pregnancy considerations Flashcards
1
Q
how should you manage hypothyroidism within pregnancy?
A
Needs more levothyroxine -T4
T4 can cross placenta and provides T4 to fetus
Need at least 25mcg extra
2
Q
what are complications of non-managed hypothyroidism within pregnancy?
A
Miscarriage
Anaemia
Small gestational age
Pre-eclampsia
3
Q
what meds needs stopping in HTN during pregnancy?
A
AceI, ARBs, thiazide/ thiazide like diuretics
4
Q
what can some HTN medications do during pregnancy?
A
Medications- can cause congenital abnormalities
5
Q
what meds can be used to manage HTN during preg?
A
Meds that can be used: labetalol (BB), nifedipine (CCB), doxazosin (AB)
6
Q
what epilepsy drugs should be stopped prior to conception?
A
Stop taking sodium valproate
Stop taking phenytoin
7
Q
what can sodium valproate do to a fetus?
A
SV: Neural tube defects
Pregnancy may worsen
8
Q
does preg affect seizures?
A
can worsen control
seizures are not harmful to baby unless mum gets injured
9
Q
what can phenytoin do to baby?
A
: cleft lip and palate
10
Q
how should RD be managed prior to co3nception and during preg?
A
Should be well controlled prior to conception
Methotrexate is contra-indicated
Corticosteroids can be used in flareups
11
Q
what can methotrexate do to fetus?
A
miscarriage, teratogenic, causing miscarriage and congenital abnormalities
12
Q
can dad use methotrexate prior to conception?
A
no!
need to stay clear
13
Q
what medications can be used to manage RA during preg?
A
Corticosteroids can be used in flareups
Can use hydroxychloroquine, sulfasalazine
14
Q
what is small gestational age?
A
Fetus measuring <10th centile
15
Q
what can be used to measure small gestational age?
A
- Estimated fetal weight
- Fetal abdo circumference
16
Q
what can cause constitutionally small baby?
A
matching mother and others in family and growing appropriately based on that
- Not at risk of complications as much
17
Q
what is fetal growth restriction?
A
: intrauterine growth restriction
- Small fetus – not growing as expected due to pathology reducing amount of nutrients and O2 being delivered to fetus through placenta
18
Q
what is placenta mediated growth restriction?
A
limits to nutrients
19
Q
what can cause placenta mediated growth restriction?
A
- Idiopathic, pre-eclampsia, maternal smoking, alcohol, anaemia, malnutrition, infection, maternal health conditions
20
Q
what can cause non-placenta mediated small fetus?
A
Non-placenta mediated: baby is small due to genetic or structural abnormality fetal pathology
- Reduced amniotic fluid
- Abnormal doppler
- Reduced fetal movements
- Abnormal CTGs
21
Q
what complications can arise from small fetus?
A
fetal death/ stillbirth, birth asphyxia – failure to establish breathing at birth
- Neonatal hypothermia/ hypoglycaemia
22
Q
what long term risks do growth restricted babies have?
A
CVS – HTN, T2DM, obesity, mood and behvioural problems
23
Q
what are RF for small gestational age?
A
previous SGA baby, obesity, smoking, diabetes, existing hypertension, pre-eclampsia, geri- mother, multiple preg, low pregnancy-associated plasma protein -A, antepartum haemorrhage, antiphospholipid syndrome
24
Q
how do you manage small gestational age?
A
- Aspirin: given to those at risk of pre-eclampsia
- Treat modifiable risks eg stop smoking
- Serial growth scans
- Early delivery if growth is static may need corticosteroids to help with lung development
25
what is a large gestational age?
macrosomia, >4.5kg weight
estimated fetal weight is in 90th centile
26
what can cause LGA?
constitutional, maternal diabetes, previous macrosomia, maternal obesity or rapid weight gain, overdue, male
27
what is risks to mum with LGA fetus?
shoulder dystocia, failure to progress, perineal tears, instrumental delivery/ CS, PPH, uterine rupture
28
what is risk to baby with LGA fetus?
birth injury eg clavicular fracture, fetal distress, neonatal hyperglycaemia, obesity in childhood/ later life, T2DM in adulthood
29
how is LGA fetus managed through preg?
