6 - Obs - Other Medical Disorders in Pregnancy - DM + GDM in pregnancy Flashcards
For pre-existing diabetics (<1%) … ? reqs ? in preg
Gest DM - (3.5-18%) - ? levels rise ? to diabetic level
insulin
incr
glucose
temporarily
GDM
NICE use ? glucose level >? or >? 2h after ?g glucose load
fasting
7
7.8
75
Fetal complx
Gestational Diabetics ? affected. T1 and T2 diabetics affected ?
-Congen abnorms ?-?x more common in established DMs
-? labour occurs in 10% of ? diabetics
-Fetal ? maturity at any given gestation is ? than with non-DM pregs
-Increased ? - causes incr ? output and ? is common
- larger fetus (called ?) -> ? and ? trauma more common
-fetal ? and ? in labour and sudden fetal ? are more common, related esp to poor ? trimester ? control
less equally 3-4 preterm established lung less birthweight urine polyhydramnios macrosomia dystocia birth compromise distress death 3rd glucose
Maternal Complx -
Insulin req ? considerably by ?
of preg. ? is rare, but ? may result from attempts to achieve ? glucose control.
??? and wound/endometrial ?
after delivery are more common.
Pre-existing ??? detected in up to 25% of overt diabetics and ? more common.
Pre-existing IHD often ?
C section/? delivery more likely due to fetal ? and incr fetal ?.
Diabetic nephropathy (5-10%) is more ass w poorer fetal outcomes, but doesn’t get ?.
Diabetic ? often deteriorates and may need trt.
incr end Ketoacidosis Hypose optimum UTI infection HTN preeclampsia worsens instrumental compromise size worse retinopathy
Management of Pre-existing Diabetes in Pregnancy
Precise glucose control and fetal ? for evidence of ?. Antenatal care is ? led, with delivery in unit w ????facilities. MDT approach inv obstetrician, midwife, ?? , ?
and physician. Woman must control her DM and be ?
monitoring compromise consultant NICU GP Dietician motivated
Preconceptual Care
? ? diabetic women wishing to get pregnant must have ?function, ?? and ? assessed. Glucose control optimized, ?5mg/d given. Optimal control reduces risk of ? abnormalities and ? labour. ? or ? used if antihypertensives required
insulin dependent renal BP retinae folate congen preterm methyldopa labetalol
Monitoring and Treating DM
High ? reflects poor control. Visits every ?w up to ?wks and ? thereafter. Glucose levels checked ? several times by pt, before and after ?, and before ? with home glucometer. Keep levels consistently <6mmol/l. In T2DM hypoglycaemic agents may need to be supplemented w ?. Careful ? and night time ?/? acting w 3 ? short acting insulin injections used. Doses will need ? through preg, and ? prescribed in case of hypo.
HbA1c 2 34 weekly daily food bed <6 insulin diet long/intermediate preprandial incr glucagon
Monitoring Fetus
Usual scans plus fetal ?. USS to monitor fetal ? and ?volume. Even if control good ? and ? can occur. Umbilical aa ? not useful unless ? and ???? develop.
echo growth liquor macrosomia polyhydramnios doppler preeclampsia IUGR
Monitoring or Treating the Complications of Diabetes
? function should be checked and the ? screened for ?.
?, 75mg daily from 12wks is advised to reduce risk of ?. DKA should be trt apprt.
renal retinae retinopathy aspirin preeclampsia
Timing and Mode of Delivery
Should be by ?wks. ? trauma more likely and ? C section often used where est fetal weight exceeds ?kg. During ?, glucose levels maintained w ? ? of insulin and ? infusion.
39 birth elective 4 labour sliding scale dextrose
RF’s for GDM
- ? ? of GDM
- Previous fetus >??
- Previous unexplained ?
- ?-? relative with DM
- BMI>?
- racial origin - ? asian, black ? or ? eastern
- polyhydramnios
- persistent ?
prev Hx 4.5kg stillbirth first -degree 30 south, caribbean, middle glycosuria
Management of GDM
Most won’t need ?.
Diet: If abnormal ??? -> diet and ? advice and monitor glucose at ? as w pre-existing DM, but only ? days a wk.
Oral Hypoglycaemic Agents: eg ? incr used. In conjunction w diet and exercise achieve control in up to ?% women.
? will be required in the rest, esp where ? glucose is ?. Mgmt as for ? DM.
Postnatally, ? is discontinued, but ??? done at 3m: >50% diagnosed w DM in next ?yrs.
insulin GTT exercise home 2 metformin 60 insulin fasting high pre-existing insulin GTT 10
