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Human Development 2 > Medical Problems of Pregnancy > Flashcards

Medical Problems of Pregnancy Flashcards

1
Q

definition of Gestational diabetes

A

lack of response to glucose in the blood leading to high glucose with onset or first presentation in pregnancy

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2
Q

How many women develop gestational diabetes in pregnancy

A

1-2%
 Significantly more common among women from the Indian subcontinent and Southeast Asia
- 50% will then go onto develop diabetes later in life

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3
Q

What are the risk factors of gestational diabetes

A

 Previous GDM
 FH of Diabetes
 Previous macrosomic baby - babies are larger as they receive more glucose for growth, baby can produce a large amount of amniotic fluid
 Previous unexplained stillbirth
 Obesity
 Glycosuria
 Polyhydramnios - larger baby can produce more urine and therefore cause polyhydraminos
 Large for Gestational Age (LGA) in the current pregnancy

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4
Q

what is pregnancy a state of in terms of glucose and insulin

A
  • Pregnancy, intrinsically is a state of insulin resistance and glucose intolerance
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5
Q

Why is pregnancy a cause of state of insulin resistance and glucose intolerance

A
  • This is thought to be due to placental secretion of anti-insulin hormones (HPL, cortisol and glucagon)
    Gestational diabetes can be regarded as an exaggerated form of this physiologic condition
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6
Q

what are the maternal complications of gestational diabetes and type two diabetes (more likely complications if you have gestational diabetes)

A

1) Hyperglycaemia/hypoglycaemia
2) Pre-eclampsia
3) Infection
4) Thromboembolic disease

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7
Q

What are complications of Type 2 diabetes

A

Nephropathy
Retinopathy
Coronary Artery Disease
Poor wound healing

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8
Q

What are the foetal complications of gestational diabetes and type 2 diabetes

A

1) Macrosomia (birth asphyxia and traumatic birth injury)
2) Respiratory Distress Syndrome
3) Hypoglycaemia - used to an rich sugary environment and then when there born they are not exposed to as much sugar
4) Hyperbilirubinaemia (Jaundice)

Congenital abnormalities ( this is to do with poor glucose control (due to pre-exisiting diabetes) in the first 12 weeks of the pregnancy)

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9
Q

How do you manage gestational diabetes

A

1, Dietary modification including calorie reduction
2 metformin
3, Insulin if persistent fasting or postprandial hyperglycaemia despite adequate dietary modification
4, Intrapartum monitoring
5, Regular Ultrasound scan every two weeks to monitor fetal growth and wellbeing
6, GTT 6 weeks following delivery - make sure it has gone and you don’t have type 2 diabetes

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10
Q

where does amniotic fluid come from and when can this become a complication

A

our own urine

- larger baby can produce more urine and therefore cause polyhydraminos

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11
Q

When is the onset gestational diabetes

A
  • usually just over half way through the pregnancy
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12
Q

what is Group B streptococous

A
  • It is a bacteria that can be part of the normal flora in 25% of women
  • this can be completely harmless during pregnancy but when your waters break then the bacteria can move up into the cervix and infect the placenta and therefore infect the baby
  • when it is passed to the baby it can be life threatening
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13
Q

Group B streptococous effects on the neonate

A
  • Pneumonia
  • Meningitis
  • Non-focal sepsis
  • death
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14
Q

How do you detect group B streptococcus

A

• Opportunistic detection antenatally (swabs, urine)

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15
Q

How do you treat group b streptococcus

A

• Treating during pregnancy doesn’t work – it just comes back

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16
Q

what makes up the risk pro-life for group B streptococcus

A
  • Preterm ruptured membranes
  • Prolonged ruptured membranes
  • Previous GBS neonatal infection
  • Intrapartum fever
  • GBS bacteruiria in pregnancy
17
Q

What do you give someone who has group b streptocoosus during labour

A

• Benzylpenicillin in labour

18
Q

are urinary tract infections more common in pregnancy

A

More common in pregnancy

19
Q

What can cause urinary tract infections

A

Same organisms as usual

Asymptomatic bacteruria matters (10-15%) – treat!

20
Q

What are the complications associated with urinary tract infection s

A

Maternal – pyelonephritis

Fetal – Growth restriction, preterm labour

21
Q

How do you treat urinary tract infections

A
  • Penicillins
  • Cephalosporins
  • Nitrofurantoin
  • BE CAREFUL – trimethoprim teratogenic therefore avoided in the first weeks of pregnancy
22
Q

what is listeriosis

A

disease caused by infection with listeria, which can resemble influenza or meningitis and may cause miscarriage.

23
Q

what are the symptoms of listeriosis

A

often asymptomatic or just virus symptoms

24
Q

what can listeriosis cause to happen

A

no signs and this could then cause the baby to die, and then you know about the infection after the baby has died

25
Q

what happens if syphilis is left untreated

A

50% risk of congenital syphilis

26
Q

describe the different types of syphilis

A

Primary – chancre
Secondary – rash
Latent – nothing
Tertiary – GPI, tabes dorsalis, neurosyphilis

27
Q

how do you treat syphilis

A

Penicilin

28
Q

What can chyamydia and Gonnorhea do to the mother and baby

A

Mother
• Endometritis

Baby •	Ophthalmia neonatorum •	Pneumonia
29
Q

What is the treatment of chylmydai and gonnorhea

A

• Azithromycin (tetracyclines are teratogenic)

30
Q

what is the prevalence of anaemia in pregnancy

A

100%

31
Q

What is the physiology behind anaemia in pregnancy

A
  • Blood volume increases
  • Physiological haemodilution
  • Physiological reduction in haemoglobin level as pregnancy goes on
  • Different normal ranges: >11 at first, >10.5 by third trimester
32
Q

what is the symptom paradox in iron deficiency anaemia and pregnancy

A

• Symptoms paradox – pregnancy causes tiredness, shortness of breath and palpitations as does anaemia

33
Q

when is there routine screening of haemoglobin

A

• Therefore there is route screening of haemoglobin 12 weeks, 28 weeks and nearer to birth

34
Q

what complications are there with iron deficiency anaemia

A
  • Not much in the way of fetal complications

* Maternal problems linked to bleeding at the time of delivery

35
Q

How do you treat iron deficiency anaemia

A
  • Oral iron tablets or syrup
  • Iron infusion
  • Blood transfusion
36
Q

What other things can cause complications

A

Sickle cell disease

Thalassaemia

37
Q

How does sickle cell disease cause complications

A
  • CVS try to make more efficiency but reliant of RBC being effective everywhere so with sickle cell disease presents with more crisis as this happens n times of phsiolgoical stress
38
Q

What are the risk factors to do with sickle cell disease

A

Pre-eclampsia, growth restriction, iatrogenic preterm birth

39
Q

How is sickle cell disease inherited

A

Inheritance – sex-linked

CVS / prenatal diagnosis

Human Development 2 (34 decks)

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