Women's Health : Maternal Medicine Flashcards
What is Obstetric Cholestasis?
Obstetric condition causing increased serum bile acids and hepatic dysfunction.
What causes Obstetric Cholestasis?
Obstetric condition causing increased serum bile acids and hepatic dysfunction.
How does oestrogen affect Obstetric Cholestasis?
Inhibits hepatic bile acid receptors in genetically susceptible women,
leading to impaired bile acid homeostasis.
Where are bile salts deposited?
Skin and placenta
Skin deposition leads to?
Pruritus (itching)
Placental deposition causes raised levels of?
Foetal bile acids
What does raised foetal bile acid levels cause?
this can cause acute foetal deterioration - thought to be either foetal arrhythmia / cardiomyopathy or placental vasoconstriction.
Presentation of obsteric cholestasis symptoms?
● Pruritus (sparing hands and face).
● Excoriations (scratch marks).
Investigations for obsteric cholestasis?
● Serum bile acids (raised above 19 micromol/L) ● Liver function tests
Raised serum bile acids level?
> 19 micromol/L
First Line management for obstetric cholestasis?
Emollient plus antihistamine
Second Line management for obstetric cholestasi?
Ursodeoxycholic acid
Consider expedited delivery in management if?
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.
When should delivery occur for women with peak bile acid concentration >100 micromol/L?
At 35-36 weeks
What is the risk associated with peak bile acid concentration >100 micromol/L?
Increased stillbirth risk
What is Gestational Diabetes Mellitus (GDM)?
Chronic hyperglycemia and insulin resistance due to pregnancy.
What stimulates peripheral insulin resistance in normal pregnancy?
Local and placental hormones.
What is the purpose of peripheral insulin resistance?
- the purpose of this is to spare glucose for delivery to the developing foetus
What else increases free fatty acids and glucose levels?
lipolysis and gluconeogenesis
What happens to pancreatic beta-cells in GDM?
Hypertrophy and hyperplasia occur.
What is the purpose of hypertrophy and hyperplasia of pancreatic beta cells?
to protect maternal glucose homeostasis
What leads to Gestational Diabetes Mellitus (GDM)?
Beta-cell dysfunction + insulin resistance
What is a maternal complication of GDM?
Pre-eclampsia, T2DM, Increased risk of CVD
What is the increased risk of chronic type 2 diabetes after GDM?
0.6
Name some foetal complications of GDM?
Macrosomia, Neonatal hypoglycaemia, childhood obesity, increased risk of metabolic syndrome + associated complications in later life
What foetal complication is caused by macrosomia?
Shoulder dystocia
What condition causes neonatal hypoglycaemia in GDM?
Maternal hyperglycaemia raising endogenous foetal insulin
What is the risk of childhood obesity related to GDM?
2x background risk
Name some risk factors for GDM
BMI, previous macrosomia. previous GDM, FHx of DM, Ethnicity w/ high prevalence of diabetes
What is a risk factor for GDM related to weight?
BMI > 30
When should women with risk factors be screened for GDM?
24-28 weeks
When to screen women with glycosuria detected at a routine antenatal appointment?
Any time in pregnancy
First Line test for GDM?
Oral glucose tolerance test (OGTT) ; Fasting blood glucose, followed by 75g carbohydrate drink, with a second blood glucose test 2 hours later.
How do you rememeber diagnostic criteria for GDM?
5678
Fasting plasma glucose diagnostic criteria?
> 5.6mmol/L
2-hour glucose diagnostic criteria?
> 7.8mmol/L
First Line management after diagnosis for GDM?
2 week trial of diet, exercise and self-monitoring glucose levels
Second Line management for GDM if diet fails?
Metformin
What to do if FPG >7.0 in GDM?
Start insulin immediately
When should you do some extra growth scans if GDM?
Weeks 28, 32, 36
