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\author{bee.f (bee.f)}
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  /Title (6004-pregnancy.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (6004 Pregnancy Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{6004 Pregnancy Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/42226/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 20th November, 2024.\\
   Updated 29th January, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\begin{tabularx}{17.67cm}{x{8.1169 cm} x{9.1531 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gestational diabetes}}  \tn
% Row 0
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• {\bf{Intro:}} & - One of the most {\bf{common}} conditions of pregnancy, which can have serious complications for the parent and baby if not identified and managed\{\{nl\}\} - Usually goes away again after giving birth\{\{nl\}\}- It's usually diagnosed from a {\bf{blood test 24 to 28 weeks}} into pregnancy\{\{nl\}\}- Less common than Type 1 \& 2 diabetes (increasing prevalence tho)\{\{nl\}\}- Affects 4-5 in 10o women during pregnancy, or 1 in 20 pregnancies in the UK \tn 
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• {\bf{Causes:}} & - Hormonal difficulty to use insulin (increased risk of insulin resistance)\{\{nl\}\}- Cells don't respond properly to insulin by not producing enough, making it difficult to use glucose properly for energy (stays in body \& blood sugar level rises), leads to gestational diabetes \tn 
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gestational diabetes (cont)}}  \tn
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• {\bf{Risk factors:}} & - Living with overweight or obesity\{\{nl\}\}- Having had it before in a previous pregnancy\{\{nl\}\}- Having had a very large baby in a previous pregnancy (4.5kg / 10lbs or more)\{\{nl\}\}- Having a fHx of diabetes (at least one parent or sibling)\{\{nl\}\}- Having a South Asian, Black or African Caribbean or Middle Eastern background\{\{nl\}\}- Increasing age (NHS recommends screening if pregnant and over 40yrs or older) \tn 
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• {\bf{Prevention:}} & - Some people can't prevent it\{\{nl{]}\}- Get support to manage weight, healthy diet and keeping active before and during pregnancy \tn 
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• {\bf{What after diagnosis?}} & - Care team informs GP\{\{nl\}\}- Within {\bf{1 week}} you should be referred to a joint diabetes and antenatal clinic\{\{nl\}\}- Team will work on targeting blood sugar levels with you (will reduce risks of complications) \tn 
% Row Count 38 (+ 11)
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\begin{tabularx}{17.67cm}{x{8.1169 cm} x{9.1531 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gestational diabetes (cont)}}  \tn
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• {\bf{What happens if mom has GD?}} & - Can affect how well the placenta works\{\{nl\}\}- Can make baby unwell and affect their movements\{\{nl\}\}- If baby movements have slowed, stopped or are different to normal, {\bf{contact midwife or maternity unit immediately}} \tn 
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• {\bf{Complications:}} & - Baby growing larger than normal (more painful or difficult birth \& possible distress)\{\{nl\}\}- Neonatal hypoglycaemia (baby has low blood sugar after birth)\{\{nl\}\} As well as the above, continuous high blood sugar levels can also lead to:\{\{nl\}\}- Induced labour\{\{nl\}\}- Caesarean section\{\{nl\}\}- Baby having higher risk of being overweight or obesity \& developing Type {\bf{2}} diabetes\{\{nl\}\}- Baby having yellow skin \& eyes (jaundice) after birth \tn 
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\begin{tabularx}{17.67cm}{x{8.1169 cm} x{9.1531 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gestational diabetes (cont)}}  \tn
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• {\bf{Symptoms:}} & - Going for a wee a lot, especially at night\{\{nl\}\}- Being really thirsty\{\{nl\}\}- Feeling more tired than usual\{\{nl\}\}- Genital itching or thrush\{\{nl\}\}- Blurred eyesight\{\{nl\}\}{\emph{Many women have no noticeable symptoms}} \tn 
