Medical problems in pregnancy Flashcards
What cutoffs are used to diagnose diabetes in pregnancy?
Fasting glucose >7 or >7.8 2h after 75g glucose.
Or fasting >5.1; >10 at 1h, >8.5 at 2h after 75g glucose.
What are the fetal complications of diabetes?
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.
What are the maternal complications of diabetes in pregnancy?
Increased insulin requirement.
UTI, wound / endometrial infection after delivery.
Pre-eclampsia.
C-S or instrumental delivery more likely.
Retinopathy often deteriorates.
What is the optimum HbA1c in pregnancy?
<7
What blood glucose level should the pregnant lady be aiming for?
<6.
What monitoring would you do for a fetus in a diabetic pregnancy?
Fetal echo.
USS for growth and liquor volume.
How would you manage a pregnant diabetic woman?
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.
What are the risk factors for GDM?
Previous GDM.
Previous large baby (>4.5kg).
Unexplained stillbirth.
First degree relative with DM.
BMI >30.
South asian, carribean, middle eastern origin.
How would you manage gestational diabetes?
Conservative: diet and exercise, twice weekly BMs.
Oral hypoglycaemics: metformin.
Insulin if required.
Repeat OGTT at 3/12 postpartum.
Can asthma treatment be continued in pregnancy?
Yes.
If on long term steroids, additional needed at labour.
What are the safest epileptic drugs in pregnancy?
Carbamazepine and lamotrigine.
What are the consequences of epileptic drugs during pregnancy?
Congenital abnormalitie (NTD), especially with multiple drugs, high doses or valproate.
What effects does hypothyroidism have in pregnancy?
Miscarriage.
Preterm delivery.
Intellectual impairment in childhood.
Increased pre-eclampsia risk.
How would you manage hypothyroidism in pregnancy?
6 weekly TSH levels.
What effects does hyperthyroidism have in pregnancy?
Increased perinatal mortality.
Risk of antithyroid Abs crossing the placenta and causing neonatal thyrotoxicosis and goitre.
What treatments are used for hyperthyroidism in pregnancy?
Propylthiouracil, not carbimazole. Give the lowest possible dose to minimise chances of neonatal hypothyroidism.
What is the aetiology of cholestasis in pregnancy?
Sensitivity to oestrogen causing cholestasis.
What are the main risks of cholestasis in pregnancy?
Stillbirth.
Preterm delivery.
How does cholestasis of pregnancy present?
Itching without a rash and abnormal LFTs.
How is cholestasis in pregnancy managed?
Vitamin K 10mg/day from 36 weeks (to minimise haemorrhage risk)
Ursodeoxycholic acid (to relieve itching).
Induction at 38wks.
What is the definition of antiphospholipid syndrome?
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.
What are the complications of antiphospholipid syndrome?
Placental thrombosis.
Recurrent miscarriage.
IUGR.
Pre-eclampsia.
Fetal loss.
What are the consequences of chronic renal disease in pregnancy?
Pre-eclampsia.
IUGR.
Polyhydramnios.
Pre-term delivery.
How do you manage the fetus in chronic renal disease?
USS to check growth.
Measurement of renal function.
Screening for UTI.
HTN control.
Vaginal delivery ok.
How does pregnancy affect renal function and chronic renal disease?
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.
What are the effects of UTI on pregnancy?
Preterm labour.
Anaemia.
Increased perinatal mortality and morbidity.
More likely to cause pyelonephritis.
How much does pregnancy increase your VTE risk by? When is it highest risk?
6-fold increase.
Highest risk postnatally.
How would you investigate ?pulmonary embolism in pregnancy?
Same as normal - CXR, CT, ABG.
How would you manage a VTE in pregnancy?
LMWH.
What are the maternal and foetal risks from obesity in pregnancy?
Maternal: Thromboembolism, Pre-eclampsia, Diabetes, C-S, wound infection, difficult surgery, PPH, maternal death.
Foetal: Congenital abnormalities (NTD), increased mortality.
How is BPAD managed in pregnancy?
If well / low risk of relapse: no medication.
If unwell / high risk: continue and monitor - higher excretion in pregnancy.
What foetal effects does lithium have?
Cardiac abnormalities.
Which anti-depressants are good and bad in pregnancy?
Good: Fluoxetine (and other SSRIs).
Bad: TCA (toxic in overdose), paroxetine (cardiac defects).
Which anti-psychotics should be avoided in pregnancy?
Clozapine and olanzapine.
What are the effects of opiate use in pregnancy?
Preterm delivery.
IUGR.
Stillbirth.
Developmental delay.
Sudden infant death syndrome.
What effects does cocaine use in pregnancy have?
IUGR.
Placental abruption.
Teratogenic.
Childhood intellectual impairment.
Preterm delivery.
Stillbirth.
SIDS.
What are the effects of ecstasy in pregnancy?
Teratogenic - cardiac defects.
Gastroschisis.
What are the effects of benzodiazepines in pregnancy?
Facial clefts.
Neonatal hypotonia.
What are the features of fetal alcohol syndrome?
IUGR.
Facial abnormalities.
Small / abnormal brain.
Developmental delay.
What effects does smoking have in pregnancy?
Miscarriage.
IUGR.
Preterm birth.
Placental abruption.
Stillbirth.
SIDS.
What is the lower limit of normal for Hb in pregnancy?
11.
What is abnormal in sickle cell disease?
Hb Beta chain - known as HbS.
