MEDICAL DISORDERS IN PREGNANCY Flashcards Preview

OB/GYN > MEDICAL DISORDERS IN PREGNANCY > Flashcards

Flashcards in MEDICAL DISORDERS IN PREGNANCY Deck (92)
Loading flashcards...
1

Why are pregnant women more at risk of developing iron deficiency anaemia?

Normal physiological changes result in an increased plasma expansion which dilutes the Hb.

Iron requirements are almost tripled during pregnancy.

2

At what point would anaemia normally be picked up in a pregnant woman?

FBC is done at booking appointment (within first 10 weeks) and then repeated at 28 weeks

3

What Hb levels would prompt treatment on FBC at booking appointment and at 28 week check?

Booking: less than 110 g/L

28 weeks: less 105 g/L

4

What is the main side effect of iron supplements?

Constipation

5

Other than iron supplements, what else can pregnant women with iron deficiency anaemia be advised to do?

Vitamin C has been shown to increase iron absorption from the gut, therefore fresh orange juice is recommended.

Tannins found in tea and coffee on the other hand reduce absorption so should be avoided.

6

What are the complications of prolonged iron deficiency anaemia?

Breathlessness

Low birth weight
Preterm delivery

At higher risk of complications from perinatal haemorrhage

7

What are the complications associated with pre-existing diabetes in pregnancy?

Miscarriage

Congenital anomalies in particular cardiac

Fetal macrosomia

Polyhydramnios

Pre-eclampsia

Prematurity

Needing labour induced

Needing caesarian section

Birth trauma

Shoulder dystocia

Stillbirth

Neonatal hypoglycaemia

Obesity and diabetes later in the baby's life

8

How is folic acid supplementation different in pre-existing diabetic women looking to conceive compared to non-diabetic women?

Non-diabetic women advised to have 400 micrograms each day until 12 weeks gestation

Diabetic women are prescribed 5 mg each day until 12 weeks gestation

9

What additional ultrasound scans will pregnant women with pre-existing diabetes be offered and why?

They are entitled to early USS if they like

In addition, they will have nuchal translucency checked including a detailed assessment of the fetal heart at 20 weeks.

They are then advised to have US growth scans every 4 weeks between 28 and 36 weeks to look for macrosomia and polyhydramnios.

10

In addition to USS, what monitoring should be done of a pregnant patient with pre-existing diabetes?

Patients should have their eyes checked at booking appointment and then at 28 weeks

They should also have regular blood pressure checks and urine dip for proteinuria.

11

What factors alter glucose metabolism in pregnancy such that pregnancy itself is a state of impaired glucose tolerance?

Hormones secreted by the placenta include:

Glucagon

Cortisol

Human placental lactogen

12

What is the gold standard test used to diagnose gestational diabetes?

Oral Glucose Tolerance Test (OGTT) - 75g of glucose administered post fasting and blood glucose levels recorded at 0 and 2 hours

13

Is there a difference in the definitions (in terms of results from an OGTT) between frank diabetes and gestational diabetes according to NICE?

Frank diabetes:

Fasting glucose of more than 7 mmol/L

2 hour level on OGTT of more than 11 mmol/L


Gestational diabetes:

Fasting glucose of more than 5.6 mmol/L

2 hour level on OGTT of more than 7.8 mmol/L

14

What are the risk factors for developing gestational diabetes?

BMI above 30

Previous macrosomic baby weighing more than 4.5kg

Previous gestational diabetes

First degree relative with diabetes

Country of family origin being in South Asia, Caribbean, Middle East.

15

Who is offered an OGTT in pregnancy and when during gestation will they be offered the test?

All those with risk factors should be offered OGTT at 24-28 weeks

All those who have had gestational diabetes previously should be offered OGTT soon after booking and then again at 24-28 weeks if negative

All patients with gestational diabetes should have a fasting plasma glucose arranged 6 weeks post-natally

16

What are the complications associated with gestational diabetes?

Fetal macrosomia

Polyhydramnios

Pre-eclampsia

Prematurity

Needing labour induced

Needing caesarian section

Birth trauma

Shoulder dystocia

Stillbirth

Neonatal hypoglycaemia

Obesity and diabetes later in the baby's life

17

How do we treat patients with newly diagnosed gestational diabetes with a fasting glucose of less than 7 mmol/L?

Step 1. Changes to diet and exercise regimes

Step 2. Add metformin

Step 3. Add insulin

NB. insulin should be started as first line treatment if the plasma glucose is 6-6.9 mmol/L and there is evidence of macrosomia or polyhydramnios

18

How do we treat patients with newly diagnosed gestational diabetes with a fasting glucose of more than 7 mmol/L?

Start insulin as first line treatment - oral hypoglycaemic agents are not indicated

19

How do we treat pregnant patients with pre-existing diabetes?

All oral hypoglycaemic agents other than metformin should be stopped and insulin should be started

5mg of folic acid should be given from pre-conception to 12 weeks

20

What is the main concern regarding epilepsy in pregnancy?

The fact that anti-epileptic drugs are for the most part teratogenic.

21

What supplements do we advise all epileptic women looking to conceive to be on?

5mg of folic acid

22

What are the guidelines regarding anti-epileptic therapy during pregnancy?

Patients are counselled against stopping medication. Sodium valproate is known to be particularly teratogenic therefore patients may consider swapping medication.

Lamotrigine is recommended for epileptics in pregnancy

23

Do we change doses of anti-epileptic medications in pregnancy?

Reducing dose is normally advised against, unless seizure control has been good for a long period. Doses may even need to be titrated up as increased hepatic metabolism and renal clearance in pregnancy means that levels of drugs are reduced.

24

In addition to folic acid, what prophylactic supplements should epileptic pregnant on phenytoin be given?

Patients on hepatic enzyme inducing drugs (carbamazepine and phenytoin) should be given vitamin K 10 mg orally in the last month of pregnancy.

25

When in pregnancy is the risk of seizures at its highest?

Labour and the 24 hours following delivery. Epileptics women are advised against having home births.

26

What are the guidelines surrounding breast feeding and anti-epileptic medications?

Breast feeding is considered safe in epileptic mothers taking medications.

27

What is the incidence of congenital abnormalities in mothers taking anti-epileptics compared to non-epileptic mothers?

Non-epileptic: 1-2%

Epileptic: 3-4%

28

What percentage of pregnancies are affected by hypothyroidism?

1%

29

What are the clinical features of hypothyroidism in pregnancy?

May be confused with normal symptoms of pregnancy:

Lethargy and tiredness

Weight gain

Dry skin

Hair loss


Discriminatory symptoms:

Cold intolerance

Slow pulse rate

Slow relaxing tendon reflexes

Goitre

30

What are the complications of hypothyroidism in pregnancy?

Miscarriage

Reduced intelligence

Neurodevelopmental delay

Brain damage

Up until 12 weeks gestation the fetus relies solely on maternal thyroid hormone.