Medical Problems of Pregnancy Flashcards
definition of Gestational diabetes
lack of response to glucose in the blood leading to high glucose with onset or first presentation in pregnancy
How many women develop gestational diabetes in pregnancy
1-2%
Significantly more common among women from the Indian subcontinent and Southeast Asia
- 50% will then go onto develop diabetes later in life
What are the risk factors of gestational diabetes
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
what is pregnancy a state of in terms of glucose and insulin
- Pregnancy, intrinsically is a state of insulin resistance and glucose intolerance
Why is pregnancy a cause of state of insulin resistance and glucose intolerance
- 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
what are the maternal complications of gestational diabetes and type two diabetes (more likely complications if you have gestational diabetes)
1) Hyperglycaemia/hypoglycaemia
2) Pre-eclampsia
3) Infection
4) Thromboembolic disease
What are complications of Type 2 diabetes
Nephropathy
Retinopathy
Coronary Artery Disease
Poor wound healing
What are the foetal complications of gestational diabetes and type 2 diabetes
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)
How do you manage gestational diabetes
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
where does amniotic fluid come from and when can this become a complication
our own urine
- larger baby can produce more urine and therefore cause polyhydraminos
When is the onset gestational diabetes
- usually just over half way through the pregnancy
what is Group B streptococous
- 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
Group B streptococous effects on the neonate
- Pneumonia
- Meningitis
- Non-focal sepsis
- death
How do you detect group B streptococcus
• Opportunistic detection antenatally (swabs, urine)
How do you treat group b streptococcus
• Treating during pregnancy doesn’t work – it just comes back
what makes up the risk pro-life for group B streptococcus
- Preterm ruptured membranes
- Prolonged ruptured membranes
- Previous GBS neonatal infection
- Intrapartum fever
- GBS bacteruiria in pregnancy
What do you give someone who has group b streptocoosus during labour
• Benzylpenicillin in labour
are urinary tract infections more common in pregnancy
More common in pregnancy
What can cause urinary tract infections
Same organisms as usual
Asymptomatic bacteruria matters (10-15%) – treat!
What are the complications associated with urinary tract infection s
Maternal – pyelonephritis
Fetal – Growth restriction, preterm labour
How do you treat urinary tract infections
- Penicillins
- Cephalosporins
- Nitrofurantoin
- BE CAREFUL – trimethoprim teratogenic therefore avoided in the first weeks of pregnancy
what is listeriosis
disease caused by infection with listeria, which can resemble influenza or meningitis and may cause miscarriage.
what are the symptoms of listeriosis
often asymptomatic or just virus symptoms
what can listeriosis cause to happen
no signs and this could then cause the baby to die, and then you know about the infection after the baby has died
what happens if syphilis is left untreated
50% risk of congenital syphilis
describe the different types of syphilis
Primary – chancre
Secondary – rash
Latent – nothing
Tertiary – GPI, tabes dorsalis, neurosyphilis
how do you treat syphilis
Penicilin
What can chyamydia and Gonnorhea do to the mother and baby
Mother
• Endometritis
Baby • Ophthalmia neonatorum • Pneumonia
What is the treatment of chylmydai and gonnorhea
• Azithromycin (tetracyclines are teratogenic)
what is the prevalence of anaemia in pregnancy
100%
What is the physiology behind anaemia in pregnancy
- 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
what is the symptom paradox in iron deficiency anaemia and pregnancy
• Symptoms paradox – pregnancy causes tiredness, shortness of breath and palpitations as does anaemia
when is there routine screening of haemoglobin
• Therefore there is route screening of haemoglobin 12 weeks, 28 weeks and nearer to birth
what complications are there with iron deficiency anaemia
- Not much in the way of fetal complications
* Maternal problems linked to bleeding at the time of delivery
How do you treat iron deficiency anaemia
- Oral iron tablets or syrup
- Iron infusion
- Blood transfusion
What other things can cause complications
Sickle cell disease
Thalassaemia
How does sickle cell disease cause complications
- 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
What are the risk factors to do with sickle cell disease
Pre-eclampsia, growth restriction, iatrogenic preterm birth
How is sickle cell disease inherited
Inheritance – sex-linked
CVS / prenatal diagnosis
