Medical conditions in pregnancy

Question 1

Why does glucose tolerance decrease in pregnancy?

Answer 1

Glucose tolerance decreases in pregnancy due to altered carbohydrate metabolism and the antagonistic effects of human placental lactogen, progesterone and cortisol.

Question 2

What diabetic complication may deteriorate in pregnancy?

Answer 2

Diabetic retinopathy often deteriorates and needs to be treated in pregnancy.

Question 3

What is uterine arteries doppler commonly used to detect for? When is this screening done?

Answer 3

Uterine Arterial Doppler is used as a screening test for intrauterine growth restriction and pre-eclampsia.
It is done at 23 weeks.

Question 4

What is the definition of gestational diabetes?

Answer 4

According to NICE, it is when fasting glucose levels is >7.0mmol/L or if >7.8mmol/L after 2 hours.
OR
International consensus: fasting glucose >5.1mmol/L or >10.0mmol/L after 1 hour, or >8.5mmol/L after 2 hours of 75g glucose load

Question 5

What is recommended if the estimated fetal weight is >4kg?

Answer 5

Elective Caesarean section

Question 6

What are the complications of gestational diabetes for the foetus?

Answer 6

Macrosomia
Intrauterine growth restriction
Polyhydramnios
Neonates may develop hypoglycaemia

Question 7

Why will neonates present with hypoglycaemia after being born from mothers with gestational diabetes?

Answer 7

Neonates tend to develop hypoglycaemia because it has become accustomed to hyperglycaemic states and its insulin levels are high.

Question 8

In which trimester is Trimethoprim contraindicated? Why?

Answer 8

Trimethoprim is contraindicated in the 1st trimester.

Difolate esterase inhibitor can affect fetal growth in the 1st trimester.

Question 9

In which trimester is Nitrofurantoin contraindicated? Why?

Answer 9

Nitrofurantoin is contraindicated in the 3rd trimester. This is because there is a risk of haemolytic anaemia in the newborn

Question 10

When is Tetracyclines such as Doxycycline contraindicated?

Answer 10

Doxycycline is contrainidicated throughout pregnancy

Question 11

What are the potential risks of having 2 or more UTIs during pregnancy?

Answer 11

Maternal risks: Anaemia, Hypertension and Pre-eclampsia.

Foetal risks: Prematurity and low birth weight. Chorioamnionitis.

Question 12

What does UTI in pregnancy usually associated with?

Answer 12

UTI is associated with prolonged labour.

Question 13

Which tissue produces beta-hCG?

Answer 13

Trophoblastic tissue

Question 14

beta-hCG needs to be above what value to visualise a pregnancy on transvaginal ultrasound?

Answer 14

above 1500IU

Question 15

What is the differential diagnosis for a pregnant woman who came in with heavy bleeding that has settled, but is in severe pain now?

Answer 15

Inevitable miscarriage,
Incomplete miscarriage,
Ectopic pregnancy

Question 16

Define “recurrent miscarriage”

Answer 16

3 or more consecutive miscarriages is defined as recurrent miscarriage.

Question 17

Is there pain in complete miscarriage?

Answer 17

No pain in complete miscarriage

Question 18

What is “inevitable miscarriage”?

Answer 18

Inevitable miscarriage refers to the presence of an open internal os in the presence of bleeding in the first trimester of pregnancy

Question 19

Describe the relationship between inevitable miscarriage, threatened miscarriage, incomplete miscarriage and complete miscarriage.

Answer 19

Threatened miscarriage progresses to an inevitable miscarriage if cervical dilatation occurs.
Once tissues have been expelled, it will be termed as incomplete miscarraige, which will ultimately become a complete miscarriage.

Question 20

There is no pain in which type of miscarriage?

Answer 20

Pain is settled in complete miscarriage.

Question 21

What is “threatened miscarriage”?

Answer 21

Threatened miscarriage is any vaginal bleeding during early pregnancy. The cervical os is closed on examination. There is occasional abdominal pain, but the pregnancy continues.

Question 22

What is the deepest liquor pool for polyhydramnios to be diagnosed?

Answer 22

> 10cm