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• {\bf{Tests:}} & {\bf{Oral glucose tolerance test (OGTT)}}\{\{nl\}\}{\emph{Doesn't harm mom or baby}}\{\{nl\}\}{\bf{1.}} You'll need to fast (no food or drinks) for 8-10 hours the night before \& the morning of the test\{\{nl\}\}{\bf{2.}} Blood test to measure blood glucose level\{\{nl\}\}{\bf{3.}} Will be given a glucose drink\{\{nl\}\}{\bf{4.}} Rest for 2 hours, another blood test to see how the body is dealing with the glucose\{\{nl\}\}{\bf{Results:}} Diagnosed with GD if fasting blood sugar level is {\bf{5.6mmol/l or above}}, or if your 2hr post glucose blood sugar level is {\bf{7.8mmol/l or above}}\{\{nl\}\}- GD can develop at any time during pregnancy, if you develop any symptoms (despite -ve OGTT), talk to midwife \tn 
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\begin{tabularx}{17.67cm}{x{8.1169 cm} x{9.1531 cm} }
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• {\bf{Treatments:}} & - Checking blood sugar levels regularly (pricking w/ lancet)\{\{nl\}\}- Levels outside targets discuss with healthcare team, can cause problems for mom and baby\{\{nl\}\}- Very common to need {\bf{glucose lowering medication}}, including {\bf{insulin}}\{\{nl\}\}- Regular physical activity\{\{nl\}\}- Healthy diet \tn 
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• {\bf{Medications:}} & - {\bf{Metformin:}} tablet that helps to reduce the amount of glucose produced by the liver, \& to make insulin work more effectively; taken with, or after, a meal\{\{nl\}\}- {\bf{Insulin:}} Allows glucose to enter the cells and to be used for energy; injection that goes in just undertake skin (can't be taken orally because the stomach will digest it) \tn 
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gestational diabetes (cont)}}  \tn
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• {\bf{What should I aim for?}} & - Going for regular walks after lunch or dinner\{\{nl\}\}- Pregnancy yoga\{\{nl\}\}- Swimming or water aerobics\{\{nl\}\}- Dancing in the kitchen\{\{nl\}\}- Try not to sit after a meal (being active for 15-20min within 30 min of a meal) \tn 
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• {\bf{Blood sugar level aims:}} & - Fasting: below 5.3mmol/l\{\{nl\}\}- 1hr after meals: below 7.8mmol/l\{\{nl\}\}- If not able to check until 2hr after a meal: below 6.4mmol/l \tn 
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\mymulticolumn{2}{x{17.67cm}}{\seqsplit{https://www.diabetes.org.uk/diabetes-the-basics/gestational-diabetes}}  \tn 
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gestational hypertension}}  \tn
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• {\bf{Intro:}} & - BP readings of {\bf{≥140/90 mmHg on 2 occasions at least 4hr apart after 20 weeks' gestation}} in a previously normotensive woman\{\{nl\}\}- Must be {\bf{w/o}} the presence of {\bf{proteinuria}} (\textless{}300mg in 24hr) or {\bf{other clinical features}} (thrombocytopenia, impaired renal or kidney function, pulmonary oedema, or new-onset headache) {\bf{suggestive of pre-eclampsia}} \tn 
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• {\bf{Key diagnostic factors:}} & -Presence of risk factors\{\{nl\}\}- Previously normotensive\{\{nl\}\}- BP ≥140/90 mmHg\{\{nl\}\}- \textless{}20 weeks' gestation\{\{nl\}\}- Absence of Ssx that suggest pre-eclampsia \tn 
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• {\bf{Risk factors:}} & - Nulliparous (hasn't given birth before)\{\{nl\}\}- Black or Hispanic ethnicity\{\{nl\}\}- Obesity \tn 
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gestational hypertension (cont)}}  \tn
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• {\bf{1.3 Management of chronic hypertension in pregnancy:}} & {\bf{Referral \& discussion:}}\{\{nl\}\}- Offer referral to a specialist in hypertensive disorders for women with chronic hypertension to {\bf{discuss treatment risks \& benefits}}\{\{nl\}\}- For those taking {\bf{ACE inhibitors or ARBs}}, highlight the increased risk of congenital abnormalities during pregnancy\{\{nl\}\}- Emphasise discussing {\bf{alternative antihypertensive treatment}} with healthcare professionals if planning pregnancy or taking these medications for other conditions\{\{nl\}\}{\bf{Medication safety update:}}\{\{nl\}\}- Note the MHRA's drug safety update on ACE inhibitors and angiotensin II receptor antagonists, advising against use in pregnancy {\bf{unless absolutely necessary}}\{\{nl\}\}{\bf{Antihypertensive treatment adjustment:}}\{\{nl\}\}- Promptly discontinue ACE inhibitors or ARBs if pregnancy is confirmed, preferably {\bf{within 2 working days}}, \& provide alternative options\{\{nl\}\}- For thiazide or thiazide-like diuretics, {\bf{inform about potential risks of congenital abnormalities \& neonatal complications}} during pregnancy\{\{nl\}\}- {\bf{Encourage discussion of alternative antihypertensive treatment}} with healthcare professionals for those planning pregnancy\{\{nl\}\}{\bf{Limited risk with other antihypertensive treatments:}}\{\{nl\}\}- {\bf{Assure}} women taking antihypertensive treatments other than ACE inhibitors, ARBs, thiazide, or thiazide-like diuretics that limited evidence {\bf{suggests not increased risk of congenital malformation}} \tn 
