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Ob/Gyne 3 > Module 5 : Maternal Endocrine Diseases > Flashcards

Module 5 : Maternal Endocrine Diseases Flashcards

1
Q

what is type 1 diabetes

A
  • advanced disease
  • formally known as juvenile diabetes
  • insulin controlled
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2
Q

what is the concern of type 1 diabetes in pregnancy

A
  • growth factors
    + poor vascularization to placenta
    + increased resistance at vascular bed
  • CONGENITAL ABNORMALITIES
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3
Q

how does diabetes affect the fetus

A
  • hyperglycaemia disrupts organogenesis
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4
Q

what are the most common fetal defects with maternal diabetes type 1

A
  • cardiac
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5
Q

what are other fetal defects with maternal diabetes type 1

A
  • skeletal
  • CNS
  • renal
  • GI
  • IUGR
  • macrosomia
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6
Q

what is a common patient history with moms with type 1 diabetes

A
  • spontaneous abortion
  • IUGR
  • intrauterine deaths
  • neonatal
  • caudal dysplasia sequence
  • caudal regression syndrome
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7
Q

what is the most severe form of caudal regression syndrome

A
  • mermaid syndrome
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8
Q

what is diabetes mellitus type 1

A
  • glucose intolerance
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9
Q

characteristics of DM type 1 early on

A
  • diabetic control critical

- decrease risk of congenital abnormalities

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10
Q

characteristics of DM type 1 later on

A 
- if glucose levels are elevated
  \+ macrosomia
  \+ anoxia due to pre eclampsia 
    \+ IUGR
    \+ primary fetal hazard
    \+ still birth
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11
Q

how are type II and gestational diabetes controlled

A
  • diet or insulin controlled
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12
Q

what are the fetal features of maternal diabetes type II or gestational diabetes

A
  • poly hydro
  • excessive weight gain
  • macrocosmic infants
    +. shoulder dystocia
    + nerve damage
  • pre eclampsia
  • fetal deaths
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13
Q

when is maternal glucose testing done

A
  • between 24-28 weeks
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14
Q

what is the glucose challenge test GCT

A
  • 50gm load of glucose ingested, maternal blood tested 1hr post load
  • > 7.8mmol/L abnormal
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15
Q

is the GCT a formal gestational diabetes diagnosis

A
  • no
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16
Q

what fetal assessments are done with GDM

A
  • BPP
  • biometry
  • AFI
17
Q

what are the extra fetal views needed for a LGA fetus

A 
- fetal subcutaneous fat measurement 
   \+ should be < 3mm
- inter ventricular septum thickness 
   \+ should be < 5mm
- umbilical artery cord doppler
18
Q

what are the two maternal thyroid diseases that can effect the fetus

A
  • hyperthyroidism (graves)

- hypothyroidism

19
Q

what can maternal hyperthyroidism cause in the fetus

A
  • may cause fetal goiter
  • spontaneous abortion
  • congenital anomalies
20
Q

is it common for mothers with hypothyroidism to concieve

A
  • no very hard for them to conceive due to maternal gonadal failure
  • results in multiple spontaneous abortion
21
Q

what are 3 hematological disorders that can affect the fetus

A
  • Rh isoimmunization
  • Sickle Cell Anemia
  • heterozygous thalassemia
22
Q

what is sickle cell anemia

A
  • red blood cell sickle shape rather than donut
    + results in poor fit in capillaries and small vessels
  • risk of maternal death
  • spontaneous abortion
23
Q

what test is performed when a hemolytic disorder is suspected

A
  • Coombs test to prove certain antibodies that attack red blood cells are present
24
Q

what are the two testing types in a Coombs test

A
  • direct

- indirect

25
Q

what is the direct Coombs test

A
  • detects antibodies that are stuck to the surface of the red blood cells
  • not common and would be directly froth fetus (cord blood)
26
Q

what is the indirect Coombs test

A
  • detects antibodies that are floating freely in the blood

- more common and blood comes from the mother

27
Q

how is Rh- mothers treated

A
  • 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
28
Q

what are other indications for administering drugs in the Rh- patients

A
  • spontaneous abortion
  • therapeutic abortion
  • ectopic pregnancy
  • AFTER AMNIO
  • maternal hemorrhage vaginal bleeding
29
Q

what is the role of sonography in Rh disease

A
  • 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
30
Q

what is phenylketonuria (PKU)

A
  • 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
31
Q

what does PKU result in

A
  • SA
  • microcephaly
  • mental retardation
  • CHD
  • low birth rates
  • behavioural problems
32
Q

characteristics of lupus

A
  • systemic lupus erythematosis
  • chronic autoimmune diseae
  • placenta affected
  • spontaneous abortion
  • IUGR
  • still birth
  • congenital heart block
33
Q

what does maternal obesity lead to

A
  • diabetes

- infection

34
Q

what is at an increase incidence of occurred due to maternal obesity

A
  • multiples
  • UTI
  • uterine fibroids
    + grow with stimulations from estrogen
    + rapid growth causes pain
35
Q

what is hyperemeisis gravidarum

A
  • excessive vomiting in pregnancy causing dehydration and electrolyte imbalance

Ob/Gyne 3 (10 decks)

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