Medical Conditions in pregnancy Week-4 Flashcards
What are the respiritory changes that occur during pregnancy?
Increased metabolic rate by 20%- increased O2 consumptions, CO2 release, pulmonary blood flow, ventilatiion (40%), tidal volume (30-40%), decrease total lung capacity 5%
How many pregnant people will have dyspnoea during pregnancy?
70% of women with no history of resp distress.
What are some causes of respiritory distress in pregnant paitents?
Asthma, TB, SMoing/obesity, Cystic fibrosis, viruses, PE, PTx, anemaia
What percentage of pregnant people are affected by asthma?
4%- 1/3 better, 1/3 same, 1/3 worse
why do people stop medications for asthma during pregnancy?
They think its unsafe- not reccomended by a doctor
caused one maternal death between 2008-2012
most acute episodes late in pregnancy
What is the risks associated with COVID and pregnant women?
Higher risk of severe illness compared to not-pregnant
Hospitilasation, ICU, invassive ventilation and developing complications (pre-eclampsia)
What is the risks associated with COVID and the foetus?
Increased risk of still birth and being born premature
No increased risk of congenital defects, no increased risks of miscarriage
what is the definition of asthma?
Chronic reversible airway disease charicterised by constriction of the airway smooth muscle and odeama of the airways
what are the triggers for asthma?
Allergens, irranents, changes in tempreture/weather, exersice, environmental, viruses
What is the definition of gestational diabetes mellitus? (GDM)
A glucose in-tolerence of variable severity with onset or first recognition during pregnancy
What is thought to be the cause of GDM?
Placental hormones of pregnancy causing insulin resitstace, leading to hogher maternal glucose levels in order to provided nutrients to foetus
What typically occurs in response to the increased insulin resistance?
Increase in insulin levels to conteract and normalise BSL’s
Is gestational diabeties a perminant condition?
It is temporary and usually treated with diet/exersice or insulin
if a pregnant person has poorly controlled diabetes what effects might it have on them?
Pre-term births, c- sections, hypertension and longer stays in hospital
more likley to have pre-ecalmpsia
if a pregnant person has poorly controlled diabetes what effects might it have on the baby?
Higher incidence of miscarriage and still birth, prematurity, lower APGAR socres, higher birth weight, larger torso size, shoulder dystocia, hypoglycemia
what effects does pregnancy have on diabetes?
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
what are the effects of diabetes on pregancy
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
what are the risk factors for gestational diabetes?
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)
what does a marcrosomic baby refer to?
baby larger than 8 punds/4.5 kgs
If you have type one diabetes during pregnancy what are some things that might be seen?
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
if someone has type 2 diabetes in preganacy what are some things that we might see/considerations to take into account?
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
why are there changes in metabolism during pregnancy?
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
during early pregnancy what are the changes to insuling and glucose production?
normal glucose with an exagurated insulin response post meals
there is also a change to lipid metabolism to enhance maternal fat stores
during late pregnancy what are the changes to insuling and glucose production?
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
what does the rise in oestrogen affect in terms of BSL?
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
what affects do the exponental rise in progesterone levels do to BSL and when?
after 32 weeks
increases insulin resistance, exaggerated insulin realease after meals with a net result of increased BSL
what effects doe cortisol and Human placental lactogen have on BSL?
Cortisol- depletes hepatic glycogen and increased hepatic glucose priduction- increases BSL
hCS- increased insulin resistance and decreases insulan production- increased BSLs
what is the antenatal care for a pregnant person with diabetes?
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
what do IOL and LUSCS stand for?
IOL- induction of labour
LUSCS- lower uterine section cesarian section
what is important for maternal postpartum care if they have diabetes?
monitoring blood sugars
there is a decreases in required insulin after 3rd stage labpur and placenta is out
encourage breast feeting
