Medical Complications of Pregnancy

Question 1

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

Answer 1

CKD stage 1-2: unaffected, good renal outcome

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

Question 2

What are the increased risk of CKS on pregnancy outcome?

Answer 2

Preterm
C sec delivery
FGR

Question 3

When is pregnancy safe in ladies with renal transplants?

Answer 3

SAFE after 2nd year post transplant

Question 4

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

Answer 4

Achieve the best possible glycaemic control before pregnancy

Question 5

What is the most critical period of the embryo?

Answer 5

The first 42 days

During organogenesis

Question 6

What are complications of DM in pregnancy for the foetus?

Answer 6

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

Question 7

What are complications of DM in pregnancy for the mother?

Answer 7

PET
Severe hyper/hypoglycaemia
DKA
Increased operative delivery rate

Question 8

How. do you treat diabetic ladies to prevent complications?

Answer 8

75g aspirin from 12 wks gestation to delivery

Question 9

how do you monitor DM in pregnancy=

Answer 9

Home blood glucose monitoring

Up to 7 times a day, before and after meals

Question 10

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

Answer 10

Pre-prandial: <5.4

Post-prandial: <7.8

Question 11

Why is hyperglycaemia Moree common in pregnancy=

Answer 11

Because insulin resistance in creases throughout pregnancy

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

Question 12

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

Answer 12

additional US growth scans

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

Question 13

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

Answer 13

Give additional insulin

To maintain normoglycaemia

Question 14

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

Answer 14

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

Question 15

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

Answer 15

To INSULIN SLIDING SCALE

Question 16

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

Answer 16

In the second half of pregnancy

Question 17

How many pregnancies does GDM occur in?

Answer 17

1 in 5 pregnancies affected

Question 18

What is GDM?

Answer 18

Any degree of glucose intolerance with onset in pregnancy

Question 19

What does GDM increase the risk of in later life?

Answer 19

Increased risk of T2DM

Question 20

Why does GDM occur?

Answer 20

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

Question 21

What are RF for GDM?

Answer 21

Obesity, poor diet
Asian 
Prior GDM 
FH GDM 
Prior macrosomic babuy

Question 22

What are maternal sx of GDM?

Answer 22

Asymptomatic
Polyuria, polydipsia
Fatigue

Question 23

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

Answer 23

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

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

Question 24

How does the OGTT work?

Answer 24

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

Question 25

What are the values on OGTT for dx of GDM?

Answer 25

Fasting blood glucose >5.6 | 2h OGTT >7.8

Question 26

What tx exist for GDM?

Answer 26

Expectant: improve diet and lifestyle Medical: Metformin / insulin

Question 27

When do you aim to deliver for GDM?

Answer 27

BEFORE 40 wks

Question 28

How does the thyroid requirement change in pregnancy?

Answer 28

Thyroid requirement INCREASES

Question 29

What is the most common cause of hypothyroidism?

Answer 29

Hashimoto

Question 30

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

Answer 30

YES

Question 31

How do you treat hyperthyroidism in pregnancy?

Answer 31

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

Question 32

What medicine is strongly contraindicated fro hyperthyroidism in pregnancy?

Answer 32

RADIOACTIVE IODINE

Question 33

What is a risky complication of taking Carbimazole/prolylthiouracil

Answer 33

Agranulocytosis

Question 34

What are risks of uncontrolled thyrotoxicosis?

Answer 34

Miscarriage preterm delivery

Question 35

Why does GDM have complications on the foetus?

Answer 35

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

Question 36

Why does increased foetal insulin cause macrosomia?

Answer 36

Because insulin is similar in structure to GH

Question 37

What are the effects of hyperinsulinaemia on the foetus?

Answer 37

Macrososmia Organomegaaly Erythromìpioesis Polyhydraknios.

Question 38

What are risks of GDM on the baby after delivery?

Answer 38

Baby hypoglycaemia (foetal levels of insulin stay high but sudden drop in glucose) RDS (as insulin decreases surfactant production)

Question 39

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

Answer 39

Increased pigmentation Spider nave Pruritus (no rash)

Question 40

What pre-existing skin conditions can worsen during pregnancy?

Answer 40

Eczema | Acne

Question 41

What are possible skin conditions in pregnancy that cause itching?

Answer 41

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

Question 42

What is the cause of Pemphigoid gestationitis

Answer 42

Autoimmune BULLOUS disorder

Question 43

Describe the lesions in Pemphigoid gestationitis

Answer 43

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

Question 44

Does Pemphigoid gestationitis affect the foetus?

Answer 44

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

Question 45

How do you diagnose Pemphigoid gestationitis

Answer 45

Skin biopsy

Question 46

How do you treat Pemphigoid gestationitis

Answer 46

Prednisolone, antihistamine

Question 47

What is the recurrence rate of pemphigoid gestationitis?

Answer 47

HIGH

Question 48

What is Polymorphic eruption of pregnancy

Answer 48

benign, self limiting pruritus inflammation

Question 49

When in the pregnancy does Polymorphic eruption of pregnancy usually present

Answer 49

3rd trimester / immediately post part

Question 50

Where does Polymorphic eruption of pregnancy occyr

Answer 50

On lower abdomen WITH PERI UMBILICAL SPARING | May extend to thighs, buttocks, legs, arms

Question 51

What is the recurrence of Polymorphic eruption of pregnancy like

Answer 51

DOES NOT RECUR

Question 52

How does Polymorphic eruption of pregnancy impact the pregnancy ?

Answer 52

NO IMPACT ON PREGNANCY

Question 53

What are RF for Polymorphic eruption of pregnancy

Answer 53

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

Question 54

how do you treat Polymorphic eruption of pregnancy

Answer 54

``` Emollient Topical steroid (hydrocortison() ```

Question 55

Describe the rash in Polymorphic eruption of pregnancy

Answer 55

erythematous rash on abdomen with peri umbilical sparing

Question 56

Explain prurigo of pregnancy

Answer 56

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

Question 57

How do you treat prurigo of pregnancy

Answer 57

Topical steroids + emollients

Question 58

What is pruritus folliculitis of pregnancy?

Answer 58

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