Medical Conditions in pregnancy Week-4

Question 1

What are the respiritory changes that occur during pregnancy?

Answer 1

Increased metabolic rate by 20%- increased O2 consumptions, CO2 release, pulmonary blood flow, ventilatiion (40%), tidal volume (30-40%), decrease total lung capacity 5%

Question 2

How many pregnant people will have dyspnoea during pregnancy?

Answer 2

70% of women with no history of resp distress.

Question 3

What are some causes of respiritory distress in pregnant paitents?

Answer 3

Asthma, TB, SMoing/obesity, Cystic fibrosis, viruses, PE, PTx, anemaia

Question 4

What percentage of pregnant people are affected by asthma?

Answer 4

4%- 1/3 better, 1/3 same, 1/3 worse

Question 5

why do people stop medications for asthma during pregnancy?

Answer 5

They think its unsafe- not reccomended by a doctor
caused one maternal death between 2008-2012
most acute episodes late in pregnancy

Question 6

What is the risks associated with COVID and pregnant women?

Answer 6

Higher risk of severe illness compared to not-pregnant

Hospitilasation, ICU, invassive ventilation and developing complications (pre-eclampsia)

Question 7

What is the risks associated with COVID and the foetus?

Answer 7

Increased risk of still birth and being born premature

No increased risk of congenital defects, no increased risks of miscarriage

Question 8

what is the definition of asthma?

Answer 8

Chronic reversible airway disease charicterised by constriction of the airway smooth muscle and odeama of the airways

Question 9

what are the triggers for asthma?

Answer 9

Allergens, irranents, changes in tempreture/weather, exersice, environmental, viruses

Question 10

What is the definition of gestational diabetes mellitus? (GDM)

Answer 10

A glucose in-tolerence of variable severity with onset or first recognition during pregnancy

Question 11

What is thought to be the cause of GDM?

Answer 11

Placental hormones of pregnancy causing insulin resitstace, leading to hogher maternal glucose levels in order to provided nutrients to foetus

Question 12

What typically occurs in response to the increased insulin resistance?

Answer 12

Increase in insulin levels to conteract and normalise BSL’s

Question 13

Is gestational diabeties a perminant condition?

Answer 13

It is temporary and usually treated with diet/exersice or insulin

Question 14

if a pregnant person has poorly controlled diabetes what effects might it have on them?

Answer 14

Pre-term births, c- sections, hypertension and longer stays in hospital
more likley to have pre-ecalmpsia

Question 15

if a pregnant person has poorly controlled diabetes what effects might it have on the baby?

Answer 15

Higher incidence of miscarriage and still birth, prematurity, lower APGAR socres, higher birth weight, larger torso size, shoulder dystocia, hypoglycemia

Question 16

what effects does pregnancy have on diabetes?

Answer 16

Nausea and vomiting, particular in the early stages

greater importance of tight glucose control

increased insulin dose requirments in the second half of pregnancy

increased risk of sevre hypoglycemia
risk of deteroration of

pre-existing retinopathy

risk of deterioration of established neropathy

Question 17

what are the effects of diabetes on pregancy

Answer 17

increased risk of miscarriage
risk of congential malformation
risk of marosomia
increased risk of pre-eclampsia 
increased risk of still birth, infectiion and operative delivery

Question 18

what are the risk factors for gestational diabetes?

Answer 18

age >30
multiple preganacy
PCOS
BMI >30
previous marosomic baby wighing >4.5kg
previous GDM
FHX of diabetes
Family origin with a high prevelence of diabetes (south asian, black caribbean and middle eastern)

Question 19

what does a marcrosomic baby refer to?

Answer 19

baby larger than 8 punds/4.5 kgs

Question 20

If you have type one diabetes during pregnancy what are some things that might be seen?

Answer 20

Hypoglycemia- 1st trimester
- higher than normal progesterone and oestogen
- morning sickness
- rapid foetal growth
precautions- during exercise
- need for a glucagon kit
regular meals required and reviews onm ketone testing

Question 21

if someone has type 2 diabetes in preganacy what are some things that we might see/considerations to take into account?

Answer 21

Increased insulin resistance
increased insulin requirments
increased requirment for BGL checking
All oral hypoglycemics other than metformin must be ceased prior to pregancy
Anti-lipid medications must also be ceased

Question 22

why are there changes in metabolism during pregnancy?

Answer 22

carbohydrate and lipid metabolism chages occur to ensure there is a continuous supply of nutrients to the growing foetus regardless of the intake of food from the pregnant person

Question 23

during early pregnancy what are the changes to insuling and glucose production?

Answer 23

normal glucose with an exagurated insulin response post meals
there is also a change to lipid metabolism to enhance maternal fat stores

Question 24

during late pregnancy what are the changes to insuling and glucose production?

Answer 24

high glucose production to meet demands of growing foetus and placenta
insulin doubled, but insulin resistance hogh due to increased levels of oestrogen, progestorone and HPL
Lipid metabolism changes due to HPL to promote fat buring as an alternative energy source for the mother
all to increase avaliability of glucose for foetal use

Question 25

what does the rise in oestrogen affect in terms of BSL?

Answer 25

rise after 24 weeks- increases insulin prduction and enhances peripheral glucose usage- lowers BSL

in the second trimester it also increases plama cortisol to increase BSL

Question 26

what affects do the exponental rise in progesterone levels do to BSL and when?

Answer 26

after 32 weeks

increases insulin resistance, exaggerated insulin realease after meals with a net result of increased BSL

Question 27

what effects doe cortisol and Human placental lactogen have on BSL?

Answer 27

Cortisol- depletes hepatic glycogen and increased hepatic glucose priduction- increases BSL

hCS- increased insulin resistance and decreases insulan production- increased BSLs

Question 28

what is the antenatal care for a pregnant person with diabetes?

Answer 28

collaborative care from obstetrician, diabetic educator, dietician and midwife

fortnightly vists after 26 weeks and weekly after 36
Monitor BGLS with monthly lab tests
Eunsure glucagon kit is avaliable

diet- extra folate suppliments, lower fats and simple sugars

monitor feotal growth

Question 29

what do IOL and LUSCS stand for?

Answer 29

IOL- induction of labour

LUSCS- lower uterine section cesarian section

Question 30

what is important for maternal postpartum care if they have diabetes?

Answer 30

monitoring blood sugars
there is a decreases in required insulin after 3rd stage labpur and placenta is out
encourage breast feeting