CBL 5_GDM, Rh Neg, fetal mvnts

Question 1

Risks for fetus of unmanaged GDM? (5)

Answer 1

○ Growth restriction or large for gestational age (2)
○ Preterm birth (2)
○ Stillbirth (1)
○ Hypoglycemia in neonatal period (1)
○ Metabolic disorders later in life (1)

Question 2

When might WinRo be offered? (6)

Answer 2

Miscarriage
Amniocentesis
ECV
any trauma
at 28 weeks gestation
within 72 hours after the birth if the newborn is Rh-positive

Question 3

What is the full standard does of WhinRo prenatally?

Answer 3

300 micrograms/ 1500 IU

Question 4

What are the risk factors for developing gestational diabetes? (9)

Answer 4

maternal age > 35 years
obesity (BMI >30)
ethnicity (Aboriginal, African, Asian, Hispanic, South Asian)
family history of diabetes
polycystic ovary syndrome
acanthosis nigricans
corticosteroid use
previous pregnancy complicated with GDM
previous macrosomic infant.

Question 5

At what gestation does the SOGC recommend universal screening for GDM for people without multiple risk factors?

Answer 5

24-28 weeks

Question 6

What test does the SOCG recommend for people without multiple risk factors?

Answer 6

2 step screening

Question 7

What number of people are diagnosed with gestational diabetes with the 1 step approach?

Answer 7

2x as much as 2 step

Question 8

Are there improvements of outcomes with 1 step test?

Answer 8

No, but an increase in continuous monitoring and IOL

Question 9

How is insulin different in pregnancy?

Answer 9

It is a normal adaptation in pregnancy, the placenta makes other hormones (such as hPL) that make it difficult for insulin to control blood sugar. (Insulin is a hormone stored in the pancreas that regulates the usage of glucose).This allows more glucose to remain in the bloodstream vs being stored in for energy within the cells. This in return, increases glucose availability to the placenta and is used as nutrients to the growing fetus.

Question 10

How does GDM happen?

Answer 10

In some birthers, the pancreas is unable to produce adequate insulin to control blood glucose. Which causes a rise in glucose that is accelerated in pregnancy, also known as GDM.

Gestational diabetes develops when the birthing person’s body can’t make enough insulin to keep blood glucose in a safe range

Question 11

What is the Glucose Challenge Test?

Answer 11

2 step approach; recommended as first line screen
No fasting needed
Drink 50 g glucose
Blood sample taken 1 hour after

Question 12

What is the glucose tolerance test?

Answer 12

1 step test.
Fasting 8-10 hours prior is required.
A fasting plasma glucose is taken once the client arrives at lab.
75g oral glucose is consumed; blood is drawn at 1hr and 2hrs.

Question 13

What is the Kleihauer test?

Answer 13

measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream.

PP on parent, if Rosette positive quantitative test to show how much fetal blood is present.

Question 14

What is the Rossette test?

Answer 14

a qualitative screening test performed on a maternal blood sample to determine if FMH has occurred between an Rh-positive fetus and an Rh-negative mother

PP done on parent who is Rh - with Rh + bb. Qualitative test to show presence of fetal blood.

Question 15

What is the Direct Coombs test and when is it done?

Answer 15

Done on baby pp if mother is Rh - and bb is Rh +. If posi HEMOLYTIC DISEASE OF THE NEWBORND AKA DAT

Question 16

What is the Indirect Coombs and when is it done?

Answer 16

Done on pregnant person at intake, 26-28 weeks, and pp if parent Rh - and bb Rh +. If positive shows alloimunnization has occurred.

Question 17

When are we recommending 6 kicks in 2 hours?

Answer 17

After 28 weeks

Question 18

What are the chance of forming Rhesus antibodies without Rhesus Immune Globolin?

Answer 18

Without Rhesus Immune Globulin, there is a 12 to 16 percent 1 chance you will form Rhesus antibodies that can harm your baby. The risk grows with each pregnancy.

Question 19

What is pp dose of RH IG?

Answer 19

600 IU/120 mg within 72 hours after delivery

Question 20

What are the risks posed for birthing person having GDM? (4)

Answer 20

higher risk of pre-eclampsia
shoulder dystocia
Caesarean section and large for gestational age infants
[PRE-gestational – stillbirth]

Question 21

What level requires no further testing for 2 step GDM screen?

Answer 21

Less than 7.8 mmol/L

Question 22

What level requires 1 step testing (of 2 step GDM screen)?

Answer 22

7.8-11 mmol/L

Question 23

What levels of 1 step and 2 step GDM test are diagnostic?

Answer 23

1 step: greater than 10.6 mmol/L
2 step: greater than 9 mmol/L

Question 24

What is different about insulin managed GDM vs diet managed GDM? (3)

Answer 24

consultation is not indicated
increased surveillance or continuous monitoring in labour may not be necessary unless the fetus is macrosomic
client choice should be paramount as research is not clear

Question 25

What is the ‘suggestion’ by SOGC for GDM?

Answer 25

Weekly NST
Induction offered at 38-39 weeks

Question 26

What is recommendation for people with GDM postpartum? (2)

Answer 26

-Clients with GDM should be offered testing with a 75-g oral glucose tolerance test between 6 weeks and 6 months postpartum” and
-“breastfeeding is strongly recommended”