Medical disorders in pregnancy

Question 1

What hormonal factors during pregnancy influence glucose control?

Answer 1

• Placental production of insulin antagonists (increased cortisol, human placental lactogen, progesterone, HCG)
• Typically pancreas produces more insulin but may be unable to keep up with demand especially if previous insulin resistance

Question 2

What are some risks of poor glucose control in pregnancy?

Answer 2

• increased organ malformation (cardiac, neural tube)
• increased change of fetal death
• macrosomia
• shoulder dystocia
• increased risk of (pre)eclampsia, polyhydroaminos, infection, preterm labour

Question 3

In pre-term labour with a diabetic pt why must be use more caution when giving steroids?

Answer 3

• Steroid use will increase blood glucose levels, must compensate with insulin

Question 4

What factors lead to increased VTE in pregnacy? (2)

Answer 4

• Coagulation system out of balance favouring clot formation

- gravid uterus can cause mechanical obstruction leading to venous stasis

Question 5

Can D-dimer be used to investigate VTE in pregnancy? Why or why not?

Answer 5

• No, during pregnancy there in an increasing level of circulating D-dimer giving the test no diagnostic value

Question 6

Which antiepileptic drug carries the highest risk of teratogensis?

Answer 6

• Valproic acid

Question 7

What can happen to maternal platelet count during pregnancy (Physiological)

Answer 7

• Maternal thrombocytopenia
• 100-150 (Normal is 150-400)
• Not associated with increased risk to mother or baby
• No treatment if no bleeding and count above 50

Question 8

A pregnant women has asymptomatic bacteremia what do?

Answer 8

Treat infection