Medical conditions with a gestational twist

Question 1

How can you differentiate pre-existing and gestational hypertension?

Answer 1

Gestational: New HTN at >=20 weeks

Question 2

How do you dfferentiate pre-eclampsia from gestational hypertension

Answer 2

Clinical: Severe headache, blurred vision, vomiting, below rib pain
Ix: Proteinuria (>30mg/mmol P:C, >8mg/mmol A:C)

Question 3

How can HELLP be distinguished from pre-eclampsia?

Answer 3

Haemolysis
Raised liver enzymes
Low platelets

Question 4

How can eclampsia be distinguished from pre-eclampsia?

Answer 4

Pre-eclampsia features + Seizures

Question 5

What are the high risk factors for pre-eclampsia?

Answer 5

HTN: Previous gestational, CKD
Autoimmune: Including DM

Question 6

What are the moderate risk factors for gestational hypertension>

Answer 6

Extreme times: 1st or >10yrs since last
Multiple pregnancy
Increased age (>=40yrs) 
Increased BMI (>=35)
Family history

Question 7

When do you consider preventative therapy in gestational HTN?
What do you give?

Answer 7

> =1 High risk factor OR >=2 moderate

Aspirin 75-150mg from 12 weeks

Question 8

What is severe gestational hypertension? How is it treated…
1st line
Definitive

Answer 8

Severe gest HTN: 160/110
1st: Labetalol (nifedipine if asthma). Hydralazine also used.
GS: Delivery of baby

Question 9

If someone has severe pre-eclampsia, what do you give?

Answer 9

MgSO4

Question 10

How do you manage eclampsia?

Answer 10

IV MgSO4 4g over 5-10 mins then 1g/hour
Continue until 24hrs after last seizure
CaGluconate if resp depression
+ Fluid restrict

Question 11

What constitutes gestational diabetes

Answer 11

Fasting glucose of >=5.6mmol/L

2 hour OGTT >=7.8mmol/L

Question 12

When is an OGTT performed if
No history
History

Answer 12

No: 24-28 weeks
Hx: Booking + 24-28 weeks

Question 13

How do you manage gestational diabetes?

Answer 13

Fasting <7mmol/L:

1. 1-2 week trial of diet and exercise
2. Metformin for 1-2 weeks
3. Insulin

If fasting >7mmol/L
Insulin therapy

Question 14

When can glibenclamide be given in gestational diabetes?

Answer 14

Don’t tolerate metformin

Don’t meet targets and don’t want insulin

Question 15

How do you manage pre-existing diabetes?

Answer 15

Stop orals except metformin + start insulin
Folic acid 5mg pre-conception to 12 weeks
Weight loss if BMI > 27

Question 16

What antenatal scan should be performed in pregnant diabetics?

Answer 16

20 week anomaly scan for heart chambers and outflow tract

Question 17

What supplementation should pregnant epileptics get?

Answer 17

Folic acid 5mg for first trimester

Question 18

What anti-epileptic medications are safe in pregnancy?

Answer 18

Lamotrigene
Carbamazepine
Aim for monotherapy

Question 19

What anti-epileptic causes cleft palate?

Answer 19

Phenytoin

Question 20

What anti-epileptic causes neural tube defects?

Answer 20

Sodium valproate

Question 21

Which antiepileptics can be used in breastfeeding?

Answer 21

All of them

Does pass through but in small amounts

Question 22

Woman presents with itchy hands and feet without a rash at 27 weeks pregnancy

Answer 22

Obstetric cholestasis

Also have RUQ pain, sometimes jaundice

Question 23

How does acute fatty liver disease of pregnancy and HELLP different from obstetric cholestasis

Answer 23

GI upset, headache and fatigue

Jaundice more present

Question 24

What blood results should be looked at for obstetric cholestasis?

Answer 24

Bilirubin and LFTs will be raised

Question 25

Hypoglycaemia + raised ALT are features of which condition?

Answer 25

Acute fatty liver of pregnancy

Question 26

What blood results are
Low
High
in HELLP

Answer 26

Low platelets and haemoglobin

Increased LFTs

Question 27

How is obstetric cholestasis treated?

Answer 27

Ursodeoxycholic acid
Weekly LFTs
Vit K if PT deranged
Induction at 37 weeks

Question 28

How do you treat acute fatty liver disease of pregnancy?

Answer 28

1st: Supportive
GS: Delivery