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Obs&Gynae > pregnancy considerations > Flashcards

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

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2
Q

what are complications of non-managed hypothyroidism within pregnancy?

A

Miscarriage
Anaemia
Small gestational age
Pre-eclampsia

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3
Q

what meds needs stopping in HTN during pregnancy?

A

AceI, ARBs, thiazide/ thiazide like diuretics

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4
Q

what can some HTN medications do during pregnancy?

A

Medications- can cause congenital abnormalities

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5
Q

what meds can be used to manage HTN during preg?

A

Meds that can be used: labetalol (BB), nifedipine (CCB), doxazosin (AB)

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6
Q

what epilepsy drugs should be stopped prior to conception?

A

Stop taking sodium valproate
Stop taking phenytoin

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7
Q

what can sodium valproate do to a fetus?

A

SV: Neural tube defects
Pregnancy may worsen

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8
Q

does preg affect seizures?

A

can worsen control
seizures are not harmful to baby unless mum gets injured

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9
Q

what can phenytoin do to baby?

A

: cleft lip and palate

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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

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11
Q

what can methotrexate do to fetus?

A

miscarriage, teratogenic, causing miscarriage and congenital abnormalities

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12
Q

can dad use methotrexate prior to conception?

A

no!

need to stay clear

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13
Q

what medications can be used to manage RA during preg?

A

Corticosteroids can be used in flareups
Can use hydroxychloroquine, sulfasalazine

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14
Q

what is small gestational age?

A

Fetus measuring <10th centile

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15
Q

what can be used to measure small gestational age?

A
  • Estimated fetal weight
  • Fetal abdo circumference
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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

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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

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18
Q

what is placenta mediated growth restriction?

A

limits to nutrients

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19
Q

what can cause placenta mediated growth restriction?

A
  • Idiopathic, pre-eclampsia, maternal smoking, alcohol, anaemia, malnutrition, infection, maternal health conditions
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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

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21
Q

what complications can arise from small fetus?

A

fetal death/ stillbirth, birth asphyxia – failure to establish breathing at birth
- Neonatal hypothermia/ hypoglycaemia

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22
Q

what long term risks do growth restricted babies have?

A

CVS – HTN, T2DM, obesity, mood and behvioural problems

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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

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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
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25
Q

what is a large gestational age?

A

macrosomia, >4.5kg weight
estimated fetal weight is in 90th centile

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26
Q

what can cause LGA?

A

constitutional, maternal diabetes, previous macrosomia, maternal obesity or rapid weight gain, overdue, male

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27
Q

what is risks to mum with LGA fetus?

A

shoulder dystocia, failure to progress, perineal tears, instrumental delivery/ CS, PPH, uterine rupture

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28
Q

what is risk to baby with LGA fetus?

A

birth injury eg clavicular fracture, fetal distress, neonatal hyperglycaemia, obesity in childhood/ later life, T2DM in adulthood

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29
Q

how is LGA fetus managed through preg?

A

Guided by US and OGTT at 28weeks

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30
Q

what is a multiple preg?

A

any preg with more than one fetus

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31
Q

what is monozygotic?

A

identical twins from single zygote

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32
Q

what is dizygotic?

A

non-identical from two diff zygotes

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33
Q

what is monoamniotic?

A

single sac

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34
Q

what is dichorionic?

A

two sep placentas

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35
Q

what multiples have the best survival rates?

A
  • Best outcomes are diamniotic, dichorionic  each fetus has own nutrient supply (have lambda sign on US)
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36
Q

what are complications of multiples?

A

anaemia, polyhydramios, HTN, malpresentation, spontaneous preterm, instrumental/ CS, PPH

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37
Q

what are neonatal risks to multiples?

A

miscarriage, stillbirth, fetal growth restriction, prematurity, twin-twin transfusion, twin anaemia polycythaemia sequence, congenital abnormalities

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38
Q

what is twin-twin transfusion?

A

: 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)

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39
Q

how do you manage twin-twin tranfusion?

A

foetal surgery - May need fetal surgery: laser treatment - splits placenta with a better divide of anastomosis

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40
Q

what is an ectopic preg?

A

pregnancy is implanted outside of uterus

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41
Q

where is most common site for ectopic preg?

