Increased insulin resistance due to anti-insulin hormaones (glucagons, cortisol, human placenta lactogen) Usually in second or early third trimester Risk Factors Hx of GDM FHx of DM Previous macrosmic baby Ethnicity Diagnosis At screening Retrospective HbA1c testing Maternal and symptoms Management Dietary advice BM monitoring Regular scans Obstetric Cholestasis Features Late second early third trimester Pale fatty stools Severe pruritis of soles and palms Dark urine No rash Decreased appetite Investigations AST/ALT USS for gallstones etc ↑ bilirubin ↑ Management Cholestyramine or antihistamine (reduce Featl monitoring itching) Deliver fetus if mature vitamin K (prevent haemorrhage) Counselling Complications PPH distress in labour IUD or neonatal intracranial haemorrhage Preterm labour
Increased insulin resistance due to anti-insulin hormaones (glucagons, cortisol, human placenta lactogen) Usually in second or early third trimester Risk Factors Hx of GDM Previous macrosmic baby FHx of DM Ethnicity Diagnosis At screening Maternal and symptoms Retrospective HbA1c testing Management Dietary advice BM monitoring Regular scans Obstetric Cholestasis Features Late second early third trimester Severe pruritis of soles and palms No rash Pale fatty stools Dark urine Decreased appetite Investigations ↑ AST/ALT ↑ bilirubin USS for gallstones etc Management Cholestyramine or antihistamine (reduce itching) vitamin K (prevent haemorrhage) Featl monitoring Deliver fetus if mature Counselling Complications PPH IUD Preterm labour distress in labour or neonatal intracranial haemorrhage