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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
Oral Glycemic agents in pregnancy
Contraindicated . can cross placenta. | except - Metformin and glyburide.
26
Fetal surveillance in Diabetes in pregnancy.
``` Check for growth restriction from 28 wks. Methods of surveillance : 1) daily fetal kick count 2) NST 3) weekly biophysical score ```
27
Methods of surveillance in diabetes in pregnancy.
1) daily fetal kick count 2) NST 3) weekly biophysical score
28
TOP in Overt diabetes.
37 to 37 + 6 D | Mode of delivery : vaginal delivery.
29
Indication for CS in overt diabetes.
If weight is > 4.5 kgs
30
Maternal complications in diabetic pregnancy
1) inc infections. 2) Placentomegaly 3) Polyhydramnios 4) inc risk of Post pregnancy DM
31
Fetal Complications in Diabetic pregnancy
1) fetal hyperglycemia 2) Macrosomia 3) Shoulder dystocia @ delivery.
32
Risk factor for macrosomia
1) Male fetus 2) Post dated pregnancy 3) diabetes in mother.
33
USG parameter to detect macrosomia
Abdominal circumference > 35 cms.
34
Organ least affected in macrosomia
Brain
35
Shoulder dystocia.
if delay of > 1 min after delivery of head. | Turtle sign .
36
Turtle sign.
seen in shoulder dystocia. | Pulling back of head towards perineum after its delivery.
37
Risk factors for Shoulder Dystocia - DOPA
D- Diabetes O- Obesity P- Post date pregnancy A- Anencephaly
38
Pseudo Shoulder dystocia is seen in
Anencephaly
39
Mx of shoulder Dystocia.- HELPERR
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
MC nerve injured in Mcroberts maneuver
Lateral femoral cutaneous nerve of thigh
41
First and best maneuver to be done in Shoulder dystocia.
Mcroberts maneuver.
42
Woods corkscrew maneuver
done in shoulder dystocia
43
Rubin maneuver
done in shoulder dystocia. | rotation of posterior shoulder.
44
Jacquemier maneuver
done in shoulder dystocia. | removing posterior arm of baby.
45
Barnum maneuver
done in shoulder dystocia. | removing posterior arm of baby.
46
Zavanelli Maneuver
Done in shoulder dystocia. | Push head back and do a CS.
47
Destructive procedures done in shoulder dystocia
Cleidotomy. | Symphiosotomy.
48
MC maternal complication of Shoulder dystocia
PPH
49
MC fetal complication of Shoulder dystocia
Brachial plexus injury
50
MC bone injured in shoulder dystocia.
Clavicle.
51
Sign of IUD on x ray
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
Robert's sign
Presence of gas in great vessels of fetus. | sign of IUD on x ray.
53
Spalding Sign
overlapping of cranial bones of fetus. | Sign of IUD on X ray
54
Ball sign
Sign of IUD on X ray | Hyperextension or hyperflexion of spine.
55
Neonatal complication of diabetes.
1) Prematurity RDS. 2) Hypoglycemia. 3) Hypo - ca++ , K+ and Mg ++ 4) Hyperviscosity syndrome.
56
Hyperviscosity syndrome
Neonatal complication of diabetes. | polycythemia + Hyperbilirubinemia.
57
Best test to assess Lung maturity in fetus of Diabetic mother
Phosphatidyl glycerol.
58
Tocolytic C/I in a diabetic pregnancy
Ritodrine / Isoxsuprine / Terbutaline / Salbutamol. | Risk of hyperglycemia.
59
Tocolytic of choice in a diabetic pregnancy
Nifedipine

OBS (13 decks)

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