Diabetes, abortions, ectopics Flashcards
LGA
> 4000
class B
onset of DM at 20+ with duration <10yrs
class C
onset 10-19 with duration of 10-19 yrs
class D
onset 20
class E
overt DM with calcified pelvic vessels
DM I
uteroplacental insufficiency -> growth restriction
GDM
any degress of glucose intolerance with onset during pregnancy
dt HPL creating insulin resistance
risk factors of GDM
increased age and weight previous GDM previous macrosomic infant FHx of DM ethnic
blood glucose 1st trimester
decreased d/t increased insulin sensitivity and production
blood glucose 2nd-3rd trimester
insulin sensitivity decreases
early pregnancy
decreased hepatic glucose storage decreased maternal fasting storage increased B cell hyperplasia and insulin secretion increased glycogen storage increased glucose utilization increased E and P
effects of DM on baby
macrosomnia hypoglycemia hyperbilirubinemia low Ca and Mg RDS polycythemia hyperviscosity increased risk for obesity increased risk for DMII
Acute complications of GDM
preterm labor
HTN
preeclampsia
increased risk for DMII
Dx GDM
fasting glucose <126
random glucose 200
interpartum care
IV fluids with dextrose
insulin for all DM I and some GDM/DMII
care during breastfeeding
insulin requirements usually lower
hCG in normal pregnancy
should double every 48 hours
risk factors for spontaneous abortion
age previous spontaneous abortion increasing gravidity prolonged time to implantation or conception smoking EtOH cocaine NSAIDs around time of conception caffeine low folate extremes of moms weight fever celiacs
fetal etiologies of spontaneous abortion
chromosomal abnormalities (50%)
trisomy 16 most common
congenital abnormalities
truama
maternal etiologies of spontaneous abortion
uterine structural issues
acute maternal infections
material endocrinopathies
hypercoaguable states
work up for spontaneous abortion
doppler pelvic exam pelvic US hCG blood type Ab screen serum porgesterone
Dx with pelvic US
gestational sac >25mm that does not contain yolk sac/embryo
an embryoi with crown rump length >7mm that does not have cardiac activity
Dx with lack of development
absence of heart beat 11-14 days
threatened abortion
Dx criteria for spontaneous abortion not met
bleeding, but os closed
up to 50% will miscarry
bed rest
inevitable abortion
bleeding, cramping, dilated cervix
Tx of inevitable abortion
medical abortion (misopristol)
surgical abortion D&C
wait
incomplete abortion
bleeding, pain, cervix dilated, products of conception are found w/in cervical canal
after 12 wks membranes rupture and fetus is passed, but placental tissue may be retained
Tx of incomplete abortion
medical abortion (misopristol)
surgical abortion D&C
watch for Staph aureus infection
risk factors for ectopic
previous ectopic PID assisted repro technology Hx of peritonitis smoking previous tubal ligation
Tx for ectopic
medical abortion (methotrexate) surgical
