Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB > 11.1b Pregestational Diabetes > Flashcards

11.1b Pregestational Diabetes Flashcards

1
Q

Vascular Diseases of Diabetes

A
  • Retinopathy

- Nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pregestational Diabetes

A
  • Almost always insulin dependent
  • First trimester - Glucose is usually lower and insulin response to glucose is enhanced
  • Insulin needs steadily increase after 1st trimester
  • Insulin resistance begins 14-16 weeks gestation
  • Preconception counseling recommended for all women with diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risks of Pregestational Diabetes

A
  • Risk of miscarriage is high if diabetes is present early in pregnancy or close to contraception

WITHOUT VASCULAR DISEASE
- Risk of fetal macrosomia (birthweight greater than 4000-4500g or 90%)

  • Disproportionate increase in shoulder, trunk and chest size
  • Increase likelihood of c-section due to failure of fetal descent
  • Episiotomy, forceps and vacuum birth also more likely

MEDICAL COMPLICATIONS

  • Hypertension
  • Preeclampsia
  • C-section
  • Preterm Birth
  • Maternal mortality
  • RISKS INCREASE WITH DURATION AND SEVERITY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hydramnios

A
  • Diabetes increases risk of this in 3rd trimester

RISKS

  • Placental abruption
  • Uterine dysfunction
  • Postpartum Hemorrhage
  • Vaginal Infection
  • UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ketoacidosis

A
  • Occurs most often in 2nd and 3rd trimester
  • Can occur in glucose levels barely above 200
  • Infection/Illness/Stress increases hepatic glucose production and decreased peripheral uptake of glucose leading to hyperglycemia
  • Ketoacidosis can lead to intrauterine fetal death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypoglycemia

A
  • Risks highest early in pregnancy when hepatic glucose production is low and peripheral uptake of glucose is high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Euglycemia

A
  • Normal glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hyperglycemia Risks

A
  • Miscarriage
  • Congenital malformations
  • Respiratory distress syndrome
  • Extreme prematurity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

IUDF (Stillbirth) Causes

A
  • Diabetes
  • Placental insufficiency
  • Fetal Growth Restriction
  • Macrosomia
  • Polyhydramnios
  • Obstructed Labor (Intrapartum Stillbirth)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hyperglycemia Anomalies

A
  • Happen in first trimester due to organs forming during this time
  • Main birth defect of birth diabetes
  • Most effected systems are CVD and CNS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fetus

A
  • Fetal pancreas releases insulin at 10-14 weeks gestation
  • Insulin acts as a growth hormone so when baby releases extra insulin (hyperinsulinism) due to increased mom blood glucose, it increases fetal size (macrosomia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Macrosomia Risks

A
  • Brachial Plexus Palsy
  • Facial Nerve Injury
  • Humerus/Clavicle Fracture
  • Cephalhematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Care Management

A
  • Baseline renal function (24 hour urine collection) to measure protein and creatinine
  • Urinalysis and culture to assess UTI
  • Thyroid function tests due to risk of coexisting thyroid issues
  • A1C Levels (Less than 6.5 is perfect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Education

A
  • Management and potential effects
  • Insulin administration
  • Hypo/Hyperglycemia
  • Diabetic Diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Associated Fetal Injuries

A
  • Disruption of oxygen transfer

- Birth trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Associated Mom Injuries

A
  • Improper insulin administration
  • Hypo/Hyperglycemia
  • C-section
  • Postpartum infection
17
Q

Antepartum Care

A

1st and 2nd trimester
- Routine visits every 1-2 weeks

3rd trimester
- 1-2 times a week

18
Q

Glucose Levels

A

Fasting - 60-105
1 hour after a meal - Less than 140
2 hours after a meal - Less than 120
2am - 6am - Greater than 60

19
Q

Diet

A
  • Based on blood not urine glucose levels
20
Q

Exercise

A
  • Active 30-60 minutes a day

Benefits

  • Increased insulin sensitivity
  • Increased utilization of glucose
  • Improved glucose control
  • Reduced risk of excessive weight gain
  • Can be divided into 10-20 minute periods after a meal
21
Q

Blood Glucose Testing

A
  • Glucose meter is standard for at home testing

- Urine testing is not useful in pregnancy

22
Q

Complications That Require Hospitalization

A
  • Infection (can lead to hyperglycemia and DKA)
  • 3rd trimester diabetics should be closely monitored for those whose diabetes are poorly controlled
  • If hypertension and preeclampsia also exist with diabetes they may also need hospitalization
23
Q

Fetal Surveillance

A
  • Detect IUFD or Preterm Birth

ULTRASOUND FOR

  • Fetal Growth
  • Estimated Fetal Weight
  • Detect Hydramnios
  • Macrosomia
  • Congenital Anomalies
  • Maternal Serum a-fetoprotein (15-20 weeks gestation)
  • Neural Tube Defects (18-20 weeks gestation)
  • Fetal echocardiogram due to increased cardiac anomalies (20-22 weeks gestation)
  • Most surveillance is done in 3rd trimester because risk is greatest
24
Q

Education During 3rd Trimester

A

Beginning at 28 weeks gestation

- Educate how to make daily fetal movements counts

25
Q

Determining Birth Date and Mode of Birth

A
  • Optimal time of birth is 39-40 weeks
  • Induction of labor at 39 weeks is preferred for moms who have good control of their diabetes
  • Induction of labor should be earlier for those who have not controlled their diabetes well.
  • Lung maturity must first be confirmed via amniocentesis
26
Q

Intrapartum Care

A

MONITOR

  • Dehydration
  • Hypo/Hyperglycemia
  • IV and continuous insulin via piggyback (Only Rapid and Short Acting)
  • Can also be given SubQ
  • Blood glucose should be measured every hour
  • Glucose should be maintained between 90-110
27
Q

Postpartum Care

A
  • First 24 hours postpartum, insulin requirements decrease substantially
  • This is due to expulsion of placenta which was the main source of insulin resistance
28
Q

Diagnosis of Gestational Diabetes

A
  • Diagnosis must be made on 2 occasions

OB (96 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions