasted, <7.8 1 hour post prandial
serial growth scans every 4 weeks from 28-36

Question 3

Medical mx of GDM

Answer 3

1. lifestyle (provided fasting BM <7)
2. metformin
3. add insulin

if fasting glucose >7 at diagnosis or >6 w/ complications go straight for insulin

Question 4

Intrapartum mx of GDM

Answer 4

birth NO LATER THAN 40+6

Question 5

Postnatal mx of GDM + what’s your risk of develoing T2DM

Answer 5

stop treatment immediately after birth
monitoring:
test BM 6-13 weeks postnatal
<6 low risk of developing T2DM
6.0-6.9 - high risk of developing T2DM
>7.0 - likely to have T2DM (offer diagnostic test to confirm)

Question 6

Risks of GDM

Answer 6

maternal:
HTN, traumatic delivery, stillbirth

Foetal:
macrosomia, neonatal hypoglycaemia, congenital abnormalities

Question 7

Mx of hypothyroidism in pregnancy

Answer 7

Antenatal -

monitoring: Check TFTs every 2-4 weeks
medical: continue (NB TSH falls and T4 rises in first trimester)

Postnatal -
Check TFT at 6-8 wks

Question 8

Mx hyperthyroidism

Answer 8

Antenatal -

monitor: check TFT every 2-4 weeks
medical: continue CBZ/PTU at lowest acceptable dose,

Postnatal -
check at 6-8 weeks

Question 9

What drugs used in pregnancy are contraindicated in asthma

Answer 9

Ergometrine and PGF2a (bronchoconstrictors)

Question 10

Anaesthesia advice for asthmatics

Answer 10

Regional anaesthesia preferred to GA

Question 11

What are teratogenic medications used to treat heart disease

Answer 11

ACEi
ARB
Statins
thiazide
warfarin

Question 12

Intrapartum mx of pregnancy with heart disease

Answer 12

aim for spontaneous labour, avoid IOL
advise epidural
minimise length of 2nd stage
active mx of 3rd stage (use syntocine, not ergometrine as it’s a vasoconstrictor)

Question 13

Why are antiepileptics contraindicated in pregnancy

Answer 13

Teratogenic

give: neural tube defect, facial clefts, cardiac defects

Question 14

Mx of epilepsy

Answer 14

Pre-conception:
reduce to monotherapy if possible (avoid valproate if possible)
High dose folic acid from pre-conception to 12 weeks
Antenatal - serial growth scan from 28-36 weeks every 4 weeks
Do not need to monitor drugs frequently

Postnatal - encourage breastfeeding

Question 15

Mx of obstetric cholestasis

Answer 15

Antenatal:
monitoring - LFTs and bile acid levels weekly, doppler +CTG every 2 weeks til delivery

Conservative - wear cool loose clothes, apply ice packs, topical emollients

Medical: antihistamines for sleep, urseodeoxycholic acid for pruritus, vit K

Intrapartum - induce at 37 wks, deliver no later than 40

Postnatal - measure LFTs at 40 weeks

Question 16

RF for obstetric cholestasis

Answer 16

personl/FHx, hx of liver disease, multiple pregnancy

Question 17

mx of acute fatty liver of pregnancy

Answer 17

admit to ITU

expedite delivery

Question 18

mx for anaemia

Answer 18

Antenatal - 100-200mg iron til it’s in right range, take it til 6 weeks post partum to replenish stores
Intrapartum - deliver on ward, IV access, active mx of 3rd stage,

Question 19

Mx of pre-existing diabetes in pregnancy

Answer 19

pre-conception:
stop all glucose lowering medications apart from metformin and insulin
5mg folate til 12 weeks

antenatal:
joint diabetes/obstetric clinic every 2 weeks
increased monitoring w/ scans
low dose aspirin from 12 weeks
insulin resistance increases throughout pregnancy so up dose of meds in 2nd half of pregnancy

intrapartum:
if on insulin starts SLIDING SCALE
if corticosteroids needed increase insulin

Postnatal:
check neonatal BM within 4 hours to exclude neonatal hypoglycaemia