Medical Problems in Pregnancy Flashcards
What are the main medical problems in pregnancy?
- gestational diabetes mellitus
- anaemia
- non-viral infections
What is gestational diabetes?
- diabetes of pregnancy
- carbohydrate intolerance of variable severity with onset or first presentation in pregnancy
How does gestational diabetes occur?
- pregnancy is a state of insulin resistance and glucose intolerance
- placental secretion of anti-insulin hormones (HPL, cortisol, glucagon)
- gestational diabetes exaggerates this
- genetic and environmental risk
What are the risk factors of gestational diabetes?
Previous
Family history of diabetes
Obesity
Glycosuria
How does diabetes impact size of baby?
- mother high blood sugar levels
- glucose crosses placenta into fetus
- macrosomic baby as fetus gets fat as stores glucose
- polyhydramnios as baby is bigger so urinates more
- stillbirth as baby too big so not enough nutrients
How is screening done for GD?
- for people with RF
- 26-28 weeks as before physiological drivers that are diabetogenic not present yet
- varies between places because of different definition
What are maternal complications of GD?
- hyperglycaemia/hypo
- pre-eclampsia
- infection
- thromboembolic disease
What are some pre-existing diabetes complications?
- nephropathy
- retinopathy
- CAD
- poor wound healing
What are some fetal complications of GD?
- macrosomia (birth asphyxia and TBI)
- respiratory distress syndrome
- hypoglycaemia (baby loses flood of glucose supply)
- hyperlibirubinemia (jaundice)
How is GD managed?
lower blood gluose levels:
- dietary modify (calorie induction)
- metformin (not teratogenic)
- insulin
- intrapartum monitoring
- regular US to monitor fetus
- GTT scans if T2D
What is Group B Streptococcus?
- normal flora in 25% of women
- harmless until labour
- water migrates through cervix when water breaks
- if passes through fetus life threatening
How is Group B Strep prevented?
- opportunistic detection antenatally (swabs/urine)
- treat during pregnancy doesn’t work as just comes back
- potentially clear it in labour with benzyl penicillin
- risk profiling
How is risk profiling done in Group B strep?
Think about which babies are most vulnerable:
- preterm ruptured membranes
- prolonged ruptured membranes
- previous GBS neonatal infection
- intrapartum fever
- GBS bacteriuria in pregnancy
What is the significance of UTIs in pregnancy?
- more common in pregnancy as pressure of fetus on tubes and bladder causes stasis
Why does treatment of UTI matter in pregnancy?
Risk of complications:
- maternal: pyelonephritis
- fetal: growth restriction, preterm labour
