Clinical 11 Diabeetus And Preggers

Question 1

Fetal Complications of Pre-existing Diabetes

Answer 1

Macrosomia & assoc traumatic delivery
Delayed organ maturation
FGR, aka IUGR (intra-uterine growth restriction)
Congenital anomalies
(Cardiac, Neural tube, Sacral agenesis (caudal regression))

Question 2

Fetal Complications of Gestational Diabetes

Answer 2

Macrosomia and associated traumatic delivery
Delayed organ maturation
FGR (fetal growth restriction), aka IUGR

Question 3

Screening for Gestational Diabetes

Answer 3

24-28 weeks gestation. Gest. DM usually presents in the last half of pregnancy.
1 hour 50 gram glucola test
If value exceeds 140, perform 3 hr glucose tolerance test, 100 gram loading dose
F:95, 1hr:180, 2hr:155, 3hr:140
Gestational diabetes is diagnosed if two abnormal values found on 3ºGTT

Question 4

White Classification A1

Answer 4

Abn GTT;
normal values with diet&exercise.
No insulin needed

Question 5

White Classification A2

Answer 5

Abn GTT
abnormal values with diet and exercise
Insulin needed

Question 6

Antepartum Management

Answer 6

US
Fetal Well being
Normal glucose levels

Question 7

Intrapartum management

Answer 7

Pts requiring insulin are treated with IV insulin at a rate of 0.5- 2units insulin/her
maintain glucose levels of 80-120 mg/dl

Question 8

Post-partum Management

Answer 8

Insulin requirements drop sharply after deliver as insulin antagonists from the placenta are no longer present

Question 9

Gestational diabetics

Answer 9

Don’t need insulin post-partum test with 75 GTT and screen with FBS for diabetes
Increased likelihood of becoming diabetic late rin life.