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OBS > Diabetes in Pregnancy > Flashcards

Diabetes in Pregnancy Flashcards

1
Q

Glucose reaches fetus by_____

A

Facilitated diffusion.

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2
Q

Maternal Insulin _____ Placenta

A

cannot cross

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3
Q

GLUT ______ is involved in Facilitated diffusion.

A

GLUT 1 and GLUT 3

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4
Q

Fetus starts producing insulin @

A

12 wks

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5
Q

Inc insulin in fetus causes ____

A

1) Macrosomia
2) RDS even @ term
3) Neonatal Hyperglycemia.

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6
Q

Overt Diabetes

A

Diabetic mother conceiving.

Inc risk of Malformation coz free radicals.

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7
Q

Gestational diabetes.

A

A mother on conceiving becoming diabetic .

No chance of organ malformations as organogenesis has been completed.

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8
Q

Dx of Overt Diabetes

A 
FBS= > 126
RBS= >200
HbA1C= > 6.5
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9
Q

Test to predict Chances of congenital malformations in Mothers.

A

HbA1c

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10
Q

Test to detect malformations in babies of diabetic mothers.

A

TIFFA

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11
Q

How to prevent Malformations in overt diabetes.

A

1) Strict glucose control.
2) Folic acid supplementation
dose 400 mcg / day

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12
Q

DOC in overt diabetes

A

Insulin

Oral hypoglycemic agents are C/I

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13
Q

MC system involved in malformation in overt diabetes.

A

CVS > CNS

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14
Q

MC congenital anomaly seen

A

VSD > NTD

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15
Q

Most specific congenital anomaly in over diabetes.

A

Caudal regression syndrome or Sacral agenesis.

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16
Q

MC cardiac anomaly in babies of diabetic mother

A

VSD

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17
Q

Most Specific Cardiac anomaly in overt diabetes.

A

TGA

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18
Q

Least common cardiac anomaly in overt diabetes.

A

TOF

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19
Q

ACOG Approach to Gestational Diabetes.

A

2 step approach.
1 st step : GCT- glucose challenge test @ 24-28 wks.
Give 50 gms glucose to mother and check levels after 1 hr
2nd step is 3 hr 100 gm glucose tolerance test in high risk females while fasting overnight. 4 samples are taken.if 2 or > 2 is abnormal it is dx as GDM.

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20
Q

Carpenter Coustan criteria.

A 
criteria for diagnosing GDM via 3hr 100 gm OGTT 
FBS - 95 
1 hr PP- 180
2 hr PP - 155
3 hr PP - 140 
if 2 or > 2 abnormal = GDM
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21
Q

National diabetes criteria of India .

A 
Criteria for Dx GDM via 3 hr 100 gm OGTT 
FBS- 105
1 hr PP - 190
2 hr PP - 165
3 hr PP - 145.
if 2 or > 2 is abnormal = GDM
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22
Q

One step WHO approach to GDM.

A 
Screening in high risk female.
2hr 75 gm OGTT.
Fasting overnight.
FBS.
75 gms glucose.
1 hr PP
2 hr PP.
Criteria for 75 gm OGTT.
FBS- 92.
1 hr PP - 180
2 hr PP - 152
if 1 or > 1 is abnormal = GDM.
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23
Q

DIPSI criteria

A 
Followed in india.
no fasting reqd.
During a antenatal visit give 75 gms Glucose.
check Blood sugar after 2 hrs. 
if > or = 120 - Glucose intolerance 
If > or = 140 - GDM 
if > or = 200 - overt diabetes.
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24
Q

Mx of Diabetes in pregnancy.

A

if diet and modification is achieved continue it .
if not then DOC is insulin.
Oral glycemic agents are C/I .

25
Q

Oral Glycemic agents in pregnancy

A

Contraindicated . can cross placenta.

except - Metformin and glyburide.

26
Q

Fetal surveillance in Diabetes in pregnancy.

A 
Check for growth restriction from 28 wks.
Methods of surveillance :
1) daily fetal kick count
2) NST
3) weekly biophysical score
27
Q

Methods of surveillance in diabetes in pregnancy.