Guided by US and OGTT at 28weeks
30
what is a multiple preg?
any preg with more than one fetus
31
what is monozygotic?
identical twins from single zygote
32
what is dizygotic?
non-identical from two diff zygotes
33
what is monoamniotic?
single sac
34
what is dichorionic?
two sep placentas
35
what multiples have the best survival rates?
- Best outcomes are diamniotic, dichorionic each fetus has own nutrient supply (have lambda sign on US)
36
what are complications of multiples?
anaemia, polyhydramios, HTN, malpresentation, spontaneous preterm, instrumental/ CS, PPH
37
what are neonatal risks to multiples?
miscarriage, stillbirth, fetal growth restriction, prematurity, twin-twin transfusion, twin anaemia polycythaemia sequence, congenital abnormalities
38
what is twin-twin transfusion?
: fetus shares a placenta and one twin gets lots of blood (higher risk of HF) and other twin gets lots (smaller and malnourished – less developed)
39
how do you manage twin-twin tranfusion?
foetal surgery - May need fetal surgery: laser treatment - splits placenta with a better divide of anastomosis
40
what is an ectopic preg?
pregnancy is implanted outside of uterus
41
where is most common site for ectopic preg?
- Most common site is fallopian tube but can be entrance to fallopian tube (cornual region), ovary, cervix or abdo
42
what are RF for ectopic pregnancies?
previous ectopics, previous PID, previous surgeries to fallopian tubes (zygote has tendency to implant on scar tissue), IUD, older age, smoking, POP has been linked
43
when would an ectopic typically present?
6-8wks
44
how would ectopic present?
typically at 6-8wks
- Low threshold for sus
- Possibility of pregnancy, missed peroids, recent unprotected sex, lower abdo pain (right or left iliac fossa), vaginla bleeding, cervical motion tenderness
- Dizziness/ syncope blood loss
- Shoulder tip pain (peritonitis)
45
what would a transgvaginal US show to indicate ectopic?
gestational sac may contain yolk save or fetal pole. Tubal ectopic may look similar to corpus luteum
- Other features that indicate: empty uterus, fluid in uterus pseduogestational sac
Pregnancy of unknown location: positive test but US does not show
46
how often should you measure HCG levels in ? ectopic?
- Need to keep monitoring HCG levels every 48hrs
47
why do you need serial HCG measurements for ectopics?
- >63% rise after 48hrs: intrauterine pregnancy
- <63% rise in 48hrs: ectopic
- Fall in more than 50% may indicate miscarriage urine pregnancy test should be performed after 2 wks to confirm
48
how do you manage ectopic?
need referral to early pregnancy assessment unit
expectant management
medical
surgical
49
what is expectant management?
natural termination
50
what is medical management in ectopic?
methotrexate IM injection into bum
51
following methotrexate for ectopic - how long should wait before pregnancy again?
3mths - teratogenic
52
what surgical options can be used in ectopic?
SALPINGECTOMY OR Salpingotomy used in more progressed cases, may need anti-rhesus D prophylaxis
53
what is a miscarriage?
spontaneous termination of pregnancy
54
what is an early miscarriage?
- Early <12 wks
55
what is late miscarriage?
- Late is 12-24
56
what is missed miscarriage?
fetus no longer alive but no symptoms have occurred yet
57
what is a threatened miscarriage?
: vaginal bleeding with closed cervix and fetus is still alive
58
what is an inevitable miscarriage?
vaginal bleeding with open cervix
59
what is an incomplete miscarriage?
retained products of conception remain in uterus
60
what is a complete miscarriage?
full miscarriage has occurred but no products of conception are left in uterus
61
what is anembryonic pregnancy?
full miscarriage has occurred but no products of conception are left in uterus
62
what is looked for on US for miscarriage?
transvaginal US
Three key things a sonographer looks for in early pregnancy as pregnancy develops
- Mean gestational sac diameter
- Fetal pole and crown rump length
- Fetal heart beat this is expected once crown-rump is 7mm
63
how is a <6wk miscarriage managed?
presents with bleeding and can be managed expectantly provided no pain or other complications
- Need repeat urine preg test after 7-10days to confirm
64
how is >6wk miscarriage managed?
referral to early preg assessment unit
- Need US
- Expectant: if have no heavy bleeding or infection RF spontaneous miscarriage
- Medical
surgical
65
what is medical management with >6wk ectopic?
misoprostol given (prostaglandin analogue) helps uterine contractions to expel pregnancy
66
what surgical options can be used within ectopic >6wks?
manual vacuum aspiration (LA) and electric vacuum (GA)
67
how would you manage incomplete miscarriage?
retained products huge risk of infection
- Medical management (misoprostol)
- Surgical (evacuation of retained products)
68
how do you do a evacuation of retained products?
