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Phase 3a - Women's Health > Women's Health : Maternal Medicine > Flashcards

Women's Health : Maternal Medicine Flashcards

1
Q

What is Obstetric Cholestasis?

A

Obstetric condition causing increased serum bile acids and hepatic dysfunction.

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2
Q

What causes Obstetric Cholestasis?

A

Obstetric condition causing increased serum bile acids and hepatic dysfunction.

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3
Q

How does oestrogen affect Obstetric Cholestasis?

A

Inhibits hepatic bile acid receptors in genetically susceptible women,
leading to impaired bile acid homeostasis.

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4
Q

Where are bile salts deposited?

A

Skin and placenta

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5
Q

Skin deposition leads to?

A

Pruritus (itching)

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6
Q

Placental deposition causes raised levels of?

A

Foetal bile acids

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7
Q

What does raised foetal bile acid levels cause?

A

this can cause acute foetal deterioration - thought to be either foetal arrhythmia / cardiomyopathy or placental vasoconstriction.

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8
Q

Presentation of obsteric cholestasis symptoms?

A

● Pruritus (sparing hands and face).
● Excoriations (scratch marks).

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9
Q

Investigations for obsteric cholestasis?

A

● Serum bile acids (raised above 19 micromol/L) ● Liver function tests

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10
Q

Raised serum bile acids level?

A

> 19 micromol/L

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11
Q

First Line management for obstetric cholestasis?

A

Emollient plus antihistamine

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12
Q

Second Line management for obstetric cholestasi?

A

Ursodeoxycholic acid

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13
Q

Consider expedited delivery in management if?

A

Dependent on serum bile acid concentration ○ For example: delivery at 35-36 weeks for women with peak bile acid concentration >100 micromol/L due to increased stillbirth risk.

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14
Q

When should delivery occur for women with peak bile acid concentration >100 micromol/L?

A

At 35-36 weeks

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15
Q

What is the risk associated with peak bile acid concentration >100 micromol/L?

A

Increased stillbirth risk

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16
Q

What is Gestational Diabetes Mellitus (GDM)?

A

Chronic hyperglycemia and insulin resistance due to pregnancy.

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17
Q

What stimulates peripheral insulin resistance in normal pregnancy?

A

Local and placental hormones.

18
Q

What is the purpose of peripheral insulin resistance?

A
  • the purpose of this is to spare glucose for delivery to the developing foetus
19
Q

What else increases free fatty acids and glucose levels?

A

lipolysis and gluconeogenesis

20
Q

What happens to pancreatic beta-cells in GDM?

A

Hypertrophy and hyperplasia occur.

21
Q

What is the purpose of hypertrophy and hyperplasia of pancreatic beta cells?

A

to protect maternal glucose homeostasis

22
Q

What leads to Gestational Diabetes Mellitus (GDM)?

A

Beta-cell dysfunction + insulin resistance

23
Q

What is a maternal complication of GDM?

A

Pre-eclampsia, T2DM, Increased risk of CVD

24
Q

What is the increased risk of chronic type 2 diabetes after GDM?

A

0.6

25
Q

Name some foetal complications of GDM?

A

Macrosomia, Neonatal hypoglycaemia, childhood obesity, increased risk of metabolic syndrome + associated complications in later life

26
Q

What foetal complication is caused by macrosomia?

A

Shoulder dystocia

27
Q

What condition causes neonatal hypoglycaemia in GDM?

A

Maternal hyperglycaemia raising endogenous foetal insulin

28
Q

What is the risk of childhood obesity related to GDM?

A

2x background risk

29
Q

Name some risk factors for GDM

A

BMI, previous macrosomia. previous GDM, FHx of DM, Ethnicity w/ high prevalence of diabetes

30
Q

What is a risk factor for GDM related to weight?

A

BMI > 30

31
Q

When should women with risk factors be screened for GDM?

A

24-28 weeks

32
Q

When to screen women with glycosuria detected at a routine antenatal appointment?

A

Any time in pregnancy

33
Q

First Line test for GDM?

A

Oral glucose tolerance test (OGTT) ; Fasting blood glucose, followed by 75g carbohydrate drink, with a second blood glucose test 2 hours later.

34
Q

How do you rememeber diagnostic criteria for GDM?

A

5678

35
Q

Fasting plasma glucose diagnostic criteria?

A

> 5.6mmol/L

36
Q

2-hour glucose diagnostic criteria?

A

> 7.8mmol/L

37
Q

First Line management after diagnosis for GDM?

A

2 week trial of diet, exercise and self-monitoring glucose levels

38
Q

Second Line management for GDM if diet fails?

A

Metformin

39
Q

What to do if FPG >7.0 in GDM?

A

Start insulin immediately

40
Q

When should you do some extra growth scans if GDM?

A

Weeks 28, 32, 36

Phase 3a - Women's Health (21 decks)

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