A
  • Most common site is fallopian tube  but can be entrance to fallopian tube (cornual region), ovary, cervix or abdo
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42
Q

what are RF for ectopic pregnancies?

A

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

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43
Q

when would an ectopic typically present?

A

6-8wks

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44
Q

how would ectopic present?

A

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)

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45
Q

what would a transgvaginal US show to indicate ectopic?

A

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

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46
Q

how often should you measure HCG levels in ? ectopic?

A
  • Need to keep monitoring HCG levels every 48hrs
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47
Q

why do you need serial HCG measurements for ectopics?

A
  • > 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
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48
Q

how do you manage ectopic?

A

need referral to early pregnancy assessment unit
expectant management
medical
surgical

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49
Q

what is expectant management?

A

natural termination

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50
Q

what is medical management in ectopic?

A

methotrexate  IM injection into bum

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51
Q

following methotrexate for ectopic - how long should wait before pregnancy again?

A

3mths - teratogenic

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52
Q

what surgical options can be used in ectopic?

A

SALPINGECTOMY OR Salpingotomy  used in more progressed cases, may need anti-rhesus D prophylaxis

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53
Q

what is a miscarriage?

A

spontaneous termination of pregnancy

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54
Q

what is an early miscarriage?

A
  • Early <12 wks
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55
Q

what is late miscarriage?

A
  • Late is 12-24
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56
Q

what is missed miscarriage?

A

fetus no longer alive but no symptoms have occurred yet

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57
Q

what is a threatened miscarriage?

A

: vaginal bleeding with closed cervix and fetus is still alive

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58
Q

what is an inevitable miscarriage?

A

vaginal bleeding with open cervix

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59
Q

what is an incomplete miscarriage?

A

retained products of conception remain in uterus

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60
Q

what is a complete miscarriage?

A

full miscarriage has occurred but no products of conception are left in uterus

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61
Q

what is anembryonic pregnancy?

A

full miscarriage has occurred but no products of conception are left in uterus

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62
Q

what is looked for on US for miscarriage?

A

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

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63
Q

how is a <6wk miscarriage managed?

A

presents with bleeding and can be managed expectantly  provided no pain or other complications
- Need repeat urine preg test after 7-10days to confirm

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64
Q

how is >6wk miscarriage managed?

A

referral to early preg assessment unit
- Need US
- Expectant: if have no heavy bleeding or infection RF  spontaneous miscarriage
- Medical
surgical

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65
Q

what is medical management with >6wk ectopic?

A

misoprostol given (prostaglandin analogue) helps uterine contractions to expel pregnancy

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66
Q

what surgical options can be used within ectopic >6wks?

A

manual vacuum aspiration (LA) and electric vacuum (GA)

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67
Q

how would you manage incomplete miscarriage?

A

retained products  huge risk of infection
- Medical management (misoprostol)
- Surgical (evacuation of retained products)

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68
Q

how do you do a evacuation of retained products?

A

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

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69
Q

what is risk following vacuum aspiration and curettage?

A
  • Endometritis : infection risk following
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70
Q

what are key points of the 1967 abortion act?

A
  • 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
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71
Q

where can provide pre-abortion care?

A

: self-referred, GP, GUM or family planning clinic

72
Q

what happens if a dr objects to abortion?

A

abortion IT MUST BE PASSED TO ANOTHER

73
Q

what is essential part abortion care?

A
  • Women should be offered counselling and info to help make decision from trained practitioner
  • Informed consent is essential
74
Q

what medications are used within medical abortions?

A

mifepristone
misoprostol

75
Q

what is mifepristone?

A

anti-progesterone  halts pregnancy and relaxes cervix

76
Q

what is misoprostol?

A

prostaglandin analogue (1-2days after)  soften cervix and stimulates uterine contractions from 10weeks, need more doses every 3hrs until expulsion

77
Q

what pain management can be given for surgical abortions?

A

can be LA, LA + sedation, GA depending on preference and gestational age

78
Q

what methods of surgical abortions are there?

A
  • Given misoprostol, mifepristone and osmotic dilators
  • Cervical dilation and suction <14wks
  • 14-24wks: cervical dilation and evacuation using forceps
79
Q

what is an osmotic dilator within abortion care?