Evacuation of retained products: surgical procedure involving GA
- Cervix Is gradually widened using dilators
- Retained products are removed through cervix via vacuum aspiration and curettage
69
what is risk following vacuum aspiration and curettage?
- Endometritis : infection risk following
70
what are key points of the 1967 abortion act?
- Human fertilisation and embryology act altered abortion dates from 28 to 24 weeks legally
- Abortion can be at any time if: risk to woman, terminating pregnancy will prevent grave permanent injury to physical/ mental health of woman, substantial risk to child to have physical/ mental abnormalities
- Need two medical practitioners to sign and agree to abortion
- Must occur in NHS hospital or approved premise by trained medical professional
71
where can provide pre-abortion care?
: self-referred, GP, GUM or family planning clinic
72
what happens if a dr objects to abortion?
abortion IT MUST BE PASSED TO ANOTHER
73
what is essential part abortion care?
- Women should be offered counselling and info to help make decision from trained practitioner
- Informed consent is essential
74
what medications are used within medical abortions?
mifepristone
misoprostol
75
what is mifepristone?
anti-progesterone halts pregnancy and relaxes cervix
76
what is misoprostol?
prostaglandin analogue (1-2days after) soften cervix and stimulates uterine contractions from 10weeks, need more doses every 3hrs until expulsion
77
what pain management can be given for surgical abortions?
can be LA, LA + sedation, GA depending on preference and gestational age
78
what methods of surgical abortions are there?
- Given misoprostol, mifepristone and osmotic dilators
- Cervical dilation and suction <14wks
- 14-24wks: cervical dilation and evacuation using forceps
79
what is an osmotic dilator within abortion care?
osmotic dilators devices inserted into uterus and expand as they absorb fluid and opens cervical canal
80
what symptoms may be seen post abortion?
: may experience vaginal bleeding and abdo cramps for <2wks post procedure
81
what makes up post-abortion care?
- Need urine preg test 3wks after to confirm
- Contraception is discussed and started where appropriate
- Support and counselling
82
what complications may arise following abortion?
bleeding, pain, infection, failure of abortion, damage to cervix/ uterus/ other structures
83
what is hyperemesis gravidum?
severe N+V to the point of dehydration, no food/ liquid intake and ketones in urine
84
when does morning sickness occur?
N: most common symptom esp early on
- N+V: peaks around 8-12wks
- Should resolve by 16-20wks
85
what causes N+V in preg?
- HCG produced by placenta is responsible higher levels can worsens symptoms
86
when can HCG be more increased?
molar preg
multiples
first preg
obese women
87
what is the classification if hyperemesis gravidarum?
- More than 5% of body weight loss compared with before pregnancy
- Dehydration
- Electrolyte imbalance
88
how do you quantify N+V/ hyperemesis gravidarum?
Pregnancy- unique quantification of emesis (PUQE): severity scale
89
what are the categories within PUQE?
Pregnancy- unique quantification of emesis (PUQE): severity scale
- Score out of 15
- <7 mild
- 7-12 moderate
- >12 severe
90
how do you manage severe N+V/ hyperemesis?
Management: antiemetics to suppress nausea
91
which antiemetics can be used within pregnancy?
1. Prochloroperazine most safest with most data
2. Cyclizine
3. Ondansetron
4. Metoclopramide
92
what drugs can be used for reflux/ heart burn within preg?
Reflux: rantidine or omeprazole can be used for problematic heartburn
- Ginger can help
93
how do you manage mild cases N+V?
oral antiemetics
94
when would you need admitting to hosp with N+V?
- Unable to tolerate oral antiemetics or keep fluids down
- More than 5% body weight loss
- Ketones are present on urine dipstick (+2)
- Other medical conditions that need treating
95
how would you manage moderate-severe N+V/ hyperemesis?
ambulatory care eg early preg assess unit
- IV/ IM antiemetics
- IV fluids – normal saline with added KCl
- Thiamine supplementation to prevent deficiency eg Wernickes-Korsakodd syndrome
- Thromboprophylaxis: TED stocking and LMWH during admission
96
when would rubella cause a problem within pregnancy?
