Erythromycin if allergic to penicillin
Small-for-gestational age (SGA) refers to an infant born with a birth weight less than the 10th centile.
High blood pressure - pre-eclampsia
Why are women with low PAPP-A - (Pregnancy associated plasma protein-A) put on the SGA pathway? = increases risk of growth not being good and increases risk of preeclampsia
What other risk factors might mean we should advise aspirin? = aspirin is used in pregnancy to improve blood flow in placenta , = hypertension, CKD, previous pre-eclampsia
What are the signs /symptoms of pre-eclampsia ? = protein in pee, high blood pressure, oedema, visual symptoms, upper right quadrant/gastric pain.
What are the complications of pre-eclampsia?
= pre term birth, cardiovascular disease, blind? , HELLP syndrome
What should be done if pre-eclampsia os suspected in the community?
= emergency - ambulance/hospital, close monitoring of BP, and then in the hospital urine/ blood tests should be taken.
What urine/blood tests should be taken?
= FBC, U&Es, dipstick, protein in urine
Can pre-eclampsia cause catheter? Restricted vessels due to high blood pressure, against urine? Ureter?
How do we manage pre-eclampsia?
Labetalol, magnesium sulphate to manage impeding seizure (what signs for an impeding seizure - reflexes etc) , CTG (to monitor baby) , plan delivery if baby at risk - but mothers condition needs to be stable first. , increased tone.
What are the indications for delivery?
Foetal distress, reduced foetal heart rate.
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Why is pt being checked for GDM when she doesn't have diabetes?
= potentially ethnic groups more at risk, routine for mothers with higher risks. What other risks put at risk for GDM? = polycystic ovaries (PCOS), high BMI, obesity,
note: Insulin tolerance changes during pregnancy, - want less glucose during pregnancy
We diagnose GDM at a lower level than normal diabetes,
What is gestational diabetes?
= Gestational diabetes is high blood sugar (glucose) that develops during pregnancy and usually disappears after giving birth.
Does it mean having diabetes for life? = no.
But at risk for diabetes in future
note: mothers who have GDM, have a chance of developing diabetes after birth in the next 10 years.
How can GDM affect the baby?
= macrosomia (large birth weight) , organomegaly, large baby, baby used to high blood sugar so starts producing more insulin, to store glucose so baby gets very large , so even after birth start producing more insulin, complications in development
What GTT result would confirm the GDM diagnosis?
= glucose levels more than 7.8 after 2 hours
How should a positive result be managed?
= changes to diet/lifestyle. Extra monitoring
Immediate after delivery mother can be taken off treatment
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Communication -
Breaking bad news
SPIKES protocol
(Setting, perception, invitation, knowledge, emotions and empathy, strategy and summary. )
Make sure to say CANCER and DEATH/DIED