A

osmotic dilators  devices inserted into uterus and expand as they absorb fluid and opens cervical canal

80
Q

what symptoms may be seen post abortion?

A

: may experience vaginal bleeding and abdo cramps for <2wks post procedure

81
Q

what makes up post-abortion care?

A
  • Need urine preg test 3wks after to confirm
  • Contraception is discussed and started where appropriate
  • Support and counselling
82
Q

what complications may arise following abortion?

A

bleeding, pain, infection, failure of abortion, damage to cervix/ uterus/ other structures

83
Q

what is hyperemesis gravidum?

A

severe N+V to the point of dehydration, no food/ liquid intake and ketones in urine

84
Q

when does morning sickness occur?

A

N: most common symptom esp early on
- N+V: peaks around 8-12wks
- Should resolve by 16-20wks

85
Q

what causes N+V in preg?

A
  • HCG produced by placenta is responsible  higher levels can worsens symptoms
86
Q

when can HCG be more increased?

A

molar preg
multiples
first preg
obese women

87
Q

what is the classification if hyperemesis gravidarum?

A
  • More than 5% of body weight loss compared with before pregnancy
  • Dehydration
  • Electrolyte imbalance
88
Q

how do you quantify N+V/ hyperemesis gravidarum?

A

Pregnancy- unique quantification of emesis (PUQE): severity scale

89
Q

what are the categories within PUQE?

A

Pregnancy- unique quantification of emesis (PUQE): severity scale
- Score out of 15
- <7 mild
- 7-12 moderate
- >12 severe

90
Q

how do you manage severe N+V/ hyperemesis?

A

Management: antiemetics to suppress nausea

91
Q

which antiemetics can be used within pregnancy?

A
  1. Prochloroperazine  most safest with most data
  2. Cyclizine
  3. Ondansetron
  4. Metoclopramide
92
Q

what drugs can be used for reflux/ heart burn within preg?

A

Reflux: rantidine or omeprazole can be used for problematic heartburn
- Ginger can help

93
Q

how do you manage mild cases N+V?

A

oral antiemetics

94
Q

when would you need admitting to hosp with N+V?

A
  • 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
Q

how would you manage moderate-severe N+V/ hyperemesis?

A

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
Q

when would rubella cause a problem within pregnancy?

A

Congenital rubella syndrome cause dby infection <20wks

97
Q

can you have MMR vaccine while preg?

A

no it is live

98
Q

what are the complications of rubella infection whilst preg?

A

Congenital deafness
Congenital cataracts
CHD – pulmomary stenosis
Learning disabilities

99
Q

what precaution should be done if not had MMR prior preg?

A

have MMR vaccine before conception
can be immunity testing

100
Q

what is the virus causing chickenpox?

A

varicella zoster virus

101
Q

how are you safe from VZV?

A

If previously had chickenpox – safe and immune

Can test for IgG for VSZ

102
Q

how is chickenpox dangerous to preg mum?

A

Mother: varicella pneumonia, hepatitis, encephalitis

103
Q

how is chickenpox dangerous to fetus

A

Fetal: varicella syndrome, skin lesions, malformed limbs/ digits/ atrophy/ hypoplasia, affects eyes and autonomic NS

104
Q

if a mum has not had chicken pox what can you give?

A

If not immune can give IV varicella Igs – should be given within 10days of exposure

105
Q

if a women gets chickenpox rash during preg, what drug should be given and when?

A

If rash starts: oral aciclovir, <24hrs and more than 20wks

106
Q

what are chickenpox during preg complications?

A

Fetal growth restriction
Microcephaly, hydrocephalus, LD
Scars, significant skin changes
Limb hypoplasia - varicella syndrome

107
Q

how may listeria present?

A

Can be asymptomatic, flue like,
Pneumonia

108
Q

how is listeria transmitted?

A

Transmitted via unpasteurised dairy products, processed, meats

109
Q

how do you prevent listeria infection in preg?

A

Avoid high risk food  blue cheese, practice good food hygiene

110
Q

what are the complications of listeria during preg?

A

High rate of miscarriage, fetal death, severe neonatal infection

111
Q

how would zika present?