Congenital rubella syndrome cause dby infection <20wks
97
can you have MMR vaccine while preg?
no it is live
98
what are the complications of rubella infection whilst preg?
Congenital deafness
Congenital cataracts
CHD – pulmomary stenosis
Learning disabilities
99
what precaution should be done if not had MMR prior preg?
have MMR vaccine before conception
can be immunity testing
100
what is the virus causing chickenpox?
varicella zoster virus
101
how are you safe from VZV?
If previously had chickenpox – safe and immune
Can test for IgG for VSZ
102
how is chickenpox dangerous to preg mum?
Mother: varicella pneumonia, hepatitis, encephalitis
103
how is chickenpox dangerous to fetus
Fetal: varicella syndrome, skin lesions, malformed limbs/ digits/ atrophy/ hypoplasia, affects eyes and autonomic NS
104
if a mum has not had chicken pox what can you give?
If not immune can give IV varicella Igs – should be given within 10days of exposure
105
if a women gets chickenpox rash during preg, what drug should be given and when?
If rash starts: oral aciclovir, <24hrs and more than 20wks
106
what are chickenpox during preg complications?
Fetal growth restriction
Microcephaly, hydrocephalus, LD
Scars, significant skin changes
Limb hypoplasia - varicella syndrome
107
how may listeria present?
Can be asymptomatic, flue like,
Pneumonia
108
how is listeria transmitted?
Transmitted via unpasteurised dairy products, processed, meats
109
how do you prevent listeria infection in preg?
Avoid high risk food blue cheese, practice good food hygiene
110
what are the complications of listeria during preg?
High rate of miscarriage, fetal death, severe neonatal infection
111
how would zika present?
travel history
Asymptomatic, mild flu
112
how is zika spread?
Spread by aedes mosquitos
Can be spread by sex of infected person
113
how do you test for zika virus?
Need viral pCR testing
Fetal medicine monitoring
114
how do you treat zika virus?
no treatment
115
how would zika virus affect fetus?
Congenital zika: microcephaly, fetal growth restriction, intracranial abnormalities – ventriculomegaly, cerebella atrophy
116
does a none symptomatic UTI in preg needed treating?
yes more likely to cause cystitis/ pyelonephritis
Can be asymptomatic – pregnant women constantly getting MC&S urine all way though
117
what symptoms would be seen in UTI in preg?
asymptomatic
freq, urgency, dysuria, haematuria,
118
what are the complications of UTI in preg?
Preterm labour, low birth weight, pre-eclampsia
119
which drug for UTI should be avoided in first trimester?
Avoid trimethoprim in first trimester
120
why is trimethoprim contra-indicated in first trimester?
Avoid trimethoprim in first trimester it is folate antagonist – can cause neural tube defects
121
what drug for UTI should be avoided in last trimester?
Avoid nitrofurantoin in last trimester
122
why should you avoid nitrofurantoin in last trimester?
Avoid nitrofurantoin in last trimester risk of neonatal haemolysis (jaundice)
Amoxicillin
Cefalexin
123
how long of course should be used for asymptomatic bacteruria or UTI in preg?
7 days
124
what is obstetric cholestasis?
intrahepatic cholestasis on pregnancy
- Reduced outflow of bile acid from liver
- Condition resolves following delivery
125
when is obstetric cholestasis most likely within preg?
later in preg >28wks due to increase in oestrogen and progesterone
126
what is the pathophys of obstetric cholestasis?
Pathophys: bile produced in liver and breaks down cholesterol bile acid flow from liver to hepatic ducts and past gall bladder
- Outflow is reduced and this causes build up in blood
- Causes pruritus
127
how does obstetric cholestasis present?
Presentation: common in 3rd trimester
- Itching especially palms of hands and soles of feet
- Fatigue
- Dark urine
- Pale, greasy stools
- Jaundice
- There is no rash:
128
what would a rash with obstetric cholestasis indicate?
polymorphic eruption of pregnancy/ pemphigoid gestationitis
129
what bloods would be abnormal within obstetric cholestasis?
LFT and bile acid checked
- Abnormal ALT, AST and GGT
- Raised bile acids
alp can be raised anyway
130
why is ALP raised in preg?
