Diabetes and HTN in Pregnancy Flashcards
Fetal complications of per-existing diabetes
Macrosomia
Delayed organ maturation
FGR/IUGR
Congenital anomalies - cardiac, neural tube, sacral agenesis
Fetal complications of gestation diabetes
Macrosomia
Delayed organ maturation
FGR/IUGR
NO CONGENITAL ANOMALIES
When should gestational diabetes be screened for?
24-28 weeks
Screening test for gestational diabeetus
1 hr 50 gram glucola test
> 135-140 perform 3 hr glucose tolerance test with 100g loading dose
F-95, 1hr-180, 2hr-155, 3hr-140
Dx of gestational diabetes
Two abnormal values found on 3hr glucose tolerance test
White classification
A1 - abnormal GTT, normal values, tx with diet and exercise and NO INSULIN
A2 - abnormal GTT, abnormal values, tx with diet, exercise, AND INSULIN
Serial tests for fetal well being
Non-stress test
Contraction stress test
Biophysical profile
Cord doppler studies
Post partum management of gestational diabetes
Test w/75g GTT at 6-8 weeks
Yearly screening with FBS for diabetes
What is there an increased likelihood of later in life with gestational diabetes?
Becoming diabetic
Having gestational diabetes with future pregnancies
Post-partum management of pre-preggers diabetics
Most insulin dependent diabetics do not need insulin for first 48-72 hrs after delivery
Monitor plasma glucose every 6hr and tx with insulin if glucose >150mg/dL
Systolic and diastolic pressures in HTN
SBP > 140mmHg
DBP > 90mmHg
Triad of pre-eclampsia
HTN
Proteinuria
Edema
Risk factors for pre-eclampsia
Nulliparity 35 y/o FHx Hydatidiform mole Chronic HTN Diabetes Renal dz Multiple gestation
Maternal S/S of pre-eclampsia
HTN Proteinuria Weight gain Hyper-reflexia HA Epigastric pain Visual changes
What do signs of hyper-reflexia, epigastric pain, and visual changes in pre-eclampsia indicate?
Move towards eclampsia
Fetal sequelae of pre-eclampsia
IUGR
Prematurity
Acute and chronic fetal distress
Maternal sequelae of pre-eclampsia
Placental abruption
DIC
Renal and hepatic failure
CNS hemorrhage and stroke
Pre-eclampsia
BP > 140/90
Proteinuria > 0.3gm/24hr
Mild edema
Severe pre-eclampsia
BP > 160/110 Proteinuria > 5gm/24hr Oliguria < 500mL/24hr Visual changes Pulmonary edema Epigastric pain Elevated liver enzymes Thrombocytopenia
HELLP Syndrome
Pre-eclampsia associated with hemolysis, elevated liver enzymes, low platelets
Eclampsia
Pre-eclampsia associated with convulsions
Tx of mild pre-eclampsia
Rest and observation
Assure fetal well-being
Deliver if 38 wks, progression in S/S, evidence of fetal compromise
Tx of severe pre-eclampsia
Remain hospitalized until delivery
After 32 wks, stabilize and deliver
Before 32 wks, bedrest, control of BP, steroids for lung maturation
Seizure prophylaxis
IV Magnesium Sulfate DOC
AntiHTN tx
IV Labetalol is first line
Correct BP to 140/90 - if tx below this lvl can lead to hypoperfusion of placenta and fetal compromise
AKA goal is not normal rather mild pre-eclamptic lvls
What does pre-eclampsia increase the likelihood of down the road?
Pre-eclampsia in future pregnancies
Developing essential HTN in future
Gestational HTN
HTN after 20 wks WITHOUT PROTEINURIA
BP back to normal by 12 wks post-partum
Chronic HTN
Known HTN prior to pregnancy
Develop HTN prior to 20 weeks
HTN first found during pregnancy and lasting beyond 12 wks post-partum
Chronic HTN tx
Methyldopa, CCBs, Labetalol
AVOID - BBs (cause IUGR), ACE (fetal tox)
Chronic HTN with superimposed pre-eclampsia
Chronic HTN with development of proteinuria > 0.3gm/24hr
Tx same as pre-eclampsia
What studies are indicated in HTN disorders
Non-stress test
Contraction stress test
Biophysical profile
Cord doppler studies
