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Y5 Gynae & Obstetrics > Medical Complications of Pregnancy > Flashcards

Medical Complications of Pregnancy Flashcards

1
Q

What is the effect of pregnancy on ladies with CKD depending on their CKD staging?

A

CKD stage 1-2: unaffected, good renal outcome

CKD stage 3-5; complications, accelerated decline in renal function

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2
Q

What are the increased risk of CKS on pregnancy outcome?

A

Preterm
C sec delivery
FGR

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3
Q

When is pregnancy safe in ladies with renal transplants?

A

SAFE after 2nd year post transplant

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4
Q

What is the aim of pre-pregnancy counselling with previoius DM?

A

Achieve the best possible glycaemic control before pregnancy

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5
Q

What is the most critical period of the embryo?

A

The first 42 days

During organogenesis

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6
Q

What are complications of DM in pregnancy for the foetus?

A 
Congenital abnormality 
Macrosomia > shoulder dystocia 
Miscarriage/Stillbirth 
Diabetic retinopathy 
Infection
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7
Q

What are complications of DM in pregnancy for the mother?

A

PET
Severe hyper/hypoglycaemia
DKA
Increased operative delivery rate

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8
Q

How. do you treat diabetic ladies to prevent complications?

A

75g aspirin from 12 wks gestation to delivery

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9
Q

how do you monitor DM in pregnancy=

A

Home blood glucose monitoring

Up to 7 times a day, before and after meals

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10
Q

What is the target for blood glucose pre- and post-prandial for DM patients?

A

Pre-prandial: <5.4

Post-prandial: <7.8

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11
Q

Why is hyperglycaemia Moree common in pregnancy=

A

Because insulin resistance in creases throughout pregnancy

So women with DM are required to increase their dose of metformin / insulin

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12
Q

What additional scans need to be arranged for DM patients in pregnancy ? Why=

A

additional US growth scans

This is to assess foetal growth (diagnose macrosomia, polyhydramnios)

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13
Q

How do you adjust insulin therapy if antenatal corticosteroids. are needed?

A

Give additional insulin

To maintain normoglycaemia

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14
Q

What does the presence of. complications in DM pregnant ladies mean for their delivery?

A

Presence of complications means that 50% of women deliver by C sec

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15
Q

What do you need to change regular insulin to in labour’

A

To INSULIN SLIDING SCALE

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16
Q

When is the increase in insulin dose requirement especially important in pregnancy?

A

In the second half of pregnancy

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17
Q

How many pregnancies does GDM occur in?

A

1 in 5 pregnancies affected

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18
Q

What is GDM?

A

Any degree of glucose intolerance with onset in pregnancy

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19
Q

What does GDM increase the risk of in later life?

A

Increased risk of T2DM

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20
Q

Why does GDM occur?

A

In pregnancy there is progressive insulin resistance (more insulin needed to respond to same level of glucose)

So the insulin requirement rises

If a woman has poor pancreatic reserve, her pancreas cannot response with increased insulin, leading to transient hyperglycaemia

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21
Q

What are RF for GDM?

A 
Obesity, poor diet
Asian 
Prior GDM 
FH GDM 
Prior macrosomic babuy
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22
Q

What are maternal sx of GDM?

A

Asymptomatic
Polyuria, polydipsia
Fatigue

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23
Q

When would you do a glucose test for GDM, and what kind=

A

Oral Glucose Challenge test (wait. 1h after drink)

Oral Glucose Tolerance test (if STRONG risk. Wait. 2h after drink)

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24
Q

How does the OGTT work?

A

Take fasting blood glucose
Give 75g glucose drink
Take 2h glucose

25
Q

What are the values on OGTT for dx of GDM?

A

Fasting blood glucose >5.6

2h OGTT >7.8

26
Q

What tx exist for GDM?

A

Expectant: improve diet and lifestyle
Medical: Metformin / insulin

27
Q

When do you aim to deliver for GDM?

A

BEFORE 40 wks

28
Q

How does the thyroid requirement change in pregnancy?

A

Thyroid requirement INCREASES

29
Q

What is the most common cause of hypothyroidism?

A

Hashimoto

30
Q

Is it safe to be on thyroid replacement therapy throughout pregnancy?

