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Y5 - Obstetrics & Gynaecology > Medical problems in pregnancy > Flashcards

Medical problems in pregnancy Flashcards

1
Q

What cutoffs are used to diagnose diabetes in pregnancy?

A

Fasting glucose >7 or >7.8 2h after 75g glucose.

Or fasting >5.1; >10 at 1h, >8.5 at 2h after 75g glucose.

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2
Q

What are the fetal complications of diabetes?

A

Congenital defects: neural tube and cardiac - related to perconception glucose control.

Preterm labour.

Decreased fetal lung maturity.

Increased birthweight: hyperinsunlinaemia and fat deposition.

Polyhydramnios.

Dystocia / birth trauma.

Fetal compromise / fetal distress / sudden fetal death: related to poor glucose control in 3rd trimester.

Severity correlates with sugar levels.

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3
Q

What are the maternal complications of diabetes in pregnancy?

A

Increased insulin requirement.

UTI, wound / endometrial infection after delivery.

Pre-eclampsia.

C-S or instrumental delivery more likely.

Retinopathy often deteriorates.

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4
Q

What is the optimum HbA1c in pregnancy?

A

<7

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5
Q

What blood glucose level should the pregnant lady be aiming for?

A

<6.

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6
Q

What monitoring would you do for a fetus in a diabetic pregnancy?

A

Fetal echo.

USS for growth and liquor volume.

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7
Q

How would you manage a pregnant diabetic woman?

A

Conception: optimise diabetic control, take 5mg folic acid, assess baseline diabetic complications.

During pregnancy: optimise diabetic control, give aspirin from 12wks to lower pre-eclampsia chances, monitor fetal echo and USS for growth.

Delivery: by 39wks.

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8
Q

What are the risk factors for GDM?

A

Previous GDM.

Previous large baby (>4.5kg).

Unexplained stillbirth.

First degree relative with DM.

BMI >30.

South asian, carribean, middle eastern origin.

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9
Q

How would you manage gestational diabetes?

A

Conservative: diet and exercise, twice weekly BMs.

Oral hypoglycaemics: metformin.

Insulin if required.

Repeat OGTT at 3/12 postpartum.

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10
Q

Can asthma treatment be continued in pregnancy?

A

Yes.

If on long term steroids, additional needed at labour.

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11
Q

What are the safest epileptic drugs in pregnancy?

A

Carbamazepine and lamotrigine.

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12
Q

What are the consequences of epileptic drugs during pregnancy?

A

Congenital abnormalitie (NTD), especially with multiple drugs, high doses or valproate.

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13
Q

What effects does hypothyroidism have in pregnancy?

A

Miscarriage.

Preterm delivery.

Intellectual impairment in childhood.

Increased pre-eclampsia risk.

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14
Q

How would you manage hypothyroidism in pregnancy?

A

6 weekly TSH levels.

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15
Q

What effects does hyperthyroidism have in pregnancy?

A

Increased perinatal mortality.

Risk of antithyroid Abs crossing the placenta and causing neonatal thyrotoxicosis and goitre.

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16
Q

What treatments are used for hyperthyroidism in pregnancy?

A

Propylthiouracil, not carbimazole. Give the lowest possible dose to minimise chances of neonatal hypothyroidism.

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17
Q

What is the aetiology of cholestasis in pregnancy?

A

Sensitivity to oestrogen causing cholestasis.

18
Q

What are the main risks of cholestasis in pregnancy?

A

Stillbirth.

Preterm delivery.

19
Q

How does cholestasis of pregnancy present?

A

Itching without a rash and abnormal LFTs.

20
Q

How is cholestasis in pregnancy managed?

A

Vitamin K 10mg/day from 36 weeks (to minimise haemorrhage risk)

Ursodeoxycholic acid (to relieve itching).

Induction at 38wks.

21
Q

What is the definition of antiphospholipid syndrome?

A

1 or more clinical criteria with positive lab criteria.

Clinically: vascular thrombosis, death of fetus >10wks, pre-eclampsia or IUGR requiring delivery <34wks, 3+ unexplained fetal losses <10wks.

Lab: Lupus anticoagulant, high anticardiolipin Ab, anti-beta2glycoprotein 1 Ab - each measured on two occasions >3mths apart.

22
Q

What are the complications of antiphospholipid syndrome?

A

Placental thrombosis.

Recurrent miscarriage.

IUGR.

Pre-eclampsia.

Fetal loss.

23
Q

What are the consequences of chronic renal disease in pregnancy?

A

Pre-eclampsia.

IUGR.

Polyhydramnios.

Pre-term delivery.

24
Q

How do you manage the fetus in chronic renal disease?

A

USS to check growth.

Measurement of renal function.

Screening for UTI.

HTN control.

Vaginal delivery ok.

25
Q

How does pregnancy affect renal function and chronic renal disease?

A

GFR increased about 40%, causing decreased urea and creatinine.

In chronic renal disease, deterioration occurs in late pregnancy and may not recover.

Transplants rejection isn’t affected so ciclosporins should be continued.

26
Q

What are the effects of UTI on pregnancy?

A

Preterm labour.

Anaemia.

Increased perinatal mortality and morbidity.

More likely to cause pyelonephritis.

27
Q

How much does pregnancy increase your VTE risk by? When is it highest risk?

A

6-fold increase.

Highest risk postnatally.

28
Q

How would you investigate ?pulmonary embolism in pregnancy?

A

Same as normal - CXR, CT, ABG.

29
Q

How would you manage a VTE in pregnancy?

A

LMWH.

30
Q

What are the maternal and foetal risks from obesity in pregnancy?

A

Maternal: Thromboembolism, Pre-eclampsia, Diabetes, C-S, wound infection, difficult surgery, PPH, maternal death.

Foetal: Congenital abnormalities (NTD), increased mortality.

31
Q

How is BPAD managed in pregnancy?

A

If well / low risk of relapse: no medication.

If unwell / high risk: continue and monitor - higher excretion in pregnancy.

32
Q

What foetal effects does lithium have?

A

Cardiac abnormalities.

33
Q

Which anti-depressants are good and bad in pregnancy?

A

Good: Fluoxetine (and other SSRIs).

Bad: TCA (toxic in overdose), paroxetine (cardiac defects).

34
Q

Which anti-psychotics should be avoided in pregnancy?

A

Clozapine and olanzapine.

35
Q

What are the effects of opiate use in pregnancy?

A

Preterm delivery.

IUGR.

Stillbirth.

Developmental delay.

Sudden infant death syndrome.

36
Q

What effects does cocaine use in pregnancy have?

A

IUGR.

Placental abruption.

Teratogenic.

Childhood intellectual impairment.

Preterm delivery.

Stillbirth.

SIDS.

37
Q

What are the effects of ecstasy in pregnancy?

A

Teratogenic - cardiac defects.

Gastroschisis.

38
Q

What are the effects of benzodiazepines in pregnancy?

A

Facial clefts.

Neonatal hypotonia.

39
Q

What are the features of fetal alcohol syndrome?

A

IUGR.

Facial abnormalities.

Small / abnormal brain.

Developmental delay.

40
Q

What effects does smoking have in pregnancy?

A

Miscarriage.

IUGR.

Preterm birth.

Placental abruption.

Stillbirth.

SIDS.

41
Q

What is the lower limit of normal for Hb in pregnancy?

A

11.

42
Q

What is abnormal in sickle cell disease?

A

Hb Beta chain - known as HbS.

Y5 - Obstetrics & Gynaecology (28 decks)

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