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Repro > Diabetes and HTN in Pregnancy > Flashcards

Diabetes and HTN in Pregnancy Flashcards

1
Q

Fetal complications of per-existing diabetes

A

Macrosomia
Delayed organ maturation
FGR/IUGR
Congenital anomalies - cardiac, neural tube, sacral agenesis

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2
Q

Fetal complications of gestation diabetes

A

Macrosomia
Delayed organ maturation
FGR/IUGR

NO CONGENITAL ANOMALIES

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3
Q

When should gestational diabetes be screened for?

A

24-28 weeks

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4
Q

Screening test for gestational diabeetus

A

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

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5
Q

Dx of gestational diabetes

A

Two abnormal values found on 3hr glucose tolerance test

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6
Q

White classification

A

A1 - abnormal GTT, normal values, tx with diet and exercise and NO INSULIN
A2 - abnormal GTT, abnormal values, tx with diet, exercise, AND INSULIN

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7
Q

Serial tests for fetal well being

A

Non-stress test
Contraction stress test
Biophysical profile
Cord doppler studies

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8
Q

Post partum management of gestational diabetes

A

Test w/75g GTT at 6-8 weeks

Yearly screening with FBS for diabetes

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9
Q

What is there an increased likelihood of later in life with gestational diabetes?

A

Becoming diabetic

Having gestational diabetes with future pregnancies

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10
Q

Post-partum management of pre-preggers diabetics

A

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

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11
Q

Systolic and diastolic pressures in HTN

A

SBP > 140mmHg

DBP > 90mmHg

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12
Q

Triad of pre-eclampsia

A

HTN
Proteinuria
Edema

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13
Q

Risk factors for pre-eclampsia

A 
Nulliparity
35 y/o
FHx
Hydatidiform mole
Chronic HTN
Diabetes
Renal dz
Multiple gestation
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14
Q

Maternal S/S of pre-eclampsia

A 
HTN
Proteinuria
Weight gain
Hyper-reflexia
HA
Epigastric pain
Visual changes
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15
Q

What do signs of hyper-reflexia, epigastric pain, and visual changes in pre-eclampsia indicate?

A

Move towards eclampsia

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16
Q

Fetal sequelae of pre-eclampsia

A

IUGR
Prematurity
Acute and chronic fetal distress

17
Q

Maternal sequelae of pre-eclampsia

A

Placental abruption
DIC
Renal and hepatic failure
CNS hemorrhage and stroke

18
Q

Pre-eclampsia

A

BP > 140/90
Proteinuria > 0.3gm/24hr
Mild edema

19
Q

Severe pre-eclampsia

A 
BP > 160/110
Proteinuria > 5gm/24hr
Oliguria < 500mL/24hr
Visual changes
Pulmonary edema
Epigastric pain
Elevated liver enzymes
Thrombocytopenia
20
Q

HELLP Syndrome

A

Pre-eclampsia associated with hemolysis, elevated liver enzymes, low platelets

21
Q

Eclampsia

A

Pre-eclampsia associated with convulsions

22
Q

Tx of mild pre-eclampsia

A

Rest and observation
Assure fetal well-being
Deliver if 38 wks, progression in S/S, evidence of fetal compromise

23
Q

Tx of severe pre-eclampsia

A

Remain hospitalized until delivery
After 32 wks, stabilize and deliver
Before 32 wks, bedrest, control of BP, steroids for lung maturation

24
Q

Seizure prophylaxis

A

IV Magnesium Sulfate DOC

25
Q

AntiHTN tx

A

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

26
Q

What does pre-eclampsia increase the likelihood of down the road?

A

Pre-eclampsia in future pregnancies

Developing essential HTN in future

27
Q

Gestational HTN

A

HTN after 20 wks WITHOUT PROTEINURIA

BP back to normal by 12 wks post-partum

28
Q

Chronic HTN

A

Known HTN prior to pregnancy
Develop HTN prior to 20 weeks
HTN first found during pregnancy and lasting beyond 12 wks post-partum

29
Q

Chronic HTN tx

A

Methyldopa, CCBs, Labetalol

AVOID - BBs (cause IUGR), ACE (fetal tox)

30
Q

Chronic HTN with superimposed pre-eclampsia

A

Chronic HTN with development of proteinuria > 0.3gm/24hr

Tx same as pre-eclampsia

31
Q

What studies are indicated in HTN disorders

A

Non-stress test
Contraction stress test
Biophysical profile
Cord doppler studies

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