A

YES

31
Q

How do you treat hyperthyroidism in pregnancy?

A

Carbimazole/prolylthiouracil at LOWEST DOSE POSSIBLE (may cross placenta causing foetal hypothyroidism)

32
Q

What medicine is strongly contraindicated fro hyperthyroidism in pregnancy?

A

RADIOACTIVE IODINE

33
Q

What is a risky complication of taking Carbimazole/prolylthiouracil

A

Agranulocytosis

34
Q

What are risks of uncontrolled thyrotoxicosis?

A

Miscarriage preterm delivery

35
Q

Why does GDM have complications on the foetus?

A

Because glucose is trasnsported across the placenta, but insulin is not
So the foetus can become hyperglycaemic
The foetus will increase its own insulin levels in response, causing hyperinsulinaemia

36
Q

Why does increased foetal insulin cause macrosomia?

A

Because insulin is similar in structure to GH

37
Q

What are the effects of hyperinsulinaemia on the foetus?

A

Macrososmia
Organomegaaly
Erythromìpioesis
Polyhydraknios.

38
Q

What are risks of GDM on the baby after delivery?

A

Baby hypoglycaemia (foetal levels of insulin stay high but sudden drop in glucose)

RDS (as insulin decreases surfactant production)

39
Q

What are normal physiological changes in the skin of a pregnant woman?

A

Increased pigmentation
Spider nave
Pruritus (no rash)

40
Q

What pre-existing skin conditions can worsen during pregnancy?

A

Eczema

Acne

41
Q

What are possible skin conditions in pregnancy that cause itching?

A

Pemphigoid gestationitis
Polymorphic eruption of pregnancy
Prurigo of pregnancy
Pruritic folliculitis of pregnancy

42
Q

What is the cause of Pemphigoid gestationitis

A

Autoimmune BULLOUS disorder

43
Q

Describe the lesions in Pemphigoid gestationitis

A

Bullae (large fluid filled blisters) around the border of the erythematous rash
Lots of erythematous rashes
Start at the abdomen, spread to the rest of body

Spare the face and mucosa

44
Q

Does Pemphigoid gestationitis affect the foetus?

A

YES

It is linked to IUGR (give extra growth scans)
The newborn may also develop skin lesions

45
Q

How do you diagnose Pemphigoid gestationitis

A

Skin biopsy

46
Q

How do you treat Pemphigoid gestationitis

A

Prednisolone, antihistamine

47
Q

What is the recurrence rate of pemphigoid gestationitis?

A

HIGH

48
Q

What is Polymorphic eruption of pregnancy

A

benign, self limiting pruritus inflammation

49
Q

When in the pregnancy does Polymorphic eruption of pregnancy usually present

A

3rd trimester / immediately post part

50
Q

Where does Polymorphic eruption of pregnancy occyr

A

On lower abdomen WITH PERI UMBILICAL SPARING

May extend to thighs, buttocks, legs, arms

51
Q

What is the recurrence of Polymorphic eruption of pregnancy like

A

DOES NOT RECUR

52
Q

How does Polymorphic eruption of pregnancy impact the pregnancy ?

A

NO IMPACT ON PREGNANCY

53
Q

What are RF for Polymorphic eruption of pregnancy

A
  • overextended abdomen (polyhydramnios, multiple pregnancies, macrocosmic baby) - because the skin stretch causes connective tissue damage and inflammatory response
  • nulliparous
  • multiple pregnancy
54
Q

how do you treat Polymorphic eruption of pregnancy

A 
Emollient 
Topical steroid (hydrocortison()
55
Q

Describe the rash in Polymorphic eruption of pregnancy

A

erythematous rash on abdomen with peri umbilical sparing

56
Q

Explain prurigo of pregnancy

A

Exoriated papule on extensor limbs, abdomen, shoulders +Resolves after delivery

57
Q

How do you treat prurigo of pregnancy

A

Topical steroids + emollients

58
Q

What is pruritus folliculitis of pregnancy?

A

Pruritic follicular eruption of papule and pustules affecting the trunk
Looks similar to acne
Resolves with delivery

Y5 Gynae & Obstetrics (34 decks)

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