Women's Health : Maternal Medicine

Question 1

What is Obstetric Cholestasis?

Answer 1

Obstetric condition causing increased serum bile acids and hepatic dysfunction.

Question 2

What causes Obstetric Cholestasis?

Answer 2

Obstetric condition causing increased serum bile acids and hepatic dysfunction.

Question 3

How does oestrogen affect Obstetric Cholestasis?

Answer 3

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

Question 4

Where are bile salts deposited?

Answer 4

Skin and placenta

Question 5

Skin deposition leads to?

Answer 5

Pruritus (itching)

Question 6

Placental deposition causes raised levels of?

Answer 6

Foetal bile acids

Question 7

What does raised foetal bile acid levels cause?

Answer 7

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

Question 8

Presentation of obsteric cholestasis symptoms?

Answer 8

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

Question 9

Investigations for obsteric cholestasis?

Answer 9

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

Question 10

Raised serum bile acids level?

Answer 10

> 19 micromol/L

Question 11

First Line management for obstetric cholestasis?

Answer 11

Emollient plus antihistamine

Question 12

Second Line management for obstetric cholestasi?

Answer 12

Ursodeoxycholic acid

Question 13

Consider expedited delivery in management if?

Answer 13

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.

Question 14

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

Answer 14

At 35-36 weeks

Question 15

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

Answer 15

Increased stillbirth risk

Question 16

What is Gestational Diabetes Mellitus (GDM)?

Answer 16

Chronic hyperglycemia and insulin resistance due to pregnancy.

Question 17

What stimulates peripheral insulin resistance in normal pregnancy?

Answer 17

Local and placental hormones.

Question 18

What is the purpose of peripheral insulin resistance?

Answer 18

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

Question 19

What else increases free fatty acids and glucose levels?

Answer 19

lipolysis and gluconeogenesis

Question 20

What happens to pancreatic beta-cells in GDM?

Answer 20

Hypertrophy and hyperplasia occur.

Question 21

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

Answer 21

to protect maternal glucose homeostasis

Question 22

What leads to Gestational Diabetes Mellitus (GDM)?

Answer 22

Beta-cell dysfunction + insulin resistance

Question 23

What is a maternal complication of GDM?

Answer 23

Pre-eclampsia, T2DM, Increased risk of CVD

Question 24

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

Answer 24

0.6

Question 25

Name some foetal complications of GDM?

Answer 25

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

Question 26

What foetal complication is caused by macrosomia?

Answer 26

Shoulder dystocia

Question 27

What condition causes neonatal hypoglycaemia in GDM?

Answer 27

Maternal hyperglycaemia raising endogenous foetal insulin

Question 28

What is the risk of childhood obesity related to GDM?

Answer 28

2x background risk

Question 29

Name some risk factors for GDM

Answer 29

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

Question 30

What is a risk factor for GDM related to weight?

Answer 30

BMI > 30

Question 31

When should women with risk factors be screened for GDM?

Answer 31

24-28 weeks

Question 32

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

Answer 32

Any time in pregnancy

Question 33

First Line test for GDM?

Answer 33

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

Question 34

How do you rememeber diagnostic criteria for GDM?

Answer 34

5678

Question 35

Fasting plasma glucose diagnostic criteria?

Answer 35

> 5.6mmol/L

Question 36

2-hour glucose diagnostic criteria?

Answer 36

> 7.8mmol/L

Question 37

First Line management after diagnosis for GDM?

Answer 37

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

Question 38

Second Line management for GDM if diet fails?

Answer 38

Metformin

Question 39

What to do if FPG >7.0 in GDM?

Answer 39

Start insulin immediately

Question 40

When should you do some extra growth scans if GDM?

Answer 40

Weeks 28, 32, 36