Obstetrics and Gynaecology
Medical Disorders in Pregnancy: Hypertension, Anaemia and Diabetes
Pre-eclampsia and eclampsia, anaemia and gestational diabetes for MBBS, with magnesium sulfate and insulin management, mapped to NMC code OG12.
MedNext Academy | 3 min read
Medical Disorders in Pregnancy: Hypertension, Anaemia and Diabetes
Pre-eclampsia and eclampsia, anaemia and gestational diabetes for MBBS, with magnesium sulfate and insulin management, mapped to NMC code OG12.
This chapter covers the three commonest medical disorders complicating pregnancy: hypertensive disease, anaemia and diabetes. It explains the spectrum from gestational hypertension to eclampsia with magnesium sulfate management, the diagnosis and treatment of anaemia, and the screening and control of gestational diabetes with its foetal consequences.
High-yield: Medical Disorders in Pregnancy: Hypertension, Anaemia and Diabetes
- Gestational hypertension is new hypertension after 20 weeks without proteinuria; pre-eclampsia adds proteinuria or end-organ involvement.
- Severe features of pre-eclampsia include blood pressure at or above 160/110, headache, visual disturbance, epigastric pain and thrombocytopenia.
- Eclampsia is pre-eclampsia with generalised seizures and is an obstetric emergency.
- Magnesium sulfate is the drug of choice for preventing and treating eclamptic seizures.
- Labetalol, nifedipine and hydralazine are the preferred antihypertensives for severe hypertension in pregnancy.
- The definitive treatment of pre-eclampsia is delivery of the foetus and placenta.
- Low-dose aspirin from early pregnancy reduces pre-eclampsia risk in high-risk women.
- Anaemia in pregnancy is a haemoglobin below 11 grams per decilitre and is most often iron-deficiency in India.
- Oral iron is first-line for mild to moderate anaemia; parenteral iron is used for intolerance or moderate to severe anaemia later in pregnancy.
- Severe anaemia near term or with cardiac decompensation may need blood transfusion.
- Gestational diabetes is glucose intolerance first recognised in pregnancy, screened at 24 to 28 weeks.
- Medical nutrition therapy is the first step in gestational diabetes; insulin is the drug of choice when targets are not met.
- Poorly controlled diabetes raises the risk of macrosomia, shoulder dystocia, polyhydramnios and neonatal hypoglycaemia.
- Women with gestational diabetes need a postpartum glucose tolerance test as they are at risk of later type 2 diabetes.
Drugs of choice in pregnancy
- **Eclampsia prevention and treatment:** Magnesium sulfate.
- **Severe hypertension:** Labetalol, nifedipine or hydralazine.
- **Anaemia:** Oral iron first-line; parenteral iron or transfusion when needed.
- **Gestational diabetes:** Nutrition therapy first; insulin when targets not met.
NMC competencies in this chapter
- **OG12.1:** Hypertensive disorders in pregnancy
- **OG12.2:** Anaemia in pregnancy
- **OG12.3:** Diabetes in pregnancy
Frequently Asked Questions
What is the drug of choice for eclampsia?
Magnesium sulfate, used both to prevent seizures in severe pre-eclampsia and to treat established eclamptic fits. It is not primarily an antihypertensive.
How is anaemia in pregnancy defined and treated?
A haemoglobin below 11 grams per decilitre. Oral iron is first-line for mild to moderate cases, with parenteral iron or transfusion reserved for intolerance or severe anaemia.
How is gestational diabetes managed?
Start with medical nutrition therapy and monitoring. If glucose targets are not met, insulin is the drug of choice in pregnancy.
Why do women with gestational diabetes need follow-up?
They are at higher lifetime risk of type 2 diabetes, so a postpartum glucose tolerance test and long-term lifestyle advice are recommended.
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