- ALP can increase up to 4x normally in pregnant due to placenta
131
how do you manage obstetric cholestasis?
urosodexycholic acid improves LFTs, bile acids and symptoms
Itching: emollient eg calamile to soothe skin, antihistamines (chlorphenamine) can help sleeping but may not improve itching
- Water-soluble vitK can be given if clotting is deranged
planned CS - still birth risk
132
how does vitK link to bile acids?
lack of bile acids = vitK deficiency
133
why is VTE common in preg?
: common and potentially fatal
- Blood clots within circulation
- Thrombosis occurs due to stagnation
- Hyper-coagulable states
134
what is risk of VTE?
- PE: significant cause of death in obstetrics risk reduced with VTE prophylaxis
135
what increases risk of VTE?
- Smoking
- Parity ≥ 3
- Age > 35
- BMI> 30
- Reduced mobility
- Multiple pregnancy
- Pre-eclampsia
- Gross varicose veins
- Immobility
- Family Hx of VTE
- Thrombophilia
- IVF
136
when would a preg women need VTE prophylaxis?
at 28wks if three RF, first trimester if 4+ RF
Other scenarios where need prophylaxis: hosp admission, surgical procedures, previous VTE, medical conditions (cancer/ arthritis), high risk thrombophilias, ovarian hyperstimulation syndrome
137
what drugs are given for VTE prophylaxis in preg?
- LMWH eg enoxaparin, dalteparin
- Prophylaxis stopped at labour and started straight after delivery
- If contra-indic to LMWH: intermittent pneumatic compression (inflate and deflate to massage legs) ad anti-embolic compression socks
138
how would DVT/ PE present?
Pres: unilateral red, hot, leg swell >3cm diff between legs
- PE: haemoptysis, SoB, pleuritic chest pain, hypoxia, tahcycardiam raised RR, low grade fever, haemodynamically unstable causing hypotension
139
how would you diagnose DVT, what is not used in preg?
- PE: CXR, ECG
- Definite diagnosis: CTPA or VQ scan
- Wells score is not valid in pregnancy
- D dimer is useless: raised anyway in preg
140
how do you manage VTE, DVT, PE?
LMWH for VTE
- If DVT or PE suspect: start LMWH prior to confirming
- If confirmed: continued LMWH for remaining preg and six wks postnatal can switch to DOAC after delivery
- Massive PE: unfractionated heparin, thrombolysis, surgical embolectomy
141
what is pre-eclampsia?
new HTN in preg with end-organ dysfunction with proteinuria
142
when would pre-eclampsia occur?
- Occurs after 20wks gestation when spinal arteries of placenta form abnormally leading to high vascular resistance
143
what is classic triad within pre-eclampsia?
Classic triad: HTN, proteinuria and oedema
144
what is Preg-induced HTN/ gestational HTN
HTN occurring after 20wks gestation without proteinuria
145
what is eclampsia?
Eclampsia: seizures as a result of pre-eclampsia
146
how does syncytiotrophoblast cause pre-eclampsia?
the outer most layer of blastocyte is syncytiotrophoblast grows into endometrium
- Has finger like projections called chrrionic villi containing fetal blood vessels
- Invasion of endometrium sends signals to spinal arteries in that area reducing vascular resistance more fragile – blood flow around these arteries can break down
- The breakdown = pools of blood called lacunae (forms around 20wks)
- If forming lacunae is inadequate – pre eclampsia
- Due to high vascular resistance in spiral artiers and poor perfusion of placenta causes oxidative stress systemic inflammation and impaired endothelial function
147
what is high risk of pre-eclampsia?
pre-existing HTN, previous HTN in preg, existing AI conditions, diabetes, CKD
148
what is moderate risk of pre-eclampsia?
riskL older than 40, BMI>35, >10yrs since last preg, mulitples, first preg, famHx or pre-eclampsia
149
what symptoms indicate pre-eclampsia?
headache, visual disturbances, N+V, upper abdo/ epigastric pain, oedema, reduce urine output, brisk reflexes
150
how would you diagnose pre-eclampsia?
systolic BP >140, diastolic >90 + one of following:
- Proteinuria (+1)
- Organ dysfunction
- Placental dysfunction
151
how do you manage pre-eclampsia?
aspirin given as prophylaxis if single High RF or 2+ moderate RF
- Regular monitoring of BP, symptoms and urine dip for proteinuria
152
how do you manage gestational HTN?
