Diseases in pregnancy

Test yourself on diseases in pregnancy.

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Diseases of pregnancy

Define gestational diabetes?

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Diseases of pregnancy

The onset of diabetes or abnormal glucose tolerance for the first time during pregnancy.

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Diseases of pregnancy

What are the main effects of gestational diabetes on the foetus?

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Diseases of pregnancy

-Polyhydramnos.

-Macrosomia.

-Increased incidence of preterm labour.

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Diseases of pregnancy

How can gestational diabetes be screened for?

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Diseases of pregnancy

1) Oral glucose tolerance test (OGTT) for high risk women.

2) Oral glucose load and single blood sugar estimation 2 hours later.

3) Random blood sugar at 28 weeks gestation 2 hours after last meal. Women who have high sugar values then go on to have a OGTT.

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Diseases of pregnancy

What high risk features may result in abnormal glucose tolerance test and indicate screening with OGTT?

Name 4.

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Diseases of pregnancy

1) High maternal weight (>90th centile or BMI > 30).

2) Previous large baby (>4.5kg).

3) First degree relative with diabetes.

4) Glycosuria:

-Once before 20 weeks.

-Twice after 20 weeks.

5) Polyhydramnos.

6) Previous unexplained stillbirth or neonatal death.

7)Fetal macrosomia on ultrasound.

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Diseases of pregnancy

What is the OGTT and what values warrent further investigation?

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Diseases of pregnancy

50g glucose load in flavoured water.

Fasting values of >5.8mmol/l or 2-hour values of >7.8mmol/l require further testing.

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Diseases of pregnancy

When should oral hypoglycaemics be used to treat gestational diabetes?

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Diseases of pregnancy

Never!

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Diseases of pregnancy

in gestational diabetes, how should home monitoring take place, what levels spur one to action, and what action should that be?

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Diseases of pregnancy

-Home monitoring with electronic blood glucose kits.

-Fasting and 1hr post-meal levels should be monitored at least twice a week.

-Fasting levels <5.5mmol/l and 1hr levels <9mmol/l are fine - no treatment.

-However, if values top these cut-offs, diet should be modified - low carbohydrate diet. Ketone leves in urine should now also be monitored.

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Diseases of pregnancy

When should insulin be used in gestational diabetes? How should the foetus be monitored?

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Diseases of pregnancy

Insulin should be started when:

-Blood sugar levels are >5.5mmol/l fasting or >9mmol/l 1hr after a meal, and when carbohydrate-restricted diet has failed to control this, or

-When ketosis occurs, in which case dietry restrictions should be relaxed.

-Twice-daily short and long-acting insulins should be used.

-Monthly ultrasounds scans should be performed to check foetal growth and amniotic fluid levels.

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Diseases of pregnancy

How does gestational diabetes affect timing of delivery?

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Diseases of pregnancy

-If there is no evidence of excessive foetal growth, no polyhydramnos, no maternal ketosis, and gluocse levels are not >9mmol/l 1hr after eating or >5.5mmol/l fasting, then the pregnancy can be allowed to continue up to 42 weeks.

-Women with abnormal ultrasound scans should be induced at term (though some obstetricians induce at 38-39 weeks).

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Diseases of pregnancy

When should insulin requirements dissapear in gestational diabetes?

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Diseases of pregnancy

With the delivery of the placenta!

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Diseases of pregnancy

Are women with gestational diabetes more likely to go on to develope diabetes?

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Diseases of pregnancy

-40% of women with gestational diabetes go on to develop diabetes in the next 10-20 years. This risk doubles if they are obese.

-Gestational diabetes usually recurrs in future pregnancies, though this is not inevitable.

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Diseases of pregnancy

How should gestational diabetes be controlled in labour?

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Diseases of pregnancy

Those on insulin antenatally should have the same IV insulin and glucose regime as type I diabetics

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