Diabetes in Pregnancy Flashcards
1
Q
Overview of diabetes
A
- Most common endocrine disorder in pregnancy: 4-14% of women, r/t obesity epidemic
- Key to best outcome is strict maternal glucose control
- Gestational diabetes pregnancy = high risk
- Requires multidisciplinary approach
- Usually induced early because diabetes advances age of placenta
2
Q
Pregestational Diabetes
A
- 10% of pregnancies complicated by diabetes that predates pregnancy
- Type 2 is more common than Type 1
- Almost all women with pregestational diabetes are insulin-dependent
3
Q
Gestational Diabetes
A
- Complicates 7% of pregnancies
- Carbohydrate intolerance with onset or first recognition occurring during pregnancy
4
Q
A1 Gestational Diabetes
A
Women has 2+ abnormal values on OGTT with normal fasting blood sugar
- BLOOD GLUCOSE LEVELS ARE DIET CONTROLLED
5
Q
A2 Gestational Diabetes
A
Woman not known to have diabetes before pregnancy
- BLOOD GLUCOSE LEVELS ARE MEDICATION CONTROLLED
6
Q
Diagnosis of Gest Diabetes
A
Two step method
7
Q
Step 1 of Diagnosis
A
- Screening at 24-26 weeks gestation with 50 g oral glucose
- Negative: less than 130-140 mg/dl
- Positive: over 130-140 mg/dl + step 2
8
Q
Step 2 of Diagnosis
A
- 3 hour OGTT-fasting 1 hour, 2 hour, 3 hour
- 2 abnormal values = diagnosis
9
Q
Fetal and Neonatal Risks with GDM
A
- Perinatal mortality = 3x higher
- Congenital malformations
- RDS
- Extreme prematurity
- IUFD (born still), 4% of all babies born still are complicated by diabetes = placental insufficiency, fetal growth restriction, obstructed labor
10
Q
Overarching goals in pregnancy
A
- Goal: prevent adverse pregnancy outcomes
- Multidisciplinary approach
- Pt seen every 1-2 weeks until 36 weeks and then weekly
- Pt keeps accurate diary of blood glucose concentration
11
Q
Surveillance of woman
A
- First trimester: ultrasound and fetal echo to assess congenital cardiac anomalies
- Second trimester: ultrasound to assess fetal growth
- 32 weeks: 2x/week testing NSTs and amniotic fluid volume to assess fetal well-being
12
Q
Care for GDM Woman in Labor
A
- Frequent BG checks
- Check BG if vomiting
- Test urine for ketones
- Careful monitoring of fetus via EFM and document/NOTIFY about changes
- Careful monitoring of labor progress (especially station)
- Slow descent and long labor (esp in multigravida woman) is flag for macrosomia
- Expect macrosomic baby
13
Q
Risks Associated with fetal macrosomia
A
- Birth injury
- Shoulder dystocia (should have regular drills for this)
- Brachial plexus injury
- Clavicular or humeral fractures
- Cephalohematoma
- Subdural hemorrhage
- Facial palsy
14
Q
Birth of a macrosomic infant
A
- 2 RNs in room to initiate McRoberts Maneuver
- Neonatal team and another RN for resuscitation
- Make sure O2 and suction work, warmer is on, med box is there, catheters are there, bag and mask
- May use delivery room instead of birthing where there is more room for equipment
15
Q
Infant of a diabetic mother
A
- Lived for 40 weeks in hyperglycemic state
- Now has lost glucose supply
- Response is hypoglycemia
- Baby will be tired, won’t feed, jittery, blue, low temp
