Medical Problems in Pregnancy Flashcards
What is gestational diabetes?
Any degree of glucose intolerance with onset during pregnancy
By approx. how much do insulin requirements go up in pregnancy?
30%
What are the risk factors for a poor pancreatic reserve?
BMI >30 Asian Prev gest diabetes PCOS Prev macrosomic baby
How does gestational diabetes present?
Polyuria
Polydipsia
Fatigue
What may gestational diabetes cause in the foetus?
Hyperinsulinaemia
What does hyperinsulinaemia in the foetus lead to?
Macrosomia Organomegaly Erythropoiesis Polyhydramnios (Basically everything grows too much) And pre-term delivery
What advice should be given to mothers whose babies have hyperinsulinaemia?
Regular feeding to preventhypoglycaemia
How may high insulin effect the lungs?
Reduces pulmonary phospholipids which reduces the amount of surfactant present
What is the main test for gestational diabetes?
OGTT
What result on OGTT would indicate gestational diabetes?
Fasting glucose >5.6
2hrs post prandial glucose >7.8
How is gestational diabetes managed?
Lifestyle advice
Metformin
Glibenclamide (if metformin not tolerated)
Insulin (if fasting glucose >7)
When should additional growth scans be performed with gestational diabetes?
28, 32 and 36 weeks
When should patients with gestational diabetes deliver by?
38 weeks
40 weeks 6 days if controlled through diet
What is the post-natal follow up to gestational diabetes?
Stop meds
Measure glucose at discharge and at 6-13 weeks post partum
When are pregnant women screened for anaemia?
28 weks
What is livedo reticularis?
Red/blue reticular pattern on the skin of the arms, trunk or legs
What is catastrophic antiphospholipid syndrome?
Acute formation of microthromboses
Causes infarction of multiple organs
What is the clinical criteria for antiphospholipid syndrome?
VT or AT
Recurrent miscarriage OR premature birth
What are the lab criteria for antiphospholipid syndrome?
Lupus anticoag
Anticardiolipin
Anti-beta2-glycoprotein I
On 2+ occasions, twelve weeks apart
Give pregnancy specific risk factors for VTE?
Parity >3 Multiple preg Pre-ec C-sec PPS Still birth
What should be given in pregnancy in VTE?
LMWH
Warfarin is the first line treatment for VTE in second trimester
True/false
False
Warfarin is teratogenic and should be avoided
What is hyperemesis gravidarum?
Persistent and severe vomiting during pregnancy
When does nausea and vomiting of pregnancy normally begin?
4-7th week
What is the criteria for hyperemesis gravidarum diagnosis?
More than 5% pre-preg weight loss
Dehydration
Electrolyte imbalance
Prolonged n&v
How does beta-hCG contribute to n&v in pregnancy?
Stimulates the chemoreceptor trigger zone in the brainstem (area postrema)
This feeds into vomiting centre of brain (nucleus tractus solitarius)
What are the risk factors for hyperemesis gravidarum?
First preg Prev HG Raised BMI Multiple preg Hydatidiform mole
How is mild hyperemesis gravidarum treated?
Oral antiemetics
Hydration
Dietary advice
How is moderate hyperemesis gravidarum treated?
IV fluids
Parenteral antiemetics
Thiamine
Why is thiamine given in hyperemesis gravidarum?
To prevent Wernicke’s encephalopathy
What anti-emetics can be given first line in hyperemesis gravidarum?
Cylcizine
Prochloperazine
Promethazine
Chlorpromazine