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\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Gestational hypertension (cont)}}  \tn
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• {\bf{1.4 Management of gestational hypertension:}} & {\bf{Assessment \& risk factors:}}\{\{nl\}\}- Full assessment in 2° care by a trained healthcare professional\{\{nl\}\}- Consider additional risk factors: nulliparity, age \textgreater{}40 or older, pregnancy interval \textgreater{}10 yrs, fHx of pre-eclampsia, multi-feral pregnancy, BMI 35kg/m2 or more, gestational age at presentation, previous Hx of pre-eclampsia or gestational hypertension, pre-existing vascular disease, pre-existing kidney disease\{\{nl\}\}{\bf{ Tests \& treatment:}}\{\{nl\}\}- Hypertension (BP 140/90 - 159/109 mmHg): offer pharmacological treatment ig BP remains above 140/90 mmHg\{\{nl\}\}- Severe hypertension (BP 160/110 mmHg or more): admit to hospital; if BP falls below 160/110 mmHg, manage as for hypertension\{\{nl\}\}- Antihypertensive treatment: offer to all women; target BP of 135/85 mmHg or less\{\{nl\}\}- BP measurement: 1 or 2x / week until BP is 135/85 mmHg or less\{\{nl\}\}- Dipstick proteinuria testing: 1 or 2x /week (w/ BP measurements)\{\{nl\}\}- Blood tests: measure full blood count, liver function, \& renal function at presentation \& then weekly\{\{nl\}\}- Placental growth factor (PLGF)-based testing: if suspicion of pre-eclampsia\{\{nl\}\}- Fatal assessment: offer fatal heart auscultation at every antanatal appointment; ultrasound assessment at diagnosis \& repeat every 2-4 weeks if normal; cardiotocography (CTG) if clinically indicated\{\{nl\}\}{\bf{Additional metal monitoring (severe hypertension):}}\{\{nl\}\}- Ultrasound assessment every 2 weeks if severe hypertension persists\{\{nl\}\}- CTG at diagnosis \& then only if clinically indicated \tn 
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\mymulticolumn{2}{x{17.67cm}}{\seqsplit{https://www.nice.org.uk/guidance/ng133/chapter/Recommendations\#management-of-gestational-hypertension}}  \tn 
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\begin{tabularx}{17.67cm}{x{6.908 cm} x{10.362 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pelvic girdle pain (PGP) in pregancy}}  \tn
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• {\bf{Intro:}} & - Pelvis has 3 joints that normally move slightly \& work together\{\{nl\}\}- PGP is caused by {\bf{uneven movement}} of these joints, resulting in {\bf{less stability \& pain}}\{\{nl\}\}- Factors contributing to PGP include {\bf{changes in weight \& posture}} during pregnancy \tn 
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• {\bf{Signs \& symptoms:}} & - Px in pubic region, lower back, hips groin, thighs or kness\{\{nl\}\}- Clicking or grinding in the pelvic area\{\{nl\}\}- Pain made worse by movement: walking on uneven surfaces / rough ground or for long distances; moving your knees apart (getting in/out of the car); standing on one leg (climbing the stairs, dressing, getting in/out of bath); rolling over in bed; during sexual intercourse \tn 
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• {\bf{Risk factors:}} & - Hx of back problems\{\{nl\}\}- Hx of pelvic injuries\{\{nl\}\}- Hypermobility syndrome \tn 
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\begin{tabularx}{17.67cm}{x{6.908 cm} x{10.362 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pelvic girdle pain (PGP) in pregancy (cont)}}  \tn
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• {\bf{Management options:}} & - Avoiding aggravating movements / changing positions\{\{nl\}\}- Exercises for pain relief \& mobility: focus on strengthening abdominal \& pelvic floor muscles for improved balance, posture, \& spine stability; incorporate routines that facilitate easier movement while minimising strain\{\{nl\}\}- Mobs, drops, SMT\{\{nl\}\}- Warm baths, or heat, or ice packs\{\{nl\}\}- Hydrotherapy\{\{nl\}\}- Acupuncture / dry needling\{\{nl\}\}- Support belt or crutches \tn 
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\mymulticolumn{2}{x{17.67cm}}{https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-girdle-pain-and-pregnancy/\#:\textasciitilde{}:text=PGP\%20is\%20common\%2C\%20affecting\%201,stage\%20during\%20or\%20after\%20pregnancy.}  \tn 
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