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Personal OB > Class 4 Diabetes and PIH > Flashcards

Class 4 Diabetes and PIH Flashcards

1
Q

Gestational diabetes is associated with what?

A
  • Advanced maternal age
  • Obesity
  • Family hx of DM
  • Hx of stillbirth, neonatal malformation, or macrosomia
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2
Q

When do Gestational diabetes present? When is it most prevalent? and when does it end?

A
  • When patient cannot mount sufficient insulin response during pregnancy.
  • 2nd and 3rd trimesters
  • After delivery
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3
Q

Major acute complications with GD

A
  • DKA
  • Hyperglycemia (type 2)
  • Hypoglycemia
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4
Q

GD is associated with what 3 complications?

A
  • Gestational HTN
  • Polyhydramnios
  • C-Section
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5
Q

What is the best way to prevent fetal structure abnormalities?

A

-Early glycemic control

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6
Q

Normal A1C? Risk of vascular disease A1C?

A
  • 4-6%

- 6.5%

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7
Q

What risk factors are associated with stiff joint syndrome?

A
  • Type 1 diabetes
  • Short stature
  • Joint contractures
  • Tight skin
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8
Q

What makes direct laryngoscopy difficult with DM in preggos?

A

-C-spine rigidity of atlanto-occipital joint

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9
Q

Maternal insulin requirements progressively ______ during the 2nd and 3rd trimester & ______ at the onset of labor and after delivery.

A
  • Increase

- Decrease

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10
Q

Preanesthetic evaluation considerations?

A
  • SQ insulin is unpredictable
  • IV insulin more flexible
  • Preop blood sugar
  • Evaluate for end organ damage
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11
Q

What is the biggest concern for DM end organ damage?

A

-Diabetic Autonomic Neuropathy

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12
Q

Diabetic autonomic neuropathy can cause what problem for the preggo?

A
  • HTN
  • Ortho hypotension
  • Painless MI
  • Decreased response to meds
  • Decreased HR variability
  • Resting tachycardia
  • Neurogenic bladder
  • Gastroperesis
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13
Q

Intraop blood glucose should be in what range?

A

100-180

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14
Q

2 ways to administer introp insulin?

A
  • Half of daily dose then sliding scale

- Continuous infusion (plasma glucose/desired range = units/hr)

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15
Q

Patients on NPH insulin are at great risk of anaphylaxis from what drug?

A

-Protamine

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16
Q

What meds take longer to clear in a diabetic preggo?

A

-Local anesthetics (use less)

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17
Q

How does GD effect the placenta?

A

Reduces uteroplacental blood flow 35-45%

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18
Q

GD put patients at a great risk for what 3 problems?

A
  • Superimposed preeclampsia
  • Diabetic nephropathy
  • DKA
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19
Q

How do DKA ketones effect the fetus?

A

-Decrease fetal O2

20
Q

Obese women need ______ local anesthetic in the epidural to achieve same block as non obese

A

-Less

21
Q

what are the 4 categories of preggo hypertension?

A
  • Chronic HTN
  • Pregnancy induced
  • Preeclampsia / Eclampsia
  • Preeclampsia w/ chronic
22
Q

name the top 3 causes of maternal mortality in order?

A
  • Thromboembolism
  • Non obstetric injuries
  • Hypertension
23
Q

What type of hypertension causes the most morbidity?

A

-Superimposed preeclampsia

24
Q

Maternal diastolic BP over 110 is associated with what 2 things?

A
  • Placental abruption

- fetal growth restriction

25
Q

Pregnancy induced HTN is defined as what? When does it begin? End?

A
  • Sustained SBP>140, DBP>90
  • Later in pregnancy
  • Resolves 12 weeks postpartum
26
Q

What is preeclampsia?

A
  • New onset HTN after 20 weeks gestation or early postpartum

- Has Renal or other systemic involvement

27
Q

Beside HTN what other symptoms can be seen with preeclampsia?

A
  • Proteinuria
  • Oliguria
  • Headaches
  • Visual disturbances
  • Increased LFTs
  • Thrombocytopenia
  • ABD Pain
  • Edema
  • Rapid weight gain
28
Q

Maternal risk factors for preeclampsia.

A
  • 1st pregnancy
  • younger than 18
  • Older than 35
  • hx of preeclampsia
  • African american
  • Twins
  • Chronic HTN
  • Renal disease
  • Diabetes
  • Anti-phospholipid
29
Q

Why might preeclampsia patients be difficult to intubate?

A

-Upper airway edema

30
Q

Cardiac problems with preeclampsia

A
  • Increased CO and SVR
  • Normal CVP
  • Reduced plasma volume
31
Q

Respiratory problems for preeclampsia

A

-Pulmonary edema

32
Q

Renal problems with preeclampsia

A
  • Protienuria
  • Decrease GFR and CrCl
  • BUN increases w/ severity
  • Decreased blood flow
  • Acute renal failure
33
Q

Oliguria and renal failure may occur in the absence of ______. Be careful w/ hydration as to not cause_____.

A

Hypovolemia

Pulmonary edema

34
Q

Uterine effects of preclampsia

A
  • Hypersensitivity to oxytocin
  • Preterm labor
  • Blood flow reduced
  • Abruption
  • Activity increased
35
Q

What is the leading cause of maternal death in PIH?

A

Intercranial hemorrhage

36
Q

Fetal complications of preclampsia / PIH

A
  • Abruption
  • Growth restrictions
  • Premature delivery
  • Death
37
Q

What is HELLP syndrome?

A
  • Hemolysis
  • Elevated Liver enzymes
  • Low platelets
38
Q

When does HELLP occur and what are the symptoms? And what is the cure?

A
  • Before 36 weeks
  • Malaise, epigastric pain, N/V
  • Delivery
39
Q

When is hemostasis a problem?

A
  • < 40,000

- Rate of fall is important

40
Q

Drug of choice for preeclampsia prevention of seizures? Plasma levels? What is the reversal?

A
  • Mag sulfate
  • Keep plasma level between 4-6
  • Calcium
41
Q

What are the goals for PIH and preeclamptic patients

A
  • Control BP
  • Prevent seizures
  • Delivery
42
Q

What drugs are used to control BP?

A
  • Hydralizine
  • Labetelol
  • Nitro
  • Nifedipine
  • Esmolol
43
Q

What will you see for mag toxicity?

A

-5-10 = long PR, wide QRS
-11-14 = Depressed tendon reflexes
-15-24 = SA, AV blocks respiratory paralysis
>25 cardiac arrest

44
Q

Advantages of epidural?

A
  • Gradual onset of blockade
  • Avoids neonatal depression
  • Reduce HTN = improve uterine blood flow
45
Q

Intubation considerations with PIH and preeclampsia?

A
  • Blunted laryngeal response due to pretreatment of BP lowering drugs
  • Airway edema
46
Q

How does Mag effect succs?

A

-Potentiates its effects

47
Q

MgSO4 _____response to vasconstrictors and ______ catecholamine release after sympathetic stimulation

A
  • Blunts

- Inhibits

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