Medical Problems in Pregnancy Flashcards
What are the three main problems talked about in this lecture?
Gestational Diabetes Mellitus
Anaemia
Non-viral infections
What is the definition of gestational diabetes?
‘Carbohydrate intolerance of variable severity, with onset or first presentation in pregnancy’
Why is pregnancy thought to be a state of insulin resistance and glucose intolerance?
Due to placental secretion of anti-insulin hormones (HPL, cortisol and glucagon).
How many women develop diabetes during their pregnancy?
Approximately 1-2%
What are the risk factors for gestational diabetes?
Previous history Family history of diabetes Previous macrosomic baby Previous unexplained stillbirth Obesity Glycosuria Polyhydramnios Large for Gestational Age (LGA) in the current pregnancy
What are the maternal complications with GDM? (4)
1) Hyperglycaemia/hypoglycaemia
2) Pre-eclampsia
3) Infection
4) Thromboembolic disease
Also if these patients already have diabetes, pregnancy makes their condition worse quicker.
What are the foetal complications with GDM? (4)
1) Macrosomia (birth asphyxia and traumatic birth injury)
2) Respiratory Distress Syndrome
3) Hypoglycaemia
4) Hyperbilirubinaemia (Jaundice)
If these women have pre-existing poorly controlled diabetes, there can be congenital abnormalities in the foetus.
How is GDM managed?
Dietary modification (calorie reduction)
Insulin
Intrapartum monitoring
Regular ultrasound scan (every two weeks)
Glucose tolerance test 6 weeks following delivery
Group B streptococcus - explain what this is and how it affects pregnancy.
This is part of the normal vaginal flora in 25% of women and is harmless until labour. Most carriers don’t get or pass the infection, but if it passes to the baby it can be life threatening.
What are the consequences of Group B strep infection in a neonate? (4)
Pneumonia
Meningitis
Non-focal sepsis
Death
Who is at greater risk of infecting their child with GBS? (5)
Preterm ruptured membranes Prolonged ruptured membranes Previous GBS neonatal infection Intrapartum fever GBS bacteruiria in pregnancy
How is GBS treated?
Benzylpenicillin in labour
Urinary tract infections are more common in pregnancy. Why is this important?
There is the risk of pyelonephritis in the mother and growth restriction and preterm labour in the foetus.
Why can’t trimethoprim be used to treat UTIs in pregnancy?
Teratogenic
How are UTIs treated in pregnancy?
Penicillin
Cephalosporin
Nitrofurantoin
Listeriosis - how does this present?
Often asymptomatic or just ‘virus’ symptoms
Syphilis - if it is untreated in the mother, what is the risk of congenital syphilis?
50%
What are the different stages of syphilis? (4)
Primary (chancre), secondary (rash), latent and tertiary (neurosyphilis, tabes dorsalis, general paresis of the insane)
How is syphilis treated?
Penicillin
What is the maternal complication associated with chlamydia and gonorrhoea?
Endometritis
What are the foetal complications associated with chlamydia and gonorrhoea?
Ophthalmia neonatorum
Pneumonia
How are chlamydia and gonorrhoea treated in pregnancy?
Azithromycin
How does the blood change in pregnancy?
Blood volume increases
Physiological haemodilution
Reduction in haemoglobin level
How is anaemia treated in pregnancy?
Oral iron tablets or syrup
Iron infusion
Blood transfusion
How does pregnancy affect a patient’s sickle cell anaemia disease?
More severe and frequent crises
How does sickle cell affect pregnancy?
Pre-eclampsia, growth restriction, iatrogenic preterm birth
