Diabetes and pregnancy

Question 1

What do you ask about at first antenatal visit ?

Answer 1

Period history, gynae history, obstetric history, SH, FH, DH, medical history (thyroid, endocrine, respiratory, cardiac), allergies, blood transfusions,

Question 2

What do you ask specifically to diabetic mothers at their first antenatal assessment?

Answer 2

Control of diabetes prior to pregnancy, nephropathy, retinopathy, CV exam and hypertension, endocrine check TFTs, HbA1c, renal function

Question 3

Clinical examinations on mother at booking clinic?

Answer 3

General exam, CV exam, respiratory, thyroid, breast exam, abdominal palpation for uterus, legs, BMI, fundoscopy in diabetics

Question 4

What measurement are taking in USS at booking clinic and what is the purpose?

Answer 4

Crown Rump Length, Biparietal Diameter and used to determine dates, viability of pregnancy and number of fetus

Question 5

What investigations are performed at the first antenatal visit?

Answer 5

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

Question 6

When can the triple test for down syndrome be performed and what 3 things does it test for?

Answer 6

15-20 weeks, AFP, estridiol, hCG

Question 7

What main purposes are USS monitoring done on fetus of diabetic mothers?

Answer 7

Macrosomia and IUGR

Question 8

Are mothers more likely to be hypo or hyperglycaemic in pregnancy

Answer 8

Hypoglycaemic

Question 9

Main fetal concerns of diabetic mothers in late pregnancy

Answer 9

Macrosomia, IUD, polyhydramnios, placental abruption

Question 10

Main maternal concerns of diabetic mothers in late pregnancy

Answer 10

Infections, hypoglycaemic attacks, preeclampsia, preterm labour, diabetic retinopathy

Question 11

How is blood glucose controlled during labour

Answer 11

Sliding scale of insulin and glucose

Question 12

Neonatal risks due to diabetic mothers

Answer 12

Neonatal hypoglycaemia, RDS, polycythaemia, traumatic delivery - shoulder dystocia

Question 13

5 risk factors in a womans PMH that may indicate diabetes risk in pregnancy

Answer 13

first degree relative with insulin dependant diabetes, previous unexplained stillbirth, gestational diabetes in past, baby weighing over 4kg, PCOS

Question 14

When should potential diabetics be screened for? how?

Answer 14

24-36 weeks with OGTT

Question 15

What is HbA1c level in the non-diabetic usually

Answer 15

4-6%

Question 16

Investigations performed in second trimester for pregnancies with diabetic mothers?

Answer 16

4 weekly USS for fetal growth, urinalysis and maternal BP, ECHO on fetus at 24 weeks and 20 week anomaly scan

Question 17

How often is the mother seen in the third trimester?

Answer 17

2 weekly then after 36 weeks seen weekly - evidence of macrosomia, polyhydramnios, BPD, AC, maternal BP, urinalysis, hormone tests like TFTs

Question 18

What 5 things are taken into account with the biophysical score of the fetus?

Answer 18

Fetal movements, fetal breathing, CTG, amniotic fluid index, fetal tone

Question 19

What can regular monitoring not pick up in the cases of diabetic mothers?

Answer 19

Sudden IUD

Question 20

How often are BMs checked during labour induction? labour?

Answer 20

2 hours, 1 hour

Question 21

What considerations must be made for a diabetic Csection

Answer 21

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

Question 22

When are prepregnancy insulin requirements resumed?

Answer 22

After placenta is delivered, can resume the next morning

Question 23

Why is maternal glucose aim between 6-8mmol/L

Answer 23

Prevent hypoglycaemic attacks and less tired with baby

Question 24

2 manouvres used in shoulder distocia

Answer 24

McRobert’s manoeuvre and Woods screw manoeuvre

Question 25

What 2 maternal positions are attempted to resolve shoulder distocia

Answer 25

Off the end of the bed, remove pillow, extend episiotomy and also try on all fours

Question 26

Symphysiotomy?

Answer 26

Cut superior anterior fibres of the symphysis pubis

Question 27

Cleidotomy?

Answer 27

Break clavicle of fetus

Question 28

Zavanelli manouvre?

Answer 28

Push fetus back in and CS

Question 29

Risk from shoulder distocia?

Answer 29

Erbs palsy

Question 30

How do you make sure gestational diabetes doesnt become regular diabetes?

Answer 30

6 week post delivery OGTT