A

1) daily fetal kick count
2) NST
3) weekly biophysical score

28
Q

TOP in Overt diabetes.

A

37 to 37 + 6 D

Mode of delivery : vaginal delivery.

29
Q

Indication for CS in overt diabetes.

A

If weight is > 4.5 kgs

30
Q

Maternal complications in diabetic pregnancy

A

1) inc infections.
2) Placentomegaly
3) Polyhydramnios
4) inc risk of Post pregnancy DM

31
Q

Fetal Complications in Diabetic pregnancy

A

1) fetal hyperglycemia
2) Macrosomia
3) Shoulder dystocia @ delivery.

32
Q

Risk factor for macrosomia

A

1) Male fetus
2) Post dated pregnancy
3) diabetes in mother.

33
Q

USG parameter to detect macrosomia

A

Abdominal circumference > 35 cms.

34
Q

Organ least affected in macrosomia

35
Q

Shoulder dystocia.

A

if delay of > 1 min after delivery of head.

Turtle sign .

36
Q

Turtle sign.

A

seen in shoulder dystocia.

Pulling back of head towards perineum after its delivery.

37
Q

Risk factors for Shoulder Dystocia - DOPA

A

D- Diabetes
O- Obesity
P- Post date pregnancy
A- Anencephaly

38
Q

Pseudo Shoulder dystocia is seen in

A

Anencephaly

39
Q

Mx of shoulder Dystocia.- HELPERR

A

H- Call for help
E- Episiotomy
L- legs - Flexion and abduction = Mcroberts maneuver.
P- Pressure in suprapubic - not fundal pressure
E- Enter vagina and rotate shoulders .
Woods corkscrew or Rubin’s maneuver.
R- Remove posterior arm of baby - Jacquemier or Barnum Maneuver
R- Rotate patient of all 4 limbs - Gaskin maneuver.
lastly if all fails Zavanelli maneuver.

40
Q

MC nerve injured in Mcroberts maneuver

A

Lateral femoral cutaneous nerve of thigh

41
Q

First and best maneuver to be done in Shoulder dystocia.

A

Mcroberts maneuver.

42
Q

Woods corkscrew maneuver

A

done in shoulder dystocia

43
Q

Rubin maneuver

A

done in shoulder dystocia.

rotation of posterior shoulder.

44
Q

Jacquemier maneuver

A

done in shoulder dystocia.

removing posterior arm of baby.

45
Q

Barnum maneuver

A

done in shoulder dystocia.

removing posterior arm of baby.

46
Q

Zavanelli Maneuver

A

Done in shoulder dystocia.

Push head back and do a CS.

47
Q

Destructive procedures done in shoulder dystocia

A

Cleidotomy.

Symphiosotomy.

48
Q

MC maternal complication of Shoulder dystocia

49
Q

MC fetal complication of Shoulder dystocia

A

Brachial plexus injury

50
Q

MC bone injured in shoulder dystocia.

51
Q

Sign of IUD on x ray

A

Robert’s sign - Presence of gas in great vessels of fetus.
Spalding Sign - Overlapping of Cranial Bones.
Ball sign - Hyperflexion/extension of fetal spine.

52
Q

Robert’s sign

A

Presence of gas in great vessels of fetus.

sign of IUD on x ray.

53
Q

Spalding Sign

A

overlapping of cranial bones of fetus.

Sign of IUD on X ray

54
Q

Ball sign

A

Sign of IUD on X ray

Hyperextension or hyperflexion of spine.

55
Q

Neonatal complication of diabetes.

A

1) Prematurity RDS.
2) Hypoglycemia.
3) Hypo - ca++ , K+ and Mg ++
4) Hyperviscosity syndrome.

56
Q

Hyperviscosity syndrome

A

Neonatal complication of diabetes.

polycythemia + Hyperbilirubinemia.

57
Q

Best test to assess Lung maturity in fetus of Diabetic mother

A

Phosphatidyl glycerol.

58
Q

Tocolytic C/I in a diabetic pregnancy

A

Ritodrine / Isoxsuprine / Terbutaline / Salbutamol.

Risk of hyperglycemia.

59
Q

Tocolytic of choice in a diabetic pregnancy

A

Nifedipine

OBS (13 decks)

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