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Obstetrics > Diabetes in pregnancy > Flashcards

Diabetes in pregnancy Flashcards

1
Q

What are the long term complications of diabetes?

A
  • retinopathy
  • neuropathy
  • Vascular disease
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2
Q

What are the maternal risks for someone with pre-existing DM?

A
  • increased risk of :
  • hypoglycaemia
  • DKA
  • Worsening of existing retinopathy and nephropathy
  • infections
  • pre-eclampsia
  • operative deliveries
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3
Q

fetal risks of mother with DM?

A
  • miscarriages
  • fetal abnormalities (cardiac, neural tube defects and caudal regression are the most common abnormalities)
  • pre term labour
  • Macrosomia
  • polyhydramnios
  • stillbirths
  • shoulder dystocia
  • neonatal complications: hypoglycaemia, jaundice, respiratory distress, cardiac hypertrophy

Gestational diabetes does not imply as big a risk to the fetus as in pre-existing DM

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4
Q

why is it important to diagnose GDM?

A
  • Identify patients who are at risk of developing type 2DM

- Opportunity to detect overt type 2 DM

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5
Q

How is a glucose tolerance test done?

A

fasting blood glucose value recorded first; them 75 g OGTT and blood glucose measured after 2 hours . Done after 14/16 weeks (repeat between 24-28 weeks if normal)

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6
Q

What are the criteria needed to screen someone for DM during pregnancy?

A

One critera:

  • BMI> 35
  • Previous GDM
  • 1st degree relative
  • Asiatic/ Hindu descent
  • 2 episode of glycosuria
  • macrosomia, polyhydramnios

two criteria needed:

  • Previous big baby
  • previoud term SB
  • Previous RDS at birth
  • Age >35
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7
Q

How do you interprate the results of GTT?

A

NORMAL:
Fasting: 7
2 hour > 11

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8
Q

What does fetal hyperinsulinism cause?

A
  • Macrosomia
  • Neonatal hypoglycaemia
  • Stillbirths of an unknown origin
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9
Q

What does the preconceptual assessment for known diabetics entail?

A
  • Counselling
  • Assessment for existing complications (fundoscopy, renal function)
  • Supplements: folate
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10
Q

When would you advise against pregnancy?

A

Creatinine > or equal to 250
Ischaemic heart disease
severe retinopathy or gastroparesis

HBa1c should be less than 6.1 and BMI should be less than 27

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11
Q

What investigations should be added to antenatal visits?

A

USS; 13,22,32 and 37 weeks
Fetal monitoring by CTG from 32 weeks
Assessment for complications in type 1 and 2

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12
Q

how many blood glucose readings should be done daily?

A

4 readings in a 24 hour period.
one fasting value and 2 hours post prandial after every meal.

If patients can not do it at home: should be done 2 weekly and weekly from 32 weeks

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13
Q

what is the treatment for type 1 diabetics?

A

Short-acting given 30 minutes before each meal

Intermediate insulin given at bedtime

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14
Q

What is the treatment of type 2 and GDM

A
  • diet
  • glibenclamide (Not in third trimester)
  • metformin
  • combination of the above
  • insulin if glucose not controlled on oral agents
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15
Q

When is the fetus delivered?

A
  1. If on treatment: 38 weeks
  2. IGT controlled on diet alone: 40 weeks
    3 amniocentesis should be done if gestation is uncertain
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16
Q

What is the treament in the puerperium?

A

type 1: start on a postnatal sliding scale (will need close monitoring)
Type 2: previously on oral tx: slowly introduce as needed
GDM: probably will not need treatment at all
(should have an ogtt in 6 weeks time)

17
Q

What parameters are looked at to decide if there is an indication for csection?

A 
Estimated fetal weight (>4kg)
Abdominal circumference (>p97)
18
Q

What should the blood glucose levels of a controlled diabetic be

A

-post prandial:

19
Q

What are the hormonal changes affecting metabolic status in the 1st and 2nd trimesters?

A

First: No metabolic hormaonal changes but nausea and vomiting and hypoglycaemia is common

second and third: increase in free cortisol, Human placental lactogen amd other steroid hormones therefore need more medication to achieve pregancy goals for blood glucose values.

20
Q

What is the insulin sliding scale?

A

determine blood glucose levels 30 minutes before eating.

4.1-6 = 6 (4) units of insulin
6.1- 8 = 12 (8) units of insulin
8.1-10= 18 (12)
>10= 24 (16)

21
Q

What is the management during labour

A
  • Nil per mouth (at risk for emergency c section)
  • uses continuous subcutaneous insulin infusion at 1-2 units per hour
  • 100 ml dextrose 5% per hour
  • keep blood glucose between 4-6

Obstetrics (27 decks)

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