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Obstetrics > Diabetes in Pregnancy > Flashcards

Diabetes in Pregnancy Flashcards

1
Q

Which groups are affected by diabetes more?

A

Asian descent

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2
Q

What is true diabetes?

A

A fasting blood glucose of >5,6mmol/l
Or random blood glucose of 11mmol/l
Or post-prandial(After 2 hours of glucose load) glucose of >7,8mmol/l
With the 4 P’s

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3
Q

How much glucose is given in the the glucose tolerance test?

A

75 g

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4
Q

What is the antenatal effect of diabetes on the pregnancy?

A
  1. Polyhydroamnios
  2. Macrosomia
  3. Intra-uterine death
  4. Congenital cardiac lesions
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5
Q

What are the problems we encounter during delivery with patients with Diabetes mellitus?

A

Shoulder dystocia (Erb’s palsy)

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6
Q

What are the post-partum effects we can expect as a result of diabetes?

A
  1. Hyperbilirubinaemia
  2. Respiratory distress syndrome
  3. Neonatal hypoglycemia
  4. Polycythemia
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7
Q

How does a macrosomic baby look?

A

They have a large body and normal sized head

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8
Q

What is the pathophysiology of diabetes in the fetus?

A

The mother’s hyperglycaemia (due to insulin resistance) causes fetus hyperglycaemia
This then leads to the glucose being stored as glycogen and fat in the cells

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9
Q

What are the micro vascular effects of long-standing diabetes?

A
  1. Neuropathy
  2. Retinopathy
  3. Nephropathy
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10
Q

What is the appropriate blood glucose goal for these patients?

A
  1. A fasting blood glucose of less than 5,6mmol/l
  2. A post-prandial blood glucose of <7mmol/l
  3. HBA1C of less than 6,5% is ideal
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11
Q

What is the management of patients with type 1 DM?

A

Insulin therapy

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12
Q

What is the management of type 2 DM?

A

Diet change as well as oral metformin (500mg) twice daily or 850mg three times a day

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13
Q

How often do we need to see diabetic patients?

A

We need to see them every two weeks until they are 36 weeks and then every week thereafter

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14
Q

How much energy intake should a patient with DM get daily?

A

126-147 kilojoiules/kg

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15
Q

What are the insulin options available?

A

3 injections of actrapid are preferred before breakfast, lunch and supper and intermediate acting insulin(Protophane) is given just before bed to prevent hypoglycemia during the night

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16
Q

How do we determine the patients blood glucose profile?

A

The patient should have nothing to east from midnight until the next morning around 8 o clock
‘We then test the blood glucose and then they have something to eat and then test the blood glucose again after 2 hours

17
Q

What should we do to manage these patients antenatally?

A
  1. Do fundoscopy to look for diabetic retinopathy
  2. 24 hour urine test and renal function tests(checking for nephropathy)
  3. Ultrasnound
  4. HBAC1
  5. Bacteriology to look for asymptomatic
18
Q

Why do most obstetricians induce labour as soon as the patient is 38 weeks?

A

Because they are avoiding the unexplained chance of stillbirths happening

19
Q

How can we determine the gestational age if we are unsure?

A

We can do an amniocentesis for pulmonary maturity

20
Q

What method of delivery is best for these patients?

A

Either NVD or c/s if there are indications for it

21
Q

In the case of ketonuria what is increased in the preparation of delivery?

A

Both insulin and glucose

22
Q

Why should a doctor skilled in neonatal resuscitation be present at the birth of the baby?

A

Because of the possible respiratory distress and shoulder dystocia

23
Q

What is insulin lispro?

A

A rapid acting human insulin analogue that comes in 3 and 10 ml vials given subcutaneously 15 minutes before a mealk

24
Q

What is the definition of gestational diabetes?

A

Diabetes presenting during pregnancy and has a high propensity to progress to type 2 DM later in life

25
Q

Describe type 1 diabetes?

A

Absolute Insulin deficiency due to pancreatic b-cell dysfunctio

26
Q

Describe type 2 diabetes?

A

Increasing insulin resistance due to increased demand for insulin leading to complete dysfunction with B-cell failure

27
Q

Which patients are at a increased risk of developing gestational diabetes?

A
  1. Previous gestational diabetes
  2. Above 40 years
  3. BMI>40 or >90 kg
  4. Family history
  5. Asian descendants
28
Q

What types of diabetes do we have?

A
  1. Pre-gestational diabetes: type 1 or 2
  2. Gestational diabetes
  3. Undiagnosed diabetes mellitus
29
Q

What do we often find on amniocentesis to assess lung maturity?

A

The presence of 2,5 L:S ratio or the presence of phosphatidyl-glycerol

30
Q

What are the 1st trimester effects on the baby due to DM?

A
  1. Congenital abnormalities:
    -Cardiac: VSD, Tetralogy of fallot
    Pulmonary atresia
    -neural tube defects
    -renal and renal tract defects
  2. Miscarriages can also happen
31
Q

What is the 2nd trimester effects on the baby due to DM?

A
  1. Unexplained Intra-uterine foetal death
  2. Pre-eclampsia
  3. Intra-uterine growth restriction
32
Q

What are the 3rd trimester effects on the baby due to DM?

A
  1. Polyhydroamnios
  2. Macrosomia
  3. Unexplained foetal death
  4. Preterm labour
  5. Cardiomyopathy-hypertrophy, hyperplasia
33
Q

How often do we do the HBA1C test?

A

At booking and every 8 weeks

Obstetrics (18 decks)

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