Obs med facts

Question 1

Gestational diabetes diagnosis BSL (RWH)

Answer 1

Fasting: >5.1

1hr: >10
2hrs: >8.5

Question 2

Dx new diabetes (RWH)

Answer 2

Fasting: >7.1
2hrs: >11.1
Random: >11.1
HbA1c >6.5%

Question 3

Timing of GTT

Answer 3

26-28 weeks

*can do 18 weeks if risk factors

Question 4

BSL targets in pregnancy

Answer 4

Fasting: <5.5
1hr post prandial: <7.4
2hrs post prandial: <6.5
HbA1c <6%

Question 5

Starting treatment for GM

Answer 5

Novorapid 4-6 units before meals

Protaphane 4-8 units at bedtime

Question 6

Safe antiemetics in pregnancy

Answer 6

Antihistamines:
Doxylamine 6.25-25mg TDS max 50mg/day
Cyclizine 12.5-25mg TDS max 150mg/day
Promethazine 25mg TDS max 75mg/day

Dopamine/serotonin receptor antagonist:
Metaclopramide 10mg TDS, max 30mg

*ondansetron conflicting data but does not appear to increase overall risk of birth defects

Question 7

GORD mx in pregnancy

Answer 7

Antacids: safe, no increase in congenital malformations

H2 antagonists: safe

PPI: safe

Question 8

Definition of hypertension in pregnancy

Answer 8

SBP>140mmHg
Diastolic BP>90mmHg
Recorded after 20 weeks gestation

start tx if >160/110mmHg

Severe HT if BP>170/110mmHg

Question 9

When to suspect pre-eclampsia

Answer 9

HT post 20 weeks gestation with organ involvement

Renal: proteinuria >30mg/mmol, Cr>90
Haem: plt<100, haemolysis, DIC
Liver: transaminitis, RUQ pain
Neurological: seizures, hypereflexia with sustained clonus, persistent headache, visual disturbance, stroke
Pulmonary oedema
FGR

Question 10

Ix of new onset HT after 20 weeks gestation

Answer 10

Urine PCR
FBE UEC LFT
Ultrasound of fetal growth, amniotic fluid volume and umbilical artery doppler ultrasound

Question 11

Pharmacological mx of HT

Answer 11

Methyldopa 250-750mg TDS or clonidine 75-300microg TDS (centrally acting, CI depression, SE dry mouth, sedation, blurred vision, rebound HT)

Labetalol 100-400mg q8H (CI asthma, SE bradycardia, bronchospasm, headache, nausea)

Nifedipine 20-60mg slow release BD (CI aortic stenosis, SE headache, flushing, tachycardia, peripheral oedema)

Prazocin 0.5-2mg q8H (SE orthostatic hypotension)

Hydralazine 25-50mg q8h (vasodilator, SE flushing, headache, nausea, lupus like syndrome)

Question 12

Acute antihypertensives for severe HT

Answer 12

Labetalol 20-80mg IV over 2mins, repeat every 10 mins pro (max effect within 5 mins of dose) SE bradycardia inc metal, hypotension

Nifedipine 10-20mg tablet PO, onset 30-45mins, SE headache, flushing

Hydralazine 5-10mg, IV bolus repeat every 20 mins, onset 20 mins, SE flushing, headache, nausea, hypotension, tachycardia

Question 13

Causes of sepsis in pregnancy

Answer 13

Bacterial: E.coli (most common), GAS (cause of death), k.pneumonia, staph aureus, strep pneumonia, proteus mirabilus, anaerobic organism

Viral: influenza, VZV, HSV, cytomegalovirus

Question 14

Sepsis mimics in pregnancy

Answer 14

PE, amniotic fluid embolism, acute pancreatitis, acute fatty liver of pregnancy, adverse drug reactions, acute adrenal insufficiency, acute pituitary deficiency, autoimmune conditions, malignancy, pelvic thrombosis, transfusion reaction

Question 15

Tx of sepsis unclear source

Answer 15

Community: ampicillin 2g IV q6H + gentamicin 4-7mg/kg + IV metronidazole 500mg IV q12h

Hospital acquired: Tazocin q8H and consider gentamicin

Question 16

TSH targets in pregnancy

Answer 16

Pre-exisiting hypothyroidism aim TSH<2.5

Sub clinical hypothyroidism aim TSH <4

Question 17

Ix of sub clinical hypothyroidism

Answer 17

= high TSH with normal T3/4

Only treat if TSH > 4

Send thyroid peroxidase antibodies due to risk of undiagnosed hypothyroidism and Hashimotos in the future

Question 18

Management of sub clinical hypothyroidism

Answer 18

Only treat if TSH > 4

Thyroxine 50microg daily
Retest every 4-6 weeks

After delivery can cease if uncomplicated subclinical hypothyroidism and TPO negative

If TPO positive continue with titration and repeat testing six weeks post partum

Question 19

Gestational hyperthyroidism

Answer 19

Due to direct stimulatory effect of human CGH on thyroid gland
Usually occurs during first trimester and resolves by end of first half of pregnancy

Ix: high T3/4, low TSH and negative TRAB antibodies

Question 20

Mx of gestational hyperthyroidism

Answer 20

Education and reassurance, usually self limiting
Look for possible HG
Consider b-blockers in severe cases, anti-thyroid medication usually not indicated

Question 21

Post partum thyroiditis

Answer 21

5% population
Usually hyperthyroidism followed by hypothyroidism
Strongly associated with TPO antibodies
Can do nuc med thyroid uptake scan but need to discard breast milk

Question 22

Post partum thyroiditis Mx

Answer 22

Hyperthyroid phase: monitor and consider b-blocker for symptoms
Follow up to watch for hypothyroidism and tx if occurs