Clinical Aspects of Pregnancy Flashcards
When is screening done for gestational diabetes?
What screens are done?
Screen Asx’c women: 24-28 weeks
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50-g one-hour glucose challenge = >130 mg/dL test is (+) screening test
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To Dx/Confirm 100-g three-hour oral glucose tolerance test (NORMS are Fasting = 90, 1 hour = 165, 2 hour = 145, 3 hour = 125);
- Two or more abnormal values are Dx’c for GD
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To Dx/Confirm 100-g three-hour oral glucose tolerance test (NORMS are Fasting = 90, 1 hour = 165, 2 hour = 145, 3 hour = 125);
What is the physiology behind gestational diabetes?
What is the major consequence of GD?
- After 12 weeks gestation, maternal glucose crosses the placenta and fetal beta cells can produce insulin
- If maternal glucose level is elevated after 12 weeks gestation, fetal insulin production increases–>
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^^growth hormone effects of this insulin lead to fetal macrosomia [big baby>8lbs. 14oz] causing:
- shoulder dystocia, brachial plexus injuries, hypoglycemia, clavical fractures
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^^growth hormone effects of this insulin lead to fetal macrosomia [big baby>8lbs. 14oz] causing:
What are the consequences of GD on the mom?
Approximately 50% of women with gestational diabetes will develop type 2 diabetes within five to 10 years.
Recommend screening with oral glucose tolerance test at three year intervals.
What puts a mom at ^^risk of GD?
- >35 yo
- BMI >25
- family Hx of DM
- Hx of previous GD
- macrosomia in previous pregnancies
- high-risk ethnicities [Hispanic, Asian, Native Am]
What are signs of pre-term labor?
What is pre-term labor?
preterm labor= cervical change associated w/ uterine contrxns b4 37 wks
IN nulliparous woman, uterine contractions with 2 cm dilation and 80% or greater effacement
What q’s need to be answered in the assessment of pts w/ preterm labor?
What is the gestational age?
Are the membranes ruptured?
Is the patient in labor?
Is there an infection?
What is the likelihood that the patient will deliver prematurely?
What are the risks of these infections during pregnancy:
VZV
parvo
CMV
Rubella
VZV: 1stTri ^^risk of spontaneous abortion, possible teratogenic threat
- (Varicella zoster immune globulin is available –if exposed receive VZIG within 72 hours)
Parvovirus: fetal hydrops [fetal hemolytic anemia), follow infant w/ serial US & transfusion
Cytomegalovirus – may cause infant abnormalities- no treatment
Rubella: CRS (congenital rubella syndrome) deaf, cardiac abnorm’s, cataracts, mental retardation
What can these infxns cause during pregnancy?
HIV
N. Gonorrhea
Chlamydia
Syphilis
Toxoplasmosis
HepB
HIV: C-section has been shown to lower transmission rates ..mom stays on triple therapy in pregnancy to keep their HIV viral load down
N. Gonorrhea: eye, oropharynx, external ear and anorectal mucosa
Chlamydia: conjunctivitis and Chlamydia pneumonia
Syphilis: vertical transmission- late abortion, stillborn infant , congenitally infected infant
Toxo: severe if transmitted to fetus in first trimester-seizures, hydro- or microcephaly, hepatosplenomegaly, jaundice, chorioretinitis
**Hep B causes things too but idk what
What is the differential diagnoses of antepartum bleeding?
What are your first 2 steps in eval?
Do ultrasound 1st!! [abd before transvaginal]
Then could do speculum exam
_Differential!!_ Placenta Previa (painless bleeding) Placenta Abruption (painful contractions
When does vaginal bleeding occur with placental previas?
starts after 20 wks gest.
What is…
Complete placental previa [PP]?
Partial PP?
Marginal PP?
Low lying placenta?
placental abruption?
vasa previa?
- *Complete placenta previa:** placenta completely covers the internal cervical os
- *Partial placenta previa**: placenta partially covers the internal cervical os
- *Marginal placenta previa**: placenta abuts against the internal cervical os
- *Low lying placenta:** edge of placenta is within 2-3 cm of the internal cervical os
- *Placental abuption**: Premature separation of a normally implanted placenta
- *Vasa previa**: Umbilical cord vessels that insert in the membranes with the vessels overlying the internal cervical os, vulnerable to fetal exsanguination upon rupture of the membranes
Do we want babies facing up or down?
describe suture lines and how baby is presenting?
We want babies looking down!
Abnormal presentations of baby that [most] require C sxn probably
breech= ^^ risk of hip dysplasia [esp in females] later
Vertex is probably able to have a vaginal birth
What are consequences of HTN in pregnancy?
}Pregnancy Induced Hypertension: HTN w/o proteinuria @ >20 wks gest.
- Pre-eclampsia: BPs >140/90 @>20wks w/ proteinuria & edema [strange criteria]
- Eclampsia: all of above + grand mal seizures
- HELLP: hemolysis, elevated liver enzymes, low platelets
**hemmorrhage should be another concern
What would make us start to assess fetal well-being?
}Problem is suspected after 32 weeks
}Determine if the baby can survive if delivered early
}Severity of the mother’s condition
}Concern regarding the risk of stillbirth
WHat is Bishops scale/criteria?
What is it used for?
Used to evaluate if indxn should happen or not:
- score= 5 would be unfavorable for indxn
- gray area
- score>/= 8 would be favorable for indxn [cervix is probably ripe and indxn successful]