Gestational HTN (no pro): aim for BP of 135/85
- Admit if BP is 160/110
- Urine dip weekly
- Weekly bloods: FBC, LFT, U+E
- Monitor fetal growth by serial scans
153
what are the scoring systems for admission of pre-eclampsia?
fullPIERS or PREP-S
154
what is 1st/ 2nd/ 3rd line of gestational HTN?
- Labetolol: first line HTN
- Nifedipine: modified release – 2nd line
- Methyldopa: third line – needs stopping 2days post birth
155
when would IV hydralazine be used within gestational HTN?
- IV hydralazine: antiHTN in critical care in severe pre-eclampsia or eclampsia
156
when would IV magnesium sulphate be used within pre-eclampsia?
- IV magnesium sulphate: during labour and 24hrs post to prevent seizures
157
what conservative management should be done for pre-eclampsia?
fluid restriction
158
planned, early CS may be given to mum with pre-eclampsia, what should be given prior to help baby?
- Planned early birth: mum should take corticosteroids to help fetal lungs be developed
159
what drugs should be used post birth in gestational HTN/ pre-eclampsia?
Post birth: enalapril
- CCB: first line if black/ Caribbean
- Labetalol or atenolol – third line
- Switch or combo
160
what drug should be used to manage eclampsia?
IV magnesium sulphate to manage seizures
161
what can HELLP syndrome arise from?
complication of pre-eclampsia and eclampsia
162
what are the features of HELLP syndrome?
- H: haemolysis
- Elevated Liver enzymes
- Low Platelets
163
what is gestational diabetes?
diabetes triggered by pregnancy
- Caused by reduced insulin sensitivity during pregnancy and resolves after birth
164
what are complications of gestational DM?
large for date baby risk of shoulder dystocia
- Women are also then at risk of T2DM following birth
165
what are RF of gestational DM?
RF: previous gestational DM, previous macrosomic baby ≥4.5kg
- BMI >30
- Ethnic origin: Caribbean, middle eastern, south Asian
- Fam Hx: of diabetes – first degree
166
what test is done to screen for gestational DM?
OGTT: screening test of choice – used in all pt with RF or any suggestion if gestational DM:
- Large for date fetus
- Polyhydramnios
- glucose on urine dip
167
what is polyhydramnios?
increased amniotic fluid
168
how is the OGTT performed?
Should be performed in morning after fasting – can drink plain water
- Pt drinks 75g glucose drink – BM is measured at fasting and then2hrs post
169
what values would indicate GDM?
- Normal: fasting <5.6mmol/l at 2hrs <7.8mmol/L (56-78 mnuemonic)
- Any higher in these values = gestational DM
170
how do you manage GDM in general?
refer to gestational DM clinic – endo ran with specialist training
- Need careful explanation
- Learn how to monitor and track BMs
- 4x weekly US to monitor fetal growth and amniotic fluid from 28-36wks
can give birth up to 40+6
171
if asting glucose was <7 on OGTT, what do you do in preg?
- Fasting glucose <7: trial diet and exercise fro 1-2wks then metformin then insulin
172
if a fasting glucose was >7 on OGTT what would you do in preg?
- Fasting >7: start insulin ± metformin
173
if fasting glucose was >6 and baby was macrosomia, what should you do within preg?
- Fasting glucose >6 + macrosomia = insulin ± metformin
174
what other drugs can be used within GDM apart from metformin/ insulin?
stop all other drugs
- Sulfonylurea (glibenclamide) can be used if they decline insulin or can not tolerate metformin
175
what should you do with pre-existing DM in preg?
: aim for good glucose control
- Should take 5mg folic acid from preconception until12weeks gestation
- T2DM should be metformin/ insulin managed other meds stopped
- Retinopathy screening at 28wks
- Planned delivery at 37 to 38+6
- Sliding scale insulin regime recommended for women with T1DM dextrose and insulin titrated for optimse BMs can be used in poorly controlled T2DM
176
how should GDM be managed post-natally?
should improve following delivery if gestational can immediately stop meds but do need follow up fasting test at 6wks
- Existing DM should lower insulin and be wary of hypoglycaemia insuline sensitivity will increase following birth and breastfeeding
177
what are risks to baby if mum has DM?
- Neonatal hypoglycaemia need close monitoring aim for 2mmol/L if falls needs IV dextrose of NG tube
- Polycythaemia (raised Hb)
- Jaundice – raised bilirubin
- CHD
- Cardiomyopathy
