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