A

travel history
Asymptomatic, mild flu

112
Q

how is zika spread?

A

Spread by aedes mosquitos
Can be spread by sex of infected person

113
Q

how do you test for zika virus?

A

Need viral pCR testing
Fetal medicine monitoring

114
Q

how do you treat zika virus?

A

no treatment

115
Q

how would zika virus affect fetus?

A

Congenital zika: microcephaly, fetal growth restriction, intracranial abnormalities – ventriculomegaly, cerebella atrophy

116
Q

does a none symptomatic UTI in preg needed treating?

A

yes more likely to cause cystitis/ pyelonephritis
Can be asymptomatic – pregnant women constantly getting MC&S urine all way though

117
Q

what symptoms would be seen in UTI in preg?

A

asymptomatic
freq, urgency, dysuria, haematuria,

118
Q

what are the complications of UTI in preg?

A

Preterm labour, low birth weight, pre-eclampsia

119
Q

which drug for UTI should be avoided in first trimester?

A

Avoid trimethoprim in first trimester

120
Q

why is trimethoprim contra-indicated in first trimester?

A

Avoid trimethoprim in first trimester  it is folate antagonist – can cause neural tube defects

121
Q

what drug for UTI should be avoided in last trimester?

A

Avoid nitrofurantoin in last trimester

122
Q

why should you avoid nitrofurantoin in last trimester?

A

Avoid nitrofurantoin in last trimester  risk of neonatal haemolysis (jaundice)
Amoxicillin
Cefalexin

123
Q

how long of course should be used for asymptomatic bacteruria or UTI in preg?

A

7 days

124
Q

what is obstetric cholestasis?

A

intrahepatic cholestasis on pregnancy
- Reduced outflow of bile acid from liver
- Condition resolves following delivery

125
Q

when is obstetric cholestasis most likely within preg?

A

later in preg >28wks  due to increase in oestrogen and progesterone

126
Q

what is the pathophys of obstetric cholestasis?

A

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
Q

how does obstetric cholestasis present?

A

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
Q

what would a rash with obstetric cholestasis indicate?

A

polymorphic eruption of pregnancy/ pemphigoid gestationitis

129
Q

what bloods would be abnormal within obstetric cholestasis?

A

LFT and bile acid checked
- Abnormal ALT, AST and GGT
- Raised bile acids
alp can be raised anyway

130
Q

why is ALP raised in preg?

A
  • ALP can increase up to 4x normally in pregnant due to placenta
131
Q

how do you manage obstetric cholestasis?

A

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
Q

how does vitK link to bile acids?

A

lack of bile acids = vitK deficiency

133
Q

why is VTE common in preg?

A

: common and potentially fatal
- Blood clots within circulation
- Thrombosis occurs due to stagnation
- Hyper-coagulable states

134
Q

what is risk of VTE?

A
  • PE: significant cause of death in obstetrics  risk reduced with VTE prophylaxis
135
Q

what increases risk of VTE?

A
  • Smoking
  • Parity ≥ 3
  • Age > 35
  • BMI> 30
  • Reduced mobility
  • Multiple pregnancy
  • Pre-eclampsia
  • Gross varicose veins
  • Immobility
  • Family Hx of VTE
  • Thrombophilia
  • IVF
136
Q

when would a preg women need VTE prophylaxis?

A

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
Q

what drugs are given for VTE prophylaxis in preg?

A
  • 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
Q

how would DVT/ PE present?

A

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
Q

how would you diagnose DVT, what is not used in preg?

A
  • 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
Q

how do you manage VTE, DVT, PE?

A

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
Q

what is pre-eclampsia?

A

new HTN in preg with end-organ dysfunction with proteinuria

142
Q

when would pre-eclampsia occur?

A
  • Occurs after 20wks gestation when spinal arteries of placenta form abnormally leading to high vascular resistance
143
Q

what is classic triad within pre-eclampsia?

A

Classic triad: HTN, proteinuria and oedema

144
Q

what is Preg-induced HTN/ gestational HTN

A

HTN occurring after 20wks gestation without proteinuria

145
Q

what is eclampsia?

