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OB Exam 2 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Metabolic Disorders: Diabetes Mellitus

A
  • 1st Trimester
    > BG is lower in 1st tri, if already using insulin more at risk for Hypoglycemia
  • 2nd & 3rd Trimester
    > pregnancy exerts a diabetogenic effect on maternal metabolic status; BG incrs
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2
Q

Insulin Resistance

A

As early as 14-16 weeks

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3
Q

Macrosomia

A
  • Maternal Risk/Complication
  • Growth beyond a specific threshold, regardless of gestational age
    > 4000 g (8 lb 13 oz) - 4500 g (9 lb 15 oz)
    > or greater than 90th percentile
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4
Q

Macrosomia - Causes & Complications

A
  • Causes:
    > diabetes in mom
    > obesity in mom
  • Complications
    > shoulder dystocia
    > uterine rupture or bleeding incrd
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5
Q

Hydramnios

polyhydramnios

A
  • Maternal Risk/Complication
  • Too much amniotic fluid
    > indigestion & heartburn
    > constipation
    > breathlessness
    > swollen feet & legs
    > UTIs
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6
Q

Ketoacidosis

A
  • Maternal Risk/Complication
  • BG above 250
  • As well as unstable BG
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7
Q

Ketoacidosis - Risk Factors

A
  • Pre-existing diabetes
  • Gestational diabetes
  • Infections
  • Poor med compliance
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8
Q

Ketoacidosis - Symptoms

A
  • N/V
  • Stomach pain
  • Incrd thirst polydipsia
  • Incrd urination polyuria
  • Rapid breathing tachypnea
  • Fruity-smelling breath
  • Drowsy, weak, or confused
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9
Q

Ketoacidosis - Treatment

A
  • IV fluids
  • Insulin
  • Electrolyte replacement
    > potassium
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10
Q

Fetal/Neonatal Risks

A
  • Sudden/unexplained stillbirth
  • Congenital malformations (heart/CNS)
    > high BG during development of fetus
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11
Q

Care Management: Pregestational Diabetes - Antepartum

fetal eval: goal, risk for, test used

A
  • Goal:
    > detect fetal compromise as early as possible and prevent intrauterine fetal death (IUFD)/stillbirth
  • Risk For:
    > neural tube defects: alpha-fetoprotein (AFP)/ultrasound done 16-18 weeks
    > congenital cardiac anomalies
  • Test Used:
    > Non-Stress Test (NST): after 28 weeks, biophysical profile (BPP) or contraction test if NST is nonreactive
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12
Q

Care Management: Pregestational Diabetes - Antepartum

lab test

A
  • Baseline renal function
  • Glycosylated hemoglobin A1C
  • Urine testing
    > ketones/glucose
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13
Q

How Often are Pregestational Diabetes pts Monitored

A
  • 1st & 2nd Trimester
    > every 1-2 weeks
  • 3rd Trimester
    > 1-2x/week
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14
Q

Care Management: Pregestational Diabetes - Antepartum

health promotion, hospitalization

A
  • Hlth Promotion
    > diet
    > exercise: if uterine activity is detected stop exercise
    > education on the need for incrd insulin in 2nd/3rd tri
  • Diabetes may require hospitalization for dehydration and infection
    > can lead to hyperglycemia & DKA
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15
Q

Care Management: Pregestational Diabetes - Intrapartum

monitor
complication

A
  • Monitor
    > BG 90-110
    > if baby is macrosomic then c-section birth is planned
  • Complications
    > unstable BG
    > ketoacidosis
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16
Q

Care Management: Pregestational Diabetes - Postpartum

insulin requirements

A

Decrease

17
Q

Care Management: Pregestational Diabetes - Postpartum

breastfeeding vs non-breastfeeding

A
  • Breastfeeding = lower BG
  • Non-breastfeeding = elevated BG
  • Insulin needs will return to normal w/in 7-10 days if bottle feeding
  • Safety Education
    > mom needs to check BG prior to feeding for risk of low BG
18
Q

Care Management: Pregestational Diabetes - Postpartum

contraception

A

Ideal to let the body rest 1-2 years after pregnancy

19
Q

Care Management: Gestational Diabetes - Antepartum

criteria
screen

A
  • Fails 2+ oral glucose tolerance tests (OGTT)
20
Q

Care Management: Gestational Diabetes - Antepartum

hlth promotion

A
  • Diet
  • Exercise
  • Self monitor BG
  • Education on insulin therapy
21
Q

Care Management: Gestational Diabetes - Antepartum

fetal surveillance
fetal risks

A
  • Fetal Surveillance
    > monitoring size of baby
  • Fetal Risks
    > macrosomia (common in GDM)
    > neonatal hypoglycemia ( <BG of 40)
22
Q

Care Management: Gestational Diabetes - Antepartum

maternal risks

A
  • Incrd congenital malformation
  • Preeclampsia
  • Cesarean birth
  • T2DM later in life
23
Q

Gestational Diabetes Mellitus (GDM)

intrapartum & postpartum care

A
  • Intrapartum
    > keep BG btwn 80-110 to prevent neonate hypoglycemia
  • Postpartum
    > risk for T2DM
    > education on lifestyle changes

OB Exam 2 (11 decks)

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