Diabetes and pregnancy Flashcards
What do you ask about at first antenatal visit ?
Period history, gynae history, obstetric history, SH, FH, DH, medical history (thyroid, endocrine, respiratory, cardiac), allergies, blood transfusions,
What do you ask specifically to diabetic mothers at their first antenatal assessment?
Control of diabetes prior to pregnancy, nephropathy, retinopathy, CV exam and hypertension, endocrine check TFTs, HbA1c, renal function
Clinical examinations on mother at booking clinic?
General exam, CV exam, respiratory, thyroid, breast exam, abdominal palpation for uterus, legs, BMI, fundoscopy in diabetics
What measurement are taking in USS at booking clinic and what is the purpose?
Crown Rump Length, Biparietal Diameter and used to determine dates, viability of pregnancy and number of fetus
What investigations are performed at the first antenatal visit?
FBC, HIV check, Blood group and antibody check, Rhesus, random blood sugar, syphillis, hepatitis, rubella, mid stream urine sample for UTI check, urinalysis for ketones/protein/blood
When can the triple test for down syndrome be performed and what 3 things does it test for?
15-20 weeks, AFP, estridiol, hCG
What main purposes are USS monitoring done on fetus of diabetic mothers?
Macrosomia and IUGR
Are mothers more likely to be hypo or hyperglycaemic in pregnancy
Hypoglycaemic
Main fetal concerns of diabetic mothers in late pregnancy
Macrosomia, IUD, polyhydramnios, placental abruption
Main maternal concerns of diabetic mothers in late pregnancy
Infections, hypoglycaemic attacks, preeclampsia, preterm labour, diabetic retinopathy
How is blood glucose controlled during labour
Sliding scale of insulin and glucose
Neonatal risks due to diabetic mothers
Neonatal hypoglycaemia, RDS, polycythaemia, traumatic delivery - shoulder dystocia
5 risk factors in a womans PMH that may indicate diabetes risk in pregnancy
first degree relative with insulin dependant diabetes, previous unexplained stillbirth, gestational diabetes in past, baby weighing over 4kg, PCOS
When should potential diabetics be screened for? how?
24-36 weeks with OGTT
What is HbA1c level in the non-diabetic usually
4-6%
Investigations performed in second trimester for pregnancies with diabetic mothers?
4 weekly USS for fetal growth, urinalysis and maternal BP, ECHO on fetus at 24 weeks and 20 week anomaly scan
How often is the mother seen in the third trimester?
2 weekly then after 36 weeks seen weekly - evidence of macrosomia, polyhydramnios, BPD, AC, maternal BP, urinalysis, hormone tests like TFTs
What 5 things are taken into account with the biophysical score of the fetus?
Fetal movements, fetal breathing, CTG, amniotic fluid index, fetal tone
What can regular monitoring not pick up in the cases of diabetic mothers?
Sudden IUD
How often are BMs checked during labour induction? labour?
2 hours, 1 hour
What considerations must be made for a diabetic Csection
VTE prophylaxis, sliding scale, ranitidine 150mg PO, Antibiotics intraop, first on the list, check BMs half hourly periop and then hourly till normal diet returns
When are prepregnancy insulin requirements resumed?
After placenta is delivered, can resume the next morning
Why is maternal glucose aim between 6-8mmol/L
Prevent hypoglycaemic attacks and less tired with baby
2 manouvres used in shoulder distocia
McRobert’s manoeuvre and Woods screw manoeuvre