A

Eclampsia: seizures as a result of pre-eclampsia

146
Q

how does syncytiotrophoblast cause pre-eclampsia?

A

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
Q

what is high risk of pre-eclampsia?

A

pre-existing HTN, previous HTN in preg, existing AI conditions, diabetes, CKD

148
Q

what is moderate risk of pre-eclampsia?

A

riskL older than 40, BMI>35, >10yrs since last preg, mulitples, first preg, famHx or pre-eclampsia

149
Q

what symptoms indicate pre-eclampsia?

A

headache, visual disturbances, N+V, upper abdo/ epigastric pain, oedema, reduce urine output, brisk reflexes

150
Q

how would you diagnose pre-eclampsia?

A

systolic BP >140, diastolic >90 + one of following:
- Proteinuria (+1)
- Organ dysfunction
- Placental dysfunction

151
Q

how do you manage pre-eclampsia?

A

aspirin given as prophylaxis if single High RF or 2+ moderate RF
- Regular monitoring of BP, symptoms and urine dip for proteinuria

152
Q

how do you manage gestational HTN?

A

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
Q

what are the scoring systems for admission of pre-eclampsia?

A

fullPIERS or PREP-S

154
Q

what is 1st/ 2nd/ 3rd line of gestational HTN?

A
  • Labetolol: first line HTN
  • Nifedipine: modified release – 2nd line
  • Methyldopa: third line – needs stopping 2days post birth
155
Q

when would IV hydralazine be used within gestational HTN?

A
  • IV hydralazine: antiHTN in critical care in severe pre-eclampsia or eclampsia
156
Q

when would IV magnesium sulphate be used within pre-eclampsia?

A
  • IV magnesium sulphate: during labour and 24hrs post to prevent seizures
157
Q

what conservative management should be done for pre-eclampsia?

A

fluid restriction

158
Q

planned, early CS may be given to mum with pre-eclampsia, what should be given prior to help baby?

A
  • Planned early birth: mum should take corticosteroids to help fetal lungs be developed
159
Q

what drugs should be used post birth in gestational HTN/ pre-eclampsia?

A

Post birth: enalapril
- CCB: first line if black/ Caribbean
- Labetalol or atenolol – third line
- Switch or combo

160
Q

what drug should be used to manage eclampsia?

A

IV magnesium sulphate to manage seizures

161
Q

what can HELLP syndrome arise from?

A

complication of pre-eclampsia and eclampsia

162
Q

what are the features of HELLP syndrome?

A
  • H: haemolysis
  • Elevated Liver enzymes
  • Low Platelets
163
Q

what is gestational diabetes?

A

diabetes triggered by pregnancy
- Caused by reduced insulin sensitivity during pregnancy and resolves after birth

164
Q

what are complications of gestational DM?

A

large for date baby  risk of shoulder dystocia
- Women are also then at risk of T2DM following birth

165
Q

what are RF of gestational DM?

A

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
Q

what test is done to screen for gestational DM?

A

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
Q

what is polyhydramnios?

A

increased amniotic fluid

168
Q

how is the OGTT performed?

A

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
Q

what values would indicate GDM?

A
  • Normal: fasting <5.6mmol/l at 2hrs <7.8mmol/L (56-78 mnuemonic)
  • Any higher in these values = gestational DM
170
Q

how do you manage GDM in general?

A

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
Q

if asting glucose was <7 on OGTT, what do you do in preg?

A
  • Fasting glucose <7: trial diet and exercise fro 1-2wks then metformin then insulin
172
Q

if a fasting glucose was >7 on OGTT what would you do in preg?

A
  • Fasting >7: start insulin ± metformin
173
Q

if fasting glucose was >6 and baby was macrosomia, what should you do within preg?

A
  • Fasting glucose >6 + macrosomia = insulin ± metformin
174
Q

what other drugs can be used within GDM apart from metformin/ insulin?

A

stop all other drugs
- Sulfonylurea (glibenclamide) can be used if they decline insulin or can not tolerate metformin

175
Q

what should you do with pre-existing DM in preg?

A

: 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
Q

how should GDM be managed post-natally?

A

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
Q

what are risks to baby if mum has DM?

A
  • 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

Obs&Gynae (17 decks)

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