Module 5 : Maternal Endocrine Diseases Flashcards
what is type 1 diabetes
- advanced disease
- formally known as juvenile diabetes
- insulin controlled
what is the concern of type 1 diabetes in pregnancy
- growth factors
+ poor vascularization to placenta
+ increased resistance at vascular bed - CONGENITAL ABNORMALITIES
how does diabetes affect the fetus
- hyperglycaemia disrupts organogenesis
what are the most common fetal defects with maternal diabetes type 1
- cardiac
what are other fetal defects with maternal diabetes type 1
- skeletal
- CNS
- renal
- GI
- IUGR
- macrosomia
what is a common patient history with moms with type 1 diabetes
- spontaneous abortion
- IUGR
- intrauterine deaths
- neonatal
- caudal dysplasia sequence
- caudal regression syndrome
what is the most severe form of caudal regression syndrome
- mermaid syndrome
what is diabetes mellitus type 1
- glucose intolerance
characteristics of DM type 1 early on
- diabetic control critical
- decrease risk of congenital abnormalities
characteristics of DM type 1 later on
- if glucose levels are elevated
\+ macrosomia
\+ anoxia due to pre eclampsia
\+ IUGR
\+ primary fetal hazard
\+ still birthhow are type II and gestational diabetes controlled
- diet or insulin controlled
what are the fetal features of maternal diabetes type II or gestational diabetes
- poly hydro
- excessive weight gain
- macrocosmic infants
+. shoulder dystocia
+ nerve damage - pre eclampsia
- fetal deaths
when is maternal glucose testing done
- between 24-28 weeks
what is the glucose challenge test GCT
- 50gm load of glucose ingested, maternal blood tested 1hr post load
- > 7.8mmol/L abnormal
is the GCT a formal gestational diabetes diagnosis
- no
what fetal assessments are done with GDM
- BPP
- biometry
- AFI
what are the extra fetal views needed for a LGA fetus
- fetal subcutaneous fat measurement \+ should be < 3mm - inter ventricular septum thickness \+ should be < 5mm - umbilical artery cord doppler
what are the two maternal thyroid diseases that can effect the fetus
- hyperthyroidism (graves)
- hypothyroidism
what can maternal hyperthyroidism cause in the fetus
- may cause fetal goiter
- spontaneous abortion
- congenital anomalies
is it common for mothers with hypothyroidism to concieve
- no very hard for them to conceive due to maternal gonadal failure
- results in multiple spontaneous abortion
what are 3 hematological disorders that can affect the fetus
- Rh isoimmunization
- Sickle Cell Anemia
- heterozygous thalassemia
what is sickle cell anemia
- red blood cell sickle shape rather than donut
+ results in poor fit in capillaries and small vessels - risk of maternal death
- spontaneous abortion
what test is performed when a hemolytic disorder is suspected
- Coombs test to prove certain antibodies that attack red blood cells are present
what are the two testing types in a Coombs test
- direct
- indirect
what is the direct Coombs test
- detects antibodies that are stuck to the surface of the red blood cells
- not common and would be directly froth fetus (cord blood)
what is the indirect Coombs test
- detects antibodies that are floating freely in the blood
- more common and blood comes from the mother
how is Rh- mothers treated
- given an injection of RhD immunoglobulin in first pregnancy and again after delivery
- prevents formation of antibodies in the mother
- every subsequent pregnancy will require the same protocol
what are other indications for administering drugs in the Rh- patients
- spontaneous abortion
- therapeutic abortion
- ectopic pregnancy
- AFTER AMNIO
- maternal hemorrhage vaginal bleeding
what is the role of sonography in Rh disease
- FAS
+ routine BPP and biometry is performed in fetal assessment units - ASSESSING FOR ANEMIA
+ ascites apparsa first as echogenic bowel
+ pleural and pericardial effusions - DOPPLER OF MCA
+ peak velocity of the MCA is measures
+ >1cm/sec indicate severe anemia in fetus blood transfusion required
what is phenylketonuria (PKU)
- inherited autosomal recessive disease
+ increased PKU in blood - diet provides this amino acid
- women not following low PKU low protein diet develop potentially toxic levels of metabolic products
what does PKU result in
- SA
- microcephaly
- mental retardation
- CHD
- low birth rates
- behavioural problems
characteristics of lupus
- systemic lupus erythematosis
- chronic autoimmune diseae
- placenta affected
- spontaneous abortion
- IUGR
- still birth
- congenital heart block
what does maternal obesity lead to
- diabetes
- infection
what is at an increase incidence of occurred due to maternal obesity
- multiples
- UTI
- uterine fibroids
+ grow with stimulations from estrogen
+ rapid growth causes pain
what is hyperemeisis gravidarum
- excessive vomiting in pregnancy causing dehydration and electrolyte imbalance
