Disease

Symptoms

Intrahepatic
Cholestasis of
Pregnancy

Unknwon etiology
Begins 3rd Trimester and Worsens
More severe on extremities
Associated w/ OCPs (hormonal etiology?)

Herpes Gestationis

No relationship to HSV
Begins 2nd Trimester
Autoimmune? (IgG BM Classical Pathway)
Def Dx Immuno-F of specimens
Neonatal lesions will resolve

Intense pruritus patches of cutaneous erythema small

vesicles & tense bullae
Limbs > Trunk
IUGR and stillbirth association
Tx oral corticosteroids

PUPPP

AFLP

Clinical Dx AST/ALT levels WNL

No hepatic sequelae in mother
Jaundice or bile acids associated w/ fetal problems
Cholestyramine or ursodeoxycholic acid

Lesions: abdomen things butt/arms

Erythematous urticarial plaques & small papules
surrounded by pale halo
No adverse fetal problems

Immuno-F negative for IgG and complement

Histo normal epidermis & lymphocytes/histiocytres
dermal edema

Microvascular steatosis of liver 2/2 mitochondrial

dysfunction
Rare, but very serious condition

RUQ pain, N/V, ARF, Hypoglycemia, Coagulopathy, Liver

failure
Deliver is only Tx

Abnormal LFTs in Pregnancy

Disease
AFLP

Characteristics
N/V, icteric, hypoglycemia, coagulopathy

Preeclampsia

LFTs 100-300 IU/L range, HTN, Proteinuria (>300mg/24hr)

HELLP

Hemolysis, LFTs can be up to 1000 IU/L, Platelets <100,000

ICP

Generalized itching, mildly elevated LFTs, elevated bile salts

Diabetes in Pregnancy

Disease

Notes

DKA

Can develop quicker

than non-pregnant pt
Seen more in 2nd/3rd
trimesters
Eval every DM pt with
vague S/S for DKA

Pre-Preg
DM

Can be DM-I or DM-II

Accounts for 10%
Physiologic changes
(GH, CRH, hPL, Prog)
causes insulin resistance
HbA1c is proportional
to anomaly risk

GDM

Screen at 24-28 weeks

Accounts for 90%
RFs (age>25, ethnicity,
hx DM or macrosomic
child)

Criteria/What to Do

Sequelae

Treatment

pH <7.35
BS 200 mg/dL
Serum ketones >5mEq/L
Serum bicarb <18 and ketonuria
Bicarb compensates for 1 resp
alk

IV Fluid with NS
Correct acidosis
Correct glucose with insulin
Correct lytes
Watch K+ as it can still be
depleted if labs WNL or

Maternal acidosis can

Fetal acidosis Late decels
No C/S. Treat DKA.

Ophthalmologic referral
Detained anatomy US at fetal echo
during 2nd triemster
Fetal surveillance
Optimal control deliver at 39 wks
Sub-optimal control deliver <39
weeks after lung maturity confirmed
No steroids >34 weeks
C/S is baby >4500g

ASSOCIATED with
congenital anomalies &
miscarriage b/c
hyperglycemia during
organogenesis
DM retinopathy = leading
cause of blindness in
reproductive aged women
HTN disorders
Incidence of preeclampsia
with renal/retinopathy RFs

Use folate to NTD risk

Fasting targets <105
1 hour postprandial <140

1 hr screening test (130-140)

3 hr test ( 2 abnormal values)

NOT ASSOCIATED with

congenital anomalies &
miscarriage b/c
hyperglycemia during 2nd/
3rd trimesters

1st Diet & Exercise (NO

WEIGHT LOSS)
NPH (qhs) & Aspart (ac)
Oral agents (Met & glyburide)
6 weeks PP 75g OTT
Breast feeding weight loss

Maternal & Neonatal Complications of Diabetes in Pregnancy

Neonatal

All diabetics
(Gest & Pre-gest)

Pre-Gestional

Birth injury
NICU admission
Hypoglycemia
Hyperbilirubinemia

Congenital
anomalies
IUGR

Maternal

Macrosomia
Polyhydraminos
Long term
Childhood
obesity

Increased
risk for C/S
Increased
maternal
laceration &
injury

Preeclampsia
Long term
Metabolic syndrome
& overt diabetes

Miscarriage
Prematurity

Worsening
proliferative
retinopathy

Worsening
nephropathy (if
moderate/severe
